“Take two”? The role of second opinions for breast biopsy specimens

Most pathologists do not work alone. They often share challenging cases with their colleagues locally and seek outside consultation for difficult cases if intradepartmental agreement is lacking. Because of sheer volume and complexity of interpretation, breast biopsy specimens often receive secondary review. The reasons driving these reviews are variable, but it presumably reflects the belief that another opinion can minimise or eliminate uncertainty and ultimately improve patient outcome.

In this issue, Elmore and colleagues (doi:10.1136/bmj.i3069) carried out a simulation study to analyse 12 different strategies for obtaining second opinions to improve the interpretation of breast histopathology.1 This study extends the authors’ previous work in which they reported a 25% level of discordance among pathologists in interpretation of breast biopsy specimens, particularly atypical hyperplasia.2 The first study had well described limitations, including its “artificial” study design (use of samples not representative of the actual case mix from routine practice), provision …