Table 1.
The percent of cases requiring second (2nd) and third (3rd) reviews, misclassification rates (MCR), false positive (FP), and false negative (FN) proportions by pathology interpretation strategy and expert consensus diagnosis*
| Pathology interpretation strategy | Proliferative/non-prolif. |
Reference standard expert consensus diagnosis |
||||||
|---|---|---|---|---|---|---|---|---|
| Atypia |
DCIS |
Invasive |
||||||
| Reviews 2nd, 3rd | MCR (FN, FP) | Reviews 2nd, 3rd | MCR (FN, FP) | Reviews 2nd, 3rd | MCR (FN, FP) | Reviews 2nd, 3rd | MCR (FN, FP) | |
| No second opinion | 0.0, 0.0 | 5.8 (0,5.8) | 0.0, 0.0 | 52.2 (34.7,17.4) | 0.0, 0.0 | 15.9 (13.3,2.6) | 0.0, 0.0 | 3.9 (3.9,0) |
| Second opinion based on initial diagnosis | ||||||||
| 2nd if invasive | 1.0, 0.8 | 5.4 (0,5.4) | 0.4, 0.3 | 51.9 (34.4,17.5) | 2.6, 2.4 | 13.6 (13.2,0.4) | 96.1, 1.9 | 4.7 (4.7,0) |
| 2nd if invasive or DCIS | 3.2, 2.9 | 4.7 (0,4.7) | 17.4, 13.1 | 43.7 (35.9,7.9) | 86.7, 12.2 | 15.8 (15.2,0.6) | 99.6, 3.3 | 3.9 (3.9,0) |
| 2nd if invasive, DCIS or atypia | 12.9, 10.4 | 2.1 (0,2.1) | 65.3, 36.5 | 51.9 (41.8,10) | 93.7, 17.8 | 12.1 (11.4,0.6) | 99.6, 3.3 | 3.9 (3.9,0) |
| Second opinion based on pathologist desire or policy | ||||||||
| 2nd if desired | 26.7,10.1 | 3.3 (0,3.3) | 55.9, 31.3 | 47.7 (33.7,14) | 30.5, 11.2 | 11.4 (9.9,1.5) | 15.5, 1.5 | 3.6 (3.6,0) |
| 2nd if considered borderline | 19, 7.5 | 4.0 (0, 4.0) | 45.3, 25.6 | 48.9 (34.6,14.2) | 21.4, 9.3 | 11.5 (9.9,1.5) | 3.5,0.8 | 3.8 (3.8,0) |
| 2nd if required by policy | 33.8, 7.6 | 4.7 (0,4.7) | 40.6, 23 | 47.1 (33.9,13.2) | 55.3, 10.0 | 13.7 (12.1,1.6) | 59.9, 2.1 | 4.0 (4.0,0) |
| 2nd if desired or required | 54, 14.9 | 2.9 (0,2.9) | 80.4, 45.3 | 44.3 (32.8,11.4) | 75.5, 18.0 | 10.3 (9.5,0.9) | 69.8, 3 | 3.7 (3.7,0) |
| Second opinion for all | 100, 19.7 | 2.9 (0,2.9) | 100, 55.9 | 40.9 (29.9,11.1) | 100, 21.6 | 9.9 (9.3,0.6) | 100, 3.7 | 3.5 (3.5,0) |
*
Second opinion strategies require resolution by the third reviewer if the first two disagree