Revised text to state that in a retrospective study of 939 patients with 1,042 mammographically detected lesions who underwent core needle biopsy or surgical needle localization under x-ray guidance, sensitivity of core needle biopsy for malignancy was greater than 95% and the specificity was about 90%.
Revised text to state that in the United States, only 4,900 women were diagnosed with ductal carcinoma in situ in 1983, compared with approximately 61,000 women who are expected to be diagnosed in 2016, when mammographic screening has been widely adopted (cited American Cancer Society as reference 3).
Added text about the B-Path study that included 115 practicing U.S. pathologist who interpreted a single-breast biopsy slide per case and compared their interpretations with an expert consensus-derived reference diagnosis; at the U.S. population level, it is estimated that 92.3% of breast biopsy diagnoses would be verified by an expert reference consensus diagnosis, with 4.6% of initial breast biopsies estimated to be overinterpreted and 3.2% underinterpreted.
Added Figure 1, Predicted Outcomes per 100 Breast Biopsies, Overall and by Diagnostic Category.
Revised text to state that a national survey of 252 breast pathologists participating in the B-Path study found that 65% of respondents reported having a laboratory policy that requires second opinions for all cases initially diagnosed as invasive disease.
Added text about a simulation study that used B-Path study data to evaluate 12 strategies for obtaining second opinions to improve interpretation of breast histopathology; while the second opinions improved accuracy, they did not completely eliminate diagnostic variability, especially in the challenging case of breast atypia (cited Elmore et al. [BMJ] as reference 25).
Added text about a study that used data from the Nova Scotia Breast Screening Program and identified 342 interval breast cancers in the context of 302,234 screening exams; for women aged 40 to 49 years, the annual rate of missed cancers per 1,000 women screened was 0.45, and the rate for true interval cancers was 0.93; for women aged 50 to 69 years, the rate of missed cancers per 1,000 women screened was 0.90, and the rate for true interval cancers was 3.15 (cited Payne et al. as reference 9).
Added text to state that an indication of overdiagnosis is that increases in breast cancer incidence because of screening tend to occur in early stages of the disease with little or no drop in later stages. Also added text about a cohort study in Norway that compared the increase in cancer incidence in women eligible for screening based on age after the introduction of screening, within the respective counties, with the cancer incidence in younger women not eligible for screening (cited Lousdal et al. as reference 27).
ver historia personal en: www.cerasale.com.ar [dado de baja por la Cancillería Argentina por temas políticos, propio de la censura que rige en nuestro medio]//
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