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Journal Article > Study
Raab SS, Grzybicki DM, Janosky JE, et al. Cancer. 2005;104:2205-2213.
This AHRQ-funded study estimated a 12% error rate in cancer diagnosis based on discrepant evaluation of two specimens from the same organ. Investigators compiled web-based pathologic data from four institutions and created a standardized system to establish correlation error frequencies between cytologic and histologic samples during a 6-month period (eg, bronchial washings and a lung biopsy). Findings suggested that error rates were dependent on the institution and an association existed between the institution and error cause, but agreement was lacking on whether these errors resulted from misinterpretation or poor clinical sampling. Disagreement also existed on the clinical significance of the errors, an issue that results from an undeveloped taxonomy in this arena. While a previous systematic review used autopsy findings to report on clinically significant errors, this study builds on that literature by employing a method that is not limited by the overall low rate of autopsies performed nationally.
Journal Article > Study
Elmore JG, Longton GM, Carney PA, et al. JAMA. 2015;313:1122-1132.
Microscopic review of biopsy tissue is considered the gold standard for diagnosis of cancer and other diseases, but prior research has shown a small yet consistent rate of errors in cancer diagnosis that is attributable to misinterpretation of biopsy specimens. This study sought to quantify error rates in breast cancer diagnosis by having a broad sample of pathologists review a standardized set of biopsies whose diagnoses had been established by expert clinicians. Although biopsies with cancer were diagnosed very accurately, specimens with atypia (abnormal tissue that may be pre-cancerous) had substantial variability, with pathologists tending to overdiagnose these specimens (i.e., ascribe a diagnosis of cancer or pre-cancerous lesions when the correct diagnosis was benign). The authors caution that the specimens used in this study were intentionally chosen to be relatively difficult to interpret, and this may have resulted in overestimating the error rate. A related editorial notes that while the overall rate of diagnostic error in this study was low, misdiagnosis of atypia does have important prognostic and treatment significance for women, and therefore pathologists should systematically consult with colleagues in difficult cases, and more advanced molecular diagnostic methods should be applied in order to reduce subjectivity in biopsy interpretation.