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Annals of Surgical Oncology 9:982-987 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Changes in Breast Cancer Therapy Because of Pathology Second Opinions

Valerie L. Staradub, MD, Kathleen A. Messenger, BS, Nanjiang Hao, MS, Elizabeth L. Wiley, MD and Monica Morrow, MD

From the Lynn Sage Comprehensive Breast Program (KAM), Departments of Surgery (VLS, MM), Pathology (ELW), and Preventive Medicine (NH), Northwestern University School of Medicine, Chicago, Illinois.

Correspondence: Address correspondence and reprint requests to: Valerie L. Staradub, MD, Galter 10-105, 201 E. Huron St., Chicago, IL 60611; Fax: 312-695-4956; E-mail: vstaradu{at}nmff.org

Background: Examination of pathology slides is a routine part of a breast cancer second opinion. The purpose of this study was to determine how often the pathologic second opinion (1) altered the diagnosis and (2) resulted in a change in the surgical procedure.

Methods: Patients presenting between 1997 and 2001 for a second opinion after a biopsy diagnosis of breast cancer (invasive or noninvasive) were included in this study.

Results: There were 340 patients presenting for second opinions regarding 346 breast cancers. Sixty-eight pathologic second opinions (20%) did not result in any change in pathology or prognostic factors, whereas in the remaining 80%, some change occurred. Major changes that altered surgical therapy occurred in 7.8% of cases, and pathology review provided additional prognostic information in 40%. Changes were more common in in situ carcinoma than invasive carcinoma (P = .004), but biopsy type (core vs. excisional biopsy) was not a significant predictor of change in pathologic information.

Conclusions: This study confirms the benefit of a pathology second opinion to improve preoperative estimates of prognosis and to determine the appropriate surgical procedure. Missing information on grade and histological subtype was responsible for a large number of cases, suggesting a need for widespread application of standardization and quality improvement in pathology reporting.

Key Words: Breast cancer • Pathology • Second opinion • Surgical therapy




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