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Accuracy of Biopsy Readings Questioned

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Posted 3/18/2015 12:40 PM (GMT 0)
A few days back we had a thread concerning the need for second opinions of prostate biopsies. It seems that breast biopsies also have similar issues. Highlights of a study published in the Journal of the AMA wherein 115 pathologists had their readings compared to three experts:

1. Pathologists correctly diagnosed abnormal pre-cancerous cells about half the time (coin toss odds).

2. Pathologists mistakenly found something suspicious in 13% of normal tissue.

3. There was also misdiagnosis of DCIS (abnormal cells confined to a milk duct). 13% were misdiagnosed as less serious while 3% were mistaken for invasive cancer.

It was acknowledged that, in real life, these pathologists might consult with others before rendering an opinion but, nevertheless, the lead researcher on the paper states, "As I woman, I would probably want to get a second opinion".

Here is the AP story on the study which is easier reading than the paper itself. hosted.ap.org/dynamic/stories/U/US_MED_BIOPSY_MISTAKES_?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT

Jim
Posted 3/18/2015 12:52 PM (GMT 0)
I saw this on the NBC Evening news. One of the big concerns was that reading results is "Subjective."
Posted 3/18/2015 3:01 PM (GMT 0)
What you see in a biopsy is just a matter of luck of the draw and opinion of the person looking at the tissue. No doubt there are times that cells don't exactly fit a 2 or a 3 rating or a 3 or a 4 so is it closer to a 2 or is it closer to a 3 and so on. Then too, a biopsy can miss entirely areas of questionable tissue. It happened to me. I had one core of 12 show positive for cells rated at 3 at the biopsy but I opted for surgery anyway and the post-surgery report came back showing two separate areas of cancerous cells. My prostate was badly enlarged so that just made the area of distribution of tissue samples larger. A biopsy is by no means an exact picture of what is going on.
Posted 3/18/2015 3:08 PM (GMT 0)
I was told years ago that at a local urology clinic it was standard practice to round up "questionable" gleason scores post radical surgery. It was to make the patient feel better choosing surgery and more committed to stay committed to future blood samples. Although if they were definitely a 6 they would stay a 6.
Posted 3/18/2015 5:16 PM (GMT 0)
Anytime a biopsy report contains "borderline" results, the existence of "pre-cancerous" cells, the existence of minute amounts of questionable cells, then BY ALL MEANS a second, expert opinion is warranted. But when a high-grade, dangerous, advanced tumor is diagnosed, most pathologists have no trouble accurately diagnosing these cancers. The ones who may have had trouble, they have been eliminated by lawsuits and pear censorship by now..

Nobody mentions that a second expert opinion can cost $800 or more..Be sure your insurance company will cover this before you demand one...If you are concerned about your local pathology lab, have your biopsy samples sent to an expert lab to begin with.......
Posted 3/18/2015 5:54 PM (GMT 0)
Tudpock, your point was, I believe, to highlight the IMPORTANCE of having prostate biopsy slides read by a prostate pathology expert. The first reading is often done in the community setting by a pathologist who is NOT a prostate tissue expert, and so there are valuable second-opinion services which are offered by leading prostate pathology specialty labs. Epstein at Johns Hopkins, David Bostwick at Bostwick Labs, and Jon Opopenheimer at OURLab stand out amongst the experts.

You will, I'm quite sure, correct me if this was not your main point, but it seems that a couple of the follow-up postings missed that important point. I hope that this clarification helps to get your original message back on-track.

Fairwind, was concerned that expert second opinions "can cost $800 or more." I'm not sure which "experts" he is talking about, but Epstein at JHU and Oppenheimer both cost $250 to read prostate biopsy slides and provide second opinions. They've told me about half the time private insurance pays for it. Medicare pays for it if your urologist requests the test.
Posted 3/18/2015 7:47 PM (GMT 0)

Fairwind said...
...If you are concerned about your local pathology lab, have your biopsy samples sent to an expert lab to begin with.......

@Fairwind. I can only speak for myself, but I was not knowledgeable enough at the time of my biopsy to ask about the lab. In fact I only became aware of "expert labs" after I joined HW. You raise an interesting point though (at least to me)...and that is if certain pathologists really are that expert and that good, how come urologists don't know that and send the slides to an expert to begin with? I can certainly speculate and those speculations include ignorance, financial incentives and conviction that the local lab is good enough.

@NKinney. Yes, thanks for reemphasizing my point...which I guess I made in a round-about way by revealing that the breast cancer folks have similar issues. Also, I'm glad you had figures on the cost of a second opinion - that's an important number.

Jim
Posted 3/18/2015 8:12 PM (GMT 0)

Tudpock18 said...
You raise an interesting point though (at least to me)...and that is if certain pathologists really are that expert and that good, how come urologists don't know that and send the slides to an expert to begin with?



Some do.

More than six years ago, the urologist who took my prostate biopsy samples sent them directly to Bostwick for analysis.

Like you, Tudpock, at the time I did not know about the importance of having an expert read the slides. I also did not know at the time that my urologist sent my slides directly to a prostate pathology expert. It wasn't until later, after a second reading was suggested to me, that I went back and looked at my original paperwork and found that the evaluation was done by Bostwick.
Posted 3/18/2015 10:57 PM (GMT 0)
I also, would have had no clue that my slides should be sent for a second opinion, if not for HW. AND GOOD THAT I DID.

As far as cost, I paid the bill today to JH for my second path opinion. The cost was $250. Small price to pay.
My insurance company covered it, but only allows $82, and that went to the out of network deductible. So I was out of pocket, but it was too important to not do it
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