CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Breast pathology study
I read the letter by Diane Schecter, MD (July 2015), and I respect her right to remind readers that the findings from the breast pathology study published in JAMA (Elmore JG, et al. 2015;313:1122–1132) are similar to results published nearly 25 years ago. I do object, however, to her framing the study as academia versus private practice. Nearly 25 percent of the participants had either a primary academic or an adjunct academic affiliation (see Table 2, page 1126). It is unfortunate that the media misinterpreted the article as an evaluation of overall accuracy in breast pathology. The data presented in the article need to be corrected for population prevalence of the diagnostic categories if a reader’s goal is to estimate overall accuracy. The breast pathology study sampled a broad cross section of pathologists, and the findings should indicate to all clinicians advising women undergoing breast biopsy that there are persistent challenges in reproducibly diagnosing atypical hyperplasia; some lesions may defy our current abilities to classify. We need a more flexible framework for managing these pre-neoplastic lesions while we await reliable adjunct diagnostic tools. Now that we have reaffirmed and quantified these persistent diagnostic challenges, all of us need to work collectively to help patients and clinicians as we grapple with the uncertainties inherent in the art and practice of surgical pathology.
Donald L. Weaver, MD, Professor of Pathology and Laboratory Medicine, University of Vermont, Burlington