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Expertise vs Evidence in Assessment of Breast Biopsies

Expertise vs Evidence in Assessment of Breast Biopsies Opinion Editorials represent the opinions of the authors and JAMA EDITORIAL and not those of the American Medical Association. An Atypical Science Nancy E. Davidson, MD; David L. Rimm, MD, PhD Breast biopsies are performed in 1.6 million women in the These findings are disconcerting but perhaps not all to- United States each year and yield results ranging from be- gether surprising. Morphologic diagnosis rests on broad ac- nign to atypical hyperplasia to carcinoma in situ to invasive ceptance of key criteria, some of which are easily and specifi- cancer, each with specific im- cally defined but many of which are very subtle and difficult plications for subsequent to describe in words. Diagnoses that rest on well-defined cri- Related article page 1122 management. The critical tis- teria (eg, diagnosis of invasive breast cancer) are more likely sue diagnosis from the ana- to be observer-independent whereas interpretation of subtle tomic pathologist directly determines patient management. criteria such as architectural irregularity and nuclear pleomor- That diagnosis is based on morphology, the relationship be- phism will vary between observers as a function of training, tween cellular and architectural features, devoid of any mo- experience, and perhaps innate cognitive skills. With these ca- http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Expertise vs Evidence in Assessment of Breast Biopsies

JAMA , Volume 313 (11) – Mar 17, 2015

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Publisher
American Medical Association
Copyright
Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2015.1945
pmid
25781438
Publisher site
See Article on Publisher Site

Abstract

Opinion Editorials represent the opinions of the authors and JAMA EDITORIAL and not those of the American Medical Association. An Atypical Science Nancy E. Davidson, MD; David L. Rimm, MD, PhD Breast biopsies are performed in 1.6 million women in the These findings are disconcerting but perhaps not all to- United States each year and yield results ranging from be- gether surprising. Morphologic diagnosis rests on broad ac- nign to atypical hyperplasia to carcinoma in situ to invasive ceptance of key criteria, some of which are easily and specifi- cancer, each with specific im- cally defined but many of which are very subtle and difficult plications for subsequent to describe in words. Diagnoses that rest on well-defined cri- Related article page 1122 management. The critical tis- teria (eg, diagnosis of invasive breast cancer) are more likely sue diagnosis from the ana- to be observer-independent whereas interpretation of subtle tomic pathologist directly determines patient management. criteria such as architectural irregularity and nuclear pleomor- That diagnosis is based on morphology, the relationship be- phism will vary between observers as a function of training, tween cellular and architectural features, devoid of any mo- experience, and perhaps innate cognitive skills. With these ca-

Journal

JAMAAmerican Medical Association

Published: Mar 17, 2015

References