nline Digital Atlas of Breast Pathology: Utility in Resident Education as Stratified by Postgraduate Year Level
Meenakshi Singh ; University of Colorado;
Content:
Breast pathology encompasses a diverse range of histological changes wherein many benign and malignant entities bear histological resemblance and cause diagnostic dilemmas. Pathology residents find breast pathology to be one of the more challenging areas of surgical pathology with respect to attaining a high level of diagnostic accuracy during training.
Technology:
Resources were compiled on a departmental Web server accessed through standard Web pages deploying JavaScript menus which access multiple indexed JPEG images.
Design:
We have developed an easy to use online atlas of breast pathology containing 500 images that cover the range of normal, benign, pre-invasive, and invasive malignant entities in breast pathology. Short legends and multiple examples of entities are included. To validate the teaching potential of this atlas, we conducted this study to test the hypothesis that residents with limited surgical pathology experience can show an improvement in diagnostic abilities after they have reviewed the atlas. Breast biopsy sections containing a multitude of benign lesions, some that were diagnostically challenging, were selected. Residents recorded their diagnoses before and after completing review of the atlas. Residents were stratified according to post-graduate year level. Resident identity was kept anonymous.
Results:
First year residents with minimal surgical pathology experience (2-3 months) had a very high misdiagnosis rate before reviewing the atlas. After atlas review, they were able to correct a misdiagnosis of carcinoma, identify a papilloma, and use correct terminology for ductal hyperplasia of the usual type. Second year residents (4-6 months surgical pathology experience) were able to correct a misinterpretation of lobular carcinoma in situ after atlas review and to correctly identify columnar cell change. Senior residents (4th year) had a good correlation between their pre- and post-atlas-review diagnoses and were able to identify most entities when compared to the breast pathologist's diagnoses and they picked up additional diagnoses, e.g. a radial scar, that none of the junior residents identified.
Conclusion:
Online teaching tools, such as this breast atlas, can be useful in preparing residents, particularly junior residents, to make more accurate breast pathology diagnoses.
