The review of pathology reports for breast cancer can have a significant impact on patient care, making a change in 20% of the cases examined, according to study results from Roswell Park Cancer Institute (RPCI). The study, authored by Thaer Khoury, MD, and Yousef Soofi, MD, of the Department of Pathology at RPCI, was recently published in The Breast Journal.
"Surgical pathology is a dynamically changing specialty with frequently updated guidelines and classifications," says Dr. Khoury. "This study underscores the need for a second review of the original pathologic material by a pathologist who specializes in breast cancer prior to implementation of breast cancer therapy."
A pathological diagnosis is the foundation upon which all other treatment decisions are made for patients diagnosed with breast cancer. Roswell Park requires a review of pathology slides and reports of all patients referred from different health institutions prior to implementing any further treatment.
The Roswell Park pathology team reviewed 500 breast core biopsy cases provided by referring institutions in a single calendar year. A core needle biopsy is a procedure that removes small samples of breast tissue which are then analyzed for characteristics of breast disease. The cases in the study were defined as reflecting a minor discordance when the change in diagnosis did not impact the patient and a major discordance when patient care was impacted through a change in therapy modality.
Dr. Khoury and colleagues found that 8% of the cases had a major discordance and 13% had a minor discordance. The most common reason for major discordance is interpreting biomarkers such the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factors type 2 (HER-2). These biomarkers can determine treatment options and may predict breast cancer survival. The second most common reason was borderline diseases. The change of diagnosis from benign to malignant or vice versa, while less common, was identified in 1% of the cases examined. This change has the most significant impact on patient care and outcome.