Lapeyrere Nadège, Parrens Marie, Coindre Jean-Michel, Soubeyran Isabelle, de Mascarel Antoine, Merlio Jean-Philippe, Lebail Brigitte, Lepreux Sébastien, Jaffre Anne, Gilleron Véronique, Mathoulin-Pélissier Simone, Vergier Béatrice
Réseau de cancérologie d'Aquitaine, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
Ann Pathol. 2008 Dec;28(6):478-85. doi: 10.1016/j.annpat.2008.09.044. Epub 2008 Nov 17.
The goal of this work was to evaluate the impact of expert pathological second opinion on the diagnosis and management of patients with cancer, in a French region (Aquitaine) and with an economic point of view.
The study was first quantitative, performed retrospectively on all cases of cancer, voluntary sent for a second opinion to an expert pathologist of two centers. Secondly, we restricted the study to lymphoid, melanocytic and soft tissue tumors sent for second opinion. We considered that the expert review had an important diagnostic impact either when the initial pathologist sent the specimen to identify or classify malignant tumor or hesitated between benign and malignant tumor or had no hypothesis, or if there were discordant diagnoses (malignant/benign) between the two pathologists. We considered that the expert review had a high therapeutic impact if the disagreement between initial and expert diagnoses induced a complete modification in therapy. We evaluated the cost of second opinion for the expert centers and the cost of care management.
Over the year 2006, the expert centers received 5077 lesions for consultation: 3769 specimens were sent by a pathologist for a second review, 1324 by pathologists of Aquitania and of these, 751 samples were submitted for lymphoid (55%), soft tissues (30%) or melanocytic tumors (15%). There was an important diagnostic impact for 75% of the samples; the impact of the expert review on patient management was considered high for 46% of specimens and the expert pathological diagnosis modified the clinical prognosis for 40% of the specimens. We estimated that for 53 discordant diagnoses (malignant/benign), second opinion allowed an economy of 500,000 euro.
Expert second opinion is very important not only for diagnosis and management for patient with cancer but also for economic reasons.
本研究旨在从经济角度评估专家病理二次诊断对法国阿基坦地区癌症患者诊断和治疗的影响。
该研究首先是定量研究，对所有自愿送往两个中心的专家病理学家处进行二次诊断的癌症病例进行回顾性分析。其次，我们将研究范围限制在送往二次诊断的淋巴、黑素细胞和软组织肿瘤。当最初的病理学家送检标本以鉴定或分类恶性肿瘤、在良性和恶性肿瘤之间犹豫不决或没有诊断假设时，或者当两位病理学家之间存在诊断不一致（恶性/良性）时，我们认为专家评审具有重要的诊断影响。如果最初诊断与专家诊断之间的分歧导致治疗方案完全改变，我们认为专家评审具有较高的治疗影响。我们评估了专家中心二次诊断的成本以及护理管理的成本。
2006年，专家中心共收到5077例病变进行会诊：3769份标本由病理学家送检进行二次评审，阿基坦尼亚的病理学家送检了1324份，其中751份样本用于淋巴（55%）、软组织（30%）或黑素细胞肿瘤（15%）。75%的样本有重要的诊断影响；专家评审对46%的标本的患者管理影响被认为较高，专家病理诊断改变了40%标本的临床预后。我们估计，对于53例诊断不一致（恶性/良性）的病例，二次诊断节省了50万欧元。
专家二次诊断不仅对癌症患者的诊断和治疗非常重要，而且从经济角度来看也很重要。
