Trotter Martin J, Bruecks Andrea K
Calgary Laboratory Services and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
Arch Pathol Lab Med. 2003 Nov;127(11):1489-92. doi: 10.5858/2003-127-1489-IOSBBG.
Slide review has been advocated as a means to reduce diagnostic error in surgical pathology and is considered an important component of a total quality assurance program. Blinded review is an unbiased method of error detection, and this approach may be used to determine the diagnostic discrepancy rates in surgical pathology.
To determine the diagnostic discrepancy rate for skin biopsies reported by general pathologists.
Five hundred eighty-nine biopsies from 500 consecutive cases submitted by primary care physicians and reported by general pathologists were examined by rapid-screen, blinded review by 2 dermatopathologists, and the original diagnosis was compared with the review interpretation.
Agreement was observed in 551 (93.5%) of 589 biopsies. Blinded review of these skin biopsies by experienced dermatopathologists had a sensitivity of 100% (all lesions originally reported were detected during review). False-negative errors were the most common discrepancy, but false positives, threshold discrepancies, and differences in type or grade were also observed. Only 1.4% of biopsies had discrepancies that were of potential clinical importance.
Blinded review demonstrates that general pathologists reporting skin biopsies submitted by primary care physicians have a low diagnostic error rate. The method detects both false-negative and false-positive cases and identifies problematic areas that may be targeted in continuing education activities. Blinded review is a useful component of a dermatopathology quality improvement program.
玻片复查已被提倡作为减少外科病理学诊断错误的一种手段，并且被认为是全面质量保证计划的一个重要组成部分。盲法复查是一种无偏倚的错误检测方法，这种方法可用于确定外科病理学中的诊断差异率。
确定普通病理学家报告的皮肤活检的诊断差异率。
由2名皮肤病理学家对基层医疗医生提交的500例连续病例中的589份活检标本进行快速筛查、盲法复查，并将原诊断与复查结果进行比较，这些活检标本由普通病理学家报告。
589份活检标本中有551份（93.5%）诊断一致。经验丰富的皮肤病理学家对这些皮肤活检进行盲法复查的敏感度为100%（复查时检测到了所有最初报告的病变）。假阴性错误是最常见的差异类型，但也观察到了假阳性、阈值差异以及类型或分级的差异。只有1.4%的活检标本存在具有潜在临床重要性的差异。
盲法复查表明，报告基层医疗医生提交的皮肤活检的普通病理学家诊断错误率较低。该方法能检测出假阴性和假阳性病例，并识别出继续教育活动中可能针对的问题领域。盲法复查是皮肤病理学质量改进计划的一个有用组成部分。
