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The Importance of a Pathology Second Opinion in Breast Cancer

Treatment decisions for breast cancer and their likely success are critically dependent on the analysis of the pathologist which is summarized in the pathology diagnosis.  As a colleague once put it, "The diagnosis is like an architect's drawing: if it is faulty, the house will collapse".

Unfortunately, inadvertent errors in interpretation, either for the actual diagnosis of carcinoma, or in evaluating size, stage and margins, are commonplace. The National Cancer Institute (NCI) and the American Cancer Society (ACS) strongly recommend a pathology review of the pathology slides, particularly for duct carcinoma in situ (DCIS) and other non-invasive lesions, for which the error rate on review may be as high as 25 percent. A second opinion may make the difference between a diagnosis of benign hyperplasia or an in situ carcinoma, and the need for re-excision, radiation therapy and/or chemotherapy. Second opinions can also help by confirming a diagnosis and providing reassurance that the patient is making a reasonable choice.

For a pathology second opinion to be of maximal value, it must be based on direct re-examination of the pathology slides used for the original diagnosis. In the course of making a therapeutic decision of their breast cancer far too many women receive second opinions merely based on review of the written reports. With many new breast cancers of minute size or those which are entirely non-invasive, the issue of a direct review of the diagnostic materials becomes even more critical.

The Breast Cancer Consultation Service

Michael D. Lagios, MD   •   415-789-0965

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