Breast biopsy diagnosis article in JAMA

[Tissue issue]

Ok everyone- what say you??

http://jama.jamanetwork.com/article.aspx?articleid=2203798

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[wholeheartedly]

Ok everyone- what say you??

http://jama.jamanetwork.com/article.aspx?articleid=2203798

Well the news sites have gotten ahold of this now.

How often do pathologists use just one slide for a diagnosis like this?

 

[coroner]

Well the news sites have gotten ahold of this now.

Yup, and it didn't take very long. 'Breast Biopsies Leave Room For Doubt' - The New York Times; Mar 17, 2015

Although misdiagnosing 13% of "healthy" ones as abnormal needs to be expounded on in this study e.g. is fibrocystic changes, fat, necrosis, or microcalcs still considered "healthy"?

 

[Over9000]

I am not surprised, nor should anyone be.

"anatomic pathology", a terrible, vague, opaque term we use to describe consultative tissue diagnosis, paints the picture that biopsies are indeed "lab tests" and thus should approach machine-like, 100% precision. After all, its a "lab test".

The truth is that what we perform is subjective consultative work. Case in point: the "gold standard" that was used in this study was expert breast pathologist consensus diagnosis. If that's not "eminence based medicine" then I don't know what to tell you.

AP really needs to redefine itself properly and get out from under the "lab" umbrella. Maybe then patients would give a damn about who actually looks at their tissue.

 

[Pingu]

From the NYT article: (bolding is mine)

"Then the slides were divided into four sets, and 60 slides were sent to each of 115 pathologists in eight states who routinely read breast biopsies. The doctors interpreted the slides and returned them, and the same set was sent to the next pathologist. The study took seven years to complete."

Many things change in seven years, including diagnostic criteria. Also, it should not take 7 years for 115 pathologists to interpret 60 slides

 

[longlakeboy]

Case in point: the "gold standard" that was used in this study was expert breast pathologist consensus diagnosis. If that's not "eminence based medicine" then I don't know what to tell you.

And I'm sure that will keep getting worse. Breast pathology experts are some of the biggest splitters in medicine. They'll come up with more and more meaningless and/or non-reproducible diagnostic categories, and the discordance rate will stay high.

 

[yaah]

Well, the experts only agreed like 75% of the time. Wish the news coverage would mention that.

 

[pathstudent]

I thought the JAMA article was a little more fair and reasonable in its discussion while the nyt article was basically an all out assault and undermining of community pathologists.

 

[icpshootyz]

I always love that. If an academic downtown disagrees with me, the academic is considered right. Yet it seems academics disagree with each other just as frequently as they disagree with me. Hmmm...

 

[WEBB PINKERTON]

Yawn. You could write this same article about many other cancers. Not sure why Breast CA gets so much press, must be the Komen people and other activists.

 

[oldfatman]

The editorial that goes along with article is fair. How can you have a study like this with no followup data of the consensus diagnoses? The panel could be dead wrong on every single diagnosis and no one would know.

 

[coroner]

Ok, if our specialty wasn't already marginalized enough, pour some fuel onto the fire. Now the entire world thinks not only are we're a bunch of knuckle-dragging socially awkward basement dwellers, but incompetent ones at that. 75% concordance? Wonder why? Try non-reproducible grading systems that some academic "experts" pulled out of their asses. I find it ironic that Stuart Schnitt is an author of the study. Considering that his grading system for tall/columnar cell hyperplasia (with AND without atypia) is about as damned confusing as watching Jeopardy after drinking a fifth of bourbon.

Everybody needs to read these articles. Nevermind the shortcomings of the study. The fact is it's published and in the media. No matter what response our corrupt, inept CAP offers, the damage is done. We must be able to defend ourselves since our useless professional organization can't/won't do it for us.

 

[Doctor Zaius]

Unless I missed it, none of the people quoted in the NYT article are pathologists and none of the published letters of response by the newspaper are from pathologists either. Where are our many professional organizations with a quote or response? We're letting others define and marginalize us.

 

[Over9000]

Unless I missed it, none of the people quoted in the NYT article are pathologists and none of the published letters of response by the newspaper are from pathologists either. Where are our many professional organizations with a quote or response? We're letting others define and marginalize us.

They're too busy worrying about the next lab accreditation bull****.

 

[icpshootyz]

http://commonhealth.wbur.org/2015/03/breast-biopsy-accuracy

 

[coroner]

Good points, unfortunately the public/media have jumped on the JAMA & NYT article already, rather than focusing on a critical analysis of the weaknesses of the study as this article points out. The damage is done...