Faculty Collaboration Database

Characteristics of a Breast Pathology Consultation Practice. Arch Pathol Lab Med 2017 Apr;141(4):578-584

Date

03/30/2017

Pubmed ID

28353380

DOI

10.5858/arpa.2016-0371-OA

Scopus ID

2-s2.0-85016478885 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

CONTEXT: - Intradepartmental consultation is a routine practice commonly used for new diagnoses. Expert interinstitutional case review provides insight into particularly challenging cases.

OBJECTIVE: - To investigate the practice of breast pathology consultation at a large tertiary care center.

DESIGN: - We reviewed breast pathology cases sent for private consultation and internal cases reviewed by multiple pathologists at a tertiary center. Requisitions and reports were evaluated for diagnostic reason for consultation, rate of multiple pathologist review at the tertiary center, use of immunohistochemistry, and, for private consultation cases, type of sender and concordance with the outside diagnosis.

RESULTS: - In the 985 private consultation cases, the most frequent reasons for review were borderline atypia (292 of 878; 33.3%), papillary lesion classification (151 of 878; 17.2%), evaluating invasion (123 of 878; 14%), subtyping carcinoma (75 of 878; 8.5%), and spindle cell (67 of 878; 7.6%) and fibroepithelial (65 of 878; 7.4%) lesion classification. Of 4981 consecutive internal cases, 358 (7.2%) were reviewed, most frequently for borderline atypia (90 of 358; 25.1%), subtyping carcinoma (63 of 358; 17.6%), staging/prognostic features (59 of 358; 16.5%), fibroepithelial lesion classification (45 of 358; 12.6%), evaluating invasion (37 of 358; 10.3%), and papillary (20 of 358; 5.6%) and spindle cell (18 of 358; 5.0%) lesion classification. Of all internal cases, those with a final diagnosis of atypia had a significantly higher rate of review (58 of 241; 24.1%) than those with benign (119 of 2933; 4.1%) or carcinoma (182 of 1807; 10.1%) diagnoses. Immunohistochemistry aided in diagnosis of 39.7% (391 of 985) and 21.2% (76 of 359) of consultation and internally reviewed cases, respectively.

CONCLUSIONS: - This study confirms areas of breast pathology that represent diagnostic challenge and supports that pathologists are appropriately using expert consultation.

Author List

East EG, Zhao L, Pang JC, Jorns JM

Author

Julie M. Jorns MD Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Breast
Breast Diseases
Breast Neoplasms
Breast Neoplasms, Male
Child
Female
Humans
Immunohistochemistry
Male
Middle Aged
Pathology, Clinical
Referral and Consultation
Reproducibility of Results
Sensitivity and Specificity
Young Adult