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March 17, 2015

Expertise vs Evidence in Assessment of Breast Biopsies: An Atypical Science

Author Affiliations
  • 1University of Pittsburgh Cancer Institute and UPMC CancerCenter, Pittsburgh, Pennsylvania
  • 2Department of Pathology, Yale University School of Medicine, New Haven, Connecticut

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2015;313(11):1109-1110. doi:10.1001/jama.2015.1945

Breast biopsies are performed in 1.6 million women in the United States each year1 and yield results ranging from benign to atypical hyperplasia to carcinoma in situ to invasive cancer, each with specific implications for subsequent management. The critical tissue diagnosis from the anatomic pathologist directly determines patient management. That diagnosis is based on morphology, the relationship between cellular and architectural features, devoid of any molecular evidence. The accuracy of the pathologist’s diagnoses is relatively understudied and represents an important knowledge gap at a time when medicine is becoming ever more evidence-based.