Increased concordance of pathology results with imaging findings will not only change some individual diagnoses but will have an impact on population morbidity and mortality and may improve the quality and efficiency of cancer treatment. Although it is difficult to determine its exact impact, an estimation of the number of missed breast cancer diagnoses can be suggested.
Based on the pilot study conducted at KUMC, 321 benign biopsy results were selected for radiology and pathology review. Of these 321 cases, 61 were found to have discordant results and upon further examination, four cases were found to be malignant. Using these results and projecting on a population level, (based on approximately one million needle biopsies performed per year in the US for the diagnosis of breast cancer with approximately 200,000 positive cases) 10-12,16 , we can estimate that approximately 9,969 missed cancer diagnoses per year ( Figure 1 ) could be treated earlier if radiology-pathology concordance processes were implemented nationwide. The American Cancer Society estimates that there will be 207,090 new breast cancer cases in 2010. 16 Hence, this group of missed or delayed diagnoses could represent about an additional 5 percent of these new cases.
We also completed these calculations using comparable data reported in a number of published studies. 3,17,18 The results of these calculations are reported in Table 2 . Although the results show a broad range of values, the group favors a value between 5,000 and 10,000 cases annually. However, additional studies are warranted in order to produce estimates with appropriate confidence levels.
Figure 1 : KUMC Pilot Study Results
|Author||Identified Malignant Cases||Benign Biopsy Cases||Estimated Missed Cases||Comments|
|Kim, 2008||2||386||4,145||Note that an additional 11 malignancies were diagnosed in the biopsy negative non-discordant population.|
|Youk, 2010||28||1,706||13,130||study found 50 malignant cases, but only 28 were due to imaging-histologic discordance|