Differences Significant In Second Opinions
NEW YORK Aug 24, 2001 (Reuters Health) - Some patients diagnosed with prostate or bladder cancer may needlessly undergo radical surgery, according to a report.
Florida researchers looked at 150 patients diagnosed with prostate or bladder cancer. Their records were referred to one of the study's authors, an expert in urological pathology, for a second opinion.
According to the study results, nearly 20% of the second opinions differed in treatment recommendations and diagnosis. In most instances the pathologist opted for more conservative therapy than surgery. In a few cases, he disagreed with the initial diagnosis of cancer.
The findings underscore the importance of seeking second opinions in medical matters, note Dr. William M. Murphy of the University of Florida College of Medicine in Gainesville, and colleagues. However, they add, patients do not necessarily benefit from additional advice.
``Patients should be made aware that medical diagnoses are judgments, not matters of right and wrong,'' the researchers write in a recent issue of The Journal of Urology.
``The potentially negative impact engendered by encouraging patients to doubt the expertise of their physicians...is nonetheless important,'' they note.
A diagnosis of cancer is typically made after a pathologist examines tissue under a microscope, a procedure known as biopsy. But the appearance of a microscopic slice of tissue is subject to interpretation and the experience of the physician, Dr. Zev Wajsman, the study's senior author, explained in a prepared statement.
What's more, even when doctors agree on a diagnosis of cancer, there are several options for treatment that may be decided based on how far the tumor has progressed beyond its initial location. These determinations, too, are subjective.
``We don't have computerized methods to define something in very precise terms. So the pathology interpretation is very frequently based on training, personal experience and impressions,'' Wajsman said.
In the current study, the two physicians reviewing patient records differed in 19% of cases, of which 9% involved changes in treatment. Of the diagnostic discrepancies that changed the course of treatment, some involved a tumor diagnosis of malignant rather than benign while others were deemed benign rather than cancerous.
``It's common sense if you have a diagnosis of cancer and need to make a decision regarding treatment, to get another pathologist experienced in the field to look at it,'' Murphy said in a prepared release.
The Journal of Urology 2001;165:1957-1959.
Thanks to Reuters Health
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