When the Gold Standard Loses Its Luster, Perhaps It Is Time to Change Nomenclature
Authors: Alexander Borowsky, Laura Esserman
Journal: Annals of Internal Medicine (2016)

Editorials17 May 2016When the Gold Standard Loses Its Luster, Perhaps It Is Time to Change NomenclatureAlexander Borowsky, MD and Laura Esserman, MD, MBAAlexander Borowsky, MDFrom University of California, Davis, Davis, California, and UCSF Medical Center, San Francisco, California.Search for more papers by this author and Laura Esserman, MD, MBAFrom University of California, Davis, Davis, California, and UCSF Medical Center, San Francisco, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0526 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Histopathologic diagnosis remains the most accurate way to determine optimal therapy for breast diseases. Because of this, it is often assumed to be, essentially, 100% correct. Yet, all students of science—particularly pathologists—know that every test and assay, no matter how well-executed and controlled, carries a nonzero rate of false-positive and false-negative results. Determining this rate requires a “gold standard,” or a source of truth and fact.The report from the B-Path (Breast Pathology) Study by Elmore and colleagues in this week's Annals (1) reveals problems with the precision and accuracy of the current gold standard for breast cancer diagnosis. The ...References1. Elmore JG, Nelson HD, Pepe MS, Longton GM, Tosteson ANA, Geller B, et al. Variability in pathologists' interpretations of individual breast biopsy slides: a population perspective. Ann Intern Med. 2016;164:649-55. doi:10.7326/M15-0964 LinkGoogle Scholar2. Esserman L, Yau C. Rethinking the standard for ductal carcinoma in situ treatment [Editorial]. JAMA Oncol. 2015;1:881-3. [PMID: 26291410] doi:10.1001/jamaoncol.2015.2607 CrossrefMedlineGoogle Scholar3. Davidson NE, Rimm DL. Expertise vs evidence in assessment of breast biopsies: an atypical science [Editorial]. JAMA. 2015;313:1109-10. [PMID: 25781438] doi:10.1001/jama.2015.1945 CrossrefMedlineGoogle Scholar4. Leonard G. Discordant interpretations of breast biopsy specimens by pathologists [Letter]. JAMA. 2015;314:82-3. [PMID: 26151272] doi:10.1001/jama.2015.6224 CrossrefMedlineGoogle Scholar5. 1430: The Andy Letter. Car Talk. National Public Radio. 26 July 2014. Accessed at www.cartalk.com/content/1430-andy-letter on 29 February 2016. Google Scholar6. Elmore JG, Pepe MS, Weaver DL. Discordant interpretations of breast biopsy specimens by pathologists—reply [Letter]. JAMA. 2015;314:83-4. [PMID: 26151274] doi:10.1001/jama.2015.6239 CrossrefMedlineGoogle Scholar7. Sanders ME, Schuyler PA, Simpson JF, Page DL, Dupont WD. Continued observation of the natural history of low-grade ductal carcinoma in situ reaffirms proclivity for local recurrence even after more than 30 years of follow-up. Mod Pathol. 2015;28:662-9. [PMID: 25502729] doi:10.1038/modpathol.2014.141 CrossrefMedlineGoogle Scholar8. Sagara Y, Mallory MA, Wong S, Aydogan F, DeSantis S, Barry WT, et al. Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg. 2015;150:739-45. [PMID: 26039049] doi:10.1001/jamasurg.2015.0876 CrossrefMedlineGoogle Scholar9. Cuzick J, Sestak I, Cawthorn S, Hamed H, Holli K, Howell A, et al; IBIS-I Investigators. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol. 2015;16:67-75. [PMID: 25497694] doi:10.1016/S1470-2045(14)71171-4 CrossrefMedlineGoogle Scholar10. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009;302:1685-92. [PMID: 19843904] doi:10.1001/jama.2009.1498 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, Davis, Davis, California, and UCSF Medical Center, San Francisco, California.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0526.Corresponding Author: Alexander Borowsky, MD, Center for Comparative Medicine, University of California, Davis, County Road 98 and Hutchinson Drive, Davis, CA 95616; e-mail, [email protected]edu.Current Author Addresses: Dr. Borowsky: Center for Comparative Medicine, University of California, Davis, County Road 98 and Hutchinson Drive, Davis, CA 95616.Dr. Esserman: Department of Surgery, UCSF Medical Center, 1600 Divisadero Street, Box 1710, San Francisco, CA 94115.This article was published at www.annals.org on 22 March 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoVariability in Pathologists' Interpretations of Individual Breast Biopsy Slides: A Population Perspective Joann G. Elmore , Heidi D. Nelson , Margaret S. Pepe , Gary M. Longton , Anna N.A. Tosteson , Berta Geller , Tracy Onega , Patricia A. Carney , Sara L. Jackson , Kimberly H. Allison , and Donald L. Weaver Metrics Cited byResearch Study DesignOpening the Regulatory Black Box of Clinical Cancer Research: Transnational Expertise Networks and “Disruptive” Technologies 17 May 2016Volume 164, Issue 10Page: 694-695KeywordsBiopsyBreast cancerDisclosureLesionsMortalityPathologistsPhenotypesSafetySurgerySurveillance Epidemiology and End Results ePublished: 22 March 2016 Issue Published: 17 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...