Quality Assurance for Breast Biopsies and other Breast cases:
A recent article in Journal of the American Medical Association investigated the concordance between pathologists’ diagnoses on breast biopsies. (Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens, JAMA Mar 17). There were a number of problems with the study design, which cast significant doubt on the conclusions. At the University Medical Center of Princeton at Plainsboro, the following practice is followed for all breast biopsies and excised specimens (eg lumpectomies or mastectomies) to ensure that patients receive the most accurate diagnosis:
1.All of the slides of breast specimens are initially reviewed by a board certified pathologist. Additional sections may be cut and special stains ordered if necessary to fully evaluate the case.
2.All of the slides of non-malignant breast cases are seen by a second pathologist. If there is disagreement in the diagnosis, the case is presented to the daily consensus conference where all pathologists in the department view the case under a six headed microscope . If there is still disagreement, the case is sent out to an expert pathologist who deals with unusual or difficult cases.
3.All cases of breast cancer are reviewed by all pathologists in the department at the daily consensus conference. Again, if there is disagreement, the case is sent out to an expert pathologist who deals with unusual or difficult cases.
4. A pathologist in the department, other than the primary pathologist responsible for the case, reviews the pathology report before it is verified to ensure the accuracy of the diagnosis.
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