Abstract P1-09-02: Discordance in breast cancer pathology review and its impact on patient care

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Abstract Background: Routine external biopsy review by institutional pathologists is a practice implemented by many cancer centers. However, obtaining prompt and efficient central pathology review in low- and middle-income countries can be challenging. The delay in the review process can potentially hinder timely initiation of treatment, presenting additional challenges for patients.This study assessed the percentage of disagreement between breast biopsy reports from external laboratories and internal pathological reviews conducted at the Brazilian National Cancer Institute (INCA), estimating the impact of such routine on patient care. Methods: A retrospective analysis of data collected from 500medical charts randomly selected among all breast patients treated at INCA in 2021. Cases with external biopsy samples available for review were eligible. Cohen´s kappa (k) and intraclass correlation coefficient (ICC) with two-way model were used to assess concordance between reports with categorical and numerical variables, respectively. Results: 305 patients with available external pathology sample were included with a median age of 57.5, with 98.4% women and 61% black/brown. Clinical stages at presentation: I (8,7%), II (30%), III (40%) and IV(9,4%). Agreement of malignancy on reports was 99.6%. Six out of 28 patients had the diagnosis changed from benign to malignant disease.A total of 110 (36%) cases had external immunohistochemistry (IHC) evaluation. The agreement for ER was 96.4% (k=0.897, p-value <0,001) and 90.9% for PR (k = 0.784, p-value < 0,0002). The discordance rate for ER was 4,2% (negative to positive) and 3,4% (positive to negative). The agreement for Ki-67 [ICC = 0,835, IC95% = 0,766-0,885, p-value<0,001] and grading (75.1%, k=0.501, p-value <0,001). 96.4% of agreement was observed for HER2 (k=0.837, p-value < 0,001.09). Discordance rate for HER2 was 3,6% (3 negatives to positive). Systemic treatment changes occurred in 7.6% and 3.6%, due to ER and HER2 discordance, respectively. Median time for pathology review was 21 days (IQR 9,5 - 38 days) and from first medical consultation to treatment was 67 days (IQR 46 - 106 days). Conclusion: We showed a high level of agreement in the diagnosis of malignancy and and a low disagreement on IHC review of ER and HER2, with a small impact on clinical decision making. As pathology review carries with it an increased cost, medical personnel working time and delay in treatment initiation, institutions should go through their internalprocedures and re-evaluate its necessity. Citation Format: Teixeira Pires, Lucas Zanetti de Albuquerque, Paula Domith de Oliveira Vieira, Érica Tex Paulino, José Bines. Discordance in breast cancer pathology review and its impact on patient care [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-09-02.

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