Independent Consultative Review for Breast Disease: Implications for Quality, Cost, and Outcomes

A pathology second opinion of breast biopsy material has many proponents, but is still infrequent in actual practice. Discrepancies between an initial and a review diagnosis vary in frequency between the type of review, cursory or comprehensive, and the specific type of lesion being examined. Among patients with microscopic proliferative lesions, the discrepancy rates can exceed 20%. Discrepancies with an initial diagnosis of atypical ductal hyperplasia and their potential impact on treatment costs are explored. The author's recent experience from a consult second opinion practice is reviewed and the types and frequency of discrepancies are discussed.