The results from a recent breast biopsy study reinforce the importance pathologists play in the management of breast diseases. Oncologists can have all the greatest tools at their disposal, but without an accurate diagnosis, these tools can be rendered useless.
A new study, published in The Journal of the American Medical Association (JAMA), provides further evidence towards this inclination. The March 2015 study suggests that pathologist frequently disagree on some high-risk breast lesions.
Breast Biopsy | Is it ADH or DCIS?
To diagnose a breast lesion, tissue is sampled from a patient’s breast using a biopsy needle and sent to a laboratory for testing. A pathologist, a physician specializing in the analysis of biological samples, then examines the breast tissue to determine whether cancer or other abnormalities are present.
Results can range from benign, atypia, ductal carcinoma in situ (DCIS) or invasive breast cancer. There is often only a fine line between atypical ductal hyperplasia (ADH) and DCIS, since the difference between the two entities is the volume of abnormal cells within a number of ductal elements.
In the JAMA article, researchers explained that pathologists often disagree when it comes to breast biopsy results, especially when differentiating between ADH and DCIS.
- Pathologists generally agreed, at a rate of 96 percent, when it came to samples of invasive breast cancer.
- When pathologists were studying DCIS samples, they were able to reach a consensus in 84 percent of instances.
- When studying ADH samples, fewer than half (48%) were able to reach a consensus.
- Researchers determined that 17 percent of ADH samples were over diagnosed as DCIS, while 13% of DCIS were under-diagnosed.
An accurate diagnoses for appropriate treatment planning
An accurate diagnosis plays a critical role to develop an appropriate treatment plan. Over-diagnosis may lead to over-treatment or additional unnecessary screening, whereas under-diagnosis can lead to treatment that is ineffective. For example, a woman who is diagnosed with DCIS will often be recommended a different set of treatment options compared to a woman diagnosed with ADH.
Based on the recommendations of her physician, a woman diagnosed with DCIS will often be offered surgery with or without radiation therapy as well as anti-estrogen therapy (tamoxifen, etc.). On the other hand, a woman diagnosed with ADH will typically not be offered radiation therapy and many will not be offered anti-estrogen therapy. Clear surgical margins are critical with the diagnosis of DCIS or invasive cancer, while they are not as critical with ADH. Women with ADH, DCIS or invasive cancer may be recommended to undergo screening MRI, whereas a woman with a benign breast biopsy may not necessarily be recommended to undergo this imaging modality.
Optimal Treatment Planning
Women diagnosed with atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) should consider study results such as these to ensure they receive appropriate care.
As a surgical oncologist it is my belief that we can only be as good as the pathologist who made the diagnosis. When we take on new cases, we carefully take into consideration the pathologic diagnosis and will often recommend that an outside pathologist review tissue samples to ensure an accurate diagnosis.
Breastlink believes in quality care and clear communication with our patients. If there is any question to the accuracy of a diagnosis either from imaging or pathology, we will not hesitate to secure a second opinion with experts we trust. This level of quality is mandatory in order to provide the best clinical care.