The BMJ's video: Obtaining second opinions of breast histopathology

Attention to diagnostic errors in the medical literature and mass media has led many to consider obtaining second opinions to prevent errors and improve quality. For example, obtaining second opinions, such as double reading of screening mammograms, has been associated with improved detection rates for cancer. Comparing the impact of different strategies for obtaining a second opinion on accuracy needs to be evaluated. Many potential strategies exist, ranging from review of every biopsy specimen by multiple pathologists, to obtaining second opinions only for specific case categories or only from different pathology situations eg, pathologists who see a high volume of cases weekly versus a low volume. We compared the effect of different criteria for triggering procurement of second opinions on the accuracy of interpretation of breast disease. We designed our study to assess improvements in accuracy in a controlled test situation using data from 6900 individual interpretations by 115 pathologists. We evaluated 12 strategies with different criteria for obtaining second opinions and compared how each approach may affect over-interpretation and under-interpretation rates relative to reference diagnoses.