Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens

作者：Joann G. Elmore, Gary Longton, Patricia A. Carney, Berta M. Geller, Tracy Onega, Anna N.A. Tosteson, Heidi D Nelson, Margaret S. Pepe, Kimberly H. Allison, Stuart J. Schnitt, Frances P. O’Malley, Donald L. Weaver · 发表于：JAMA · 年份：2015 · DOI：10.1001/jama.2015.1405 · 被引用次数：753 · 研究领域：Breast Lesions and Carcinomas、AI in cancer detection、Global Cancer Incidence and Screening

IMPORTANCE: A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. OBJECTIVES: To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. DESIGN, SETTING, AND PARTICIPANTS: Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. EXPOSURES: Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. MAIN OUTCOMES AND MEASURES: The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. RESULTS: Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosi...