Recently, the JAMA published a study that reviewed discordances in breast biopsies, based on the participation of pathologists in several locations in the US over a three-year period. The study showed that the overall agreement between the individual pathologists’ interpretations and the expert consensus-derived reference diagnoses was only about 75%. In addition, less than 50% agreement was shown among participant pathologists in their ability to classify atypical ductal hyperplasia (ADH). These results indicate the magnitude of discordant diagnoses and the importance of an efficient peer review workflow.
The correctness of biopsy diagnosis is crucial as it determines the patient treatment outcome. False positives might lead to unnecessary surgery and patient pain, while false negatives might lead to delayed treatment and reduced chance of patient survival or recovery. As early detection is highly correlated to successful treatment outcome in most cancers, one have nothing to lose by asking for a second opinion.
Asking for a second opinion today often involves sending physical glass, which puts the pathologist in the position of having to weigh up the added value of a colleague’s opinion against the additional time the patient has to wait. The process often involves packaging, shipping, copying reports, and, at the other end, the receiving party must unpack the material, the case must be registered in their LIS and material handed to the pathologist’s office for review. When reviewed, the process must be reversed where each step adds time before the referring physician and patient receive the answer.
Digital pathology could eliminate many of these steps and significantly reduce the time needed to have a case re-reviewed. A streamlined digital workflow reduces the barriers that currently hinder full utilization of second opinions, allowing the pathologists to send cases and get them back much faster, extending their reach to experts and doing what is best for the patient.
The variability of diagnoses in pathology is a major problem and has a large impact on patient treatment outcomes. Turning second opinion into a natural part of the review workflow is a way of minimizing the risk of error. Modern digital pathology solutions offer tools for efficient re-reviewing of cases without sending physical glass, which provides opportunities for greater utilization of second opinions to enhance the quality of cancer care.