Radiologist Responds to New York Times Article on Reliability of Breast Biopsy

An article published in The New York Times questions the reliability of breast biopsy when imaging for subtle abnormalities. According to the article, titled Breast Biopsies Leave Room for Doubt, Study Says, women whose results fall into the gray zone between normal and malignant — with diagnoses like “atypia” or “ductalcarcinoma in situ” — should seek second opinions on their biopsies.

However, the title of the article is somewhat misleading. Breast biopsy, often considered the gold standard for resolving uncertainties from unclear mammograms or ultrasound, continues to be effective. The New York Times piece refers to the pathologist’s interpretation of the biopsy.  At UCSF we have breast pathology experts who often confer with each other for difficult cases.  

Additionally, we perform radiologic-pathologic reviews between the radiologist and pathologist to ensure that the pathologic findings adequately explain the imaging findings.  This is part of our standard of care.  For cases of “atypia” our Breast Care Center physicians help counsel patients to interpret their biopsy results immediately following the procedure and thus not leave these women “hanging” in terms of what results mean and what should be done next.  For example, the finding of atypia may warrant risk assessment and the offer of risk reduction treatments such as tamoxifen.

In the study mentioned in the article, a panel of three expert pathologists examined biopsy slides from 240 women, one slide per case, and came to a consensus about the diagnosis. These slides were then sent to 115 participating pathologists. The findings, reported in JAMA, determined that the pathologists in the study did not always interpret the breast biopsy slides the same way the panel of experts did– specifically in cases where the results fell into the gray zone.  In the study, the 115 participating pathologists were unable to consult colleagues about ambiguous findings or ask for additional slides.

At UCSF, collaboration is a key to diagnosis and treatment. Our Women’s Imaging physicians work collaboratively with, and are an integral part of, the breast care team to ensure our patients get the best subspecialty breast care possible.

For more information on the value of breast biopsy, please click here.

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