Department of Pathology and Cell Biology, University of South Florida, Tampa, Florida 33612, USA.
J Am Acad Dermatol. 2013 Jan;68(1):119-28. doi: 10.1016/j.jaad.2012.06.034. Epub 2012 Aug 11.
Expert consultation and institutional policies mandating second review of pathologic diagnoses in the course of referral have been advocated to optimize patient care.
We sought to investigate the rate of diagnostic discrepancies between pathologists with and without dermatopathology fellowship training.
All available outside pathology reports were reviewed for material sent to the University of Pittsburgh Medical Center Dermatopathology Unit during 1 year. The outside diagnosis was compared with the diagnosis rendered by the referral dermatopathology service. Cases were assigned into 1 of 4 categories: melanocytic neoplasm, nonmelanocytic neoplasm, inflammatory, and other. For each case, the outside pathologist's level of dermatopathology training was noted. Any change in diagnosis resulting in significant alteration in therapy or prognosis, as dictated by the accepted standard of care, was considered a major discrepancy.
A total of 405 cases were reviewed. In 51 cases (13%), no preliminary diagnosis was rendered at the outside facility. The referral diagnosis differed from the outside diagnosis in 226 cases (56%), and major discrepancies were identified in 91 cases (22%). Of these 91 cases, 84 were received from outside pathologists who were not dermatopathology trained and 7 were received from pathologists with dermatopathology training. The 91 cases with major discrepancies were categorized as: 36 nonmelanocytic neoplasms (40%), 30 inflammatory (33%), 23 melanocytic neoplasms (25%), and 2 other (2%).
This was a retrospective study limited to 2 consultant dermatopathologists at an academic referral center, which typically receives and reviews select cases.
Dermatopathology fellowship training is associated with a substantial decrease in major diagnostic discrepancies. Pathologists without dermatopathology fellowship training tend to successfully identify those cases for which expert consultation is most useful.
专家咨询和机构政策要求在转诊过程中对病理诊断进行二次审查，以优化患者的治疗效果。
我们旨在调查具有和不具有皮肤病理专业 fellowship培训的病理学家之间的诊断差异率。
对 1 年内送到匹兹堡大学医学中心皮肤科病理科的所有可用外部病理报告进行了回顾。将外部诊断与转诊皮肤科病理服务做出的诊断进行了比较。将病例分为以下 4 类：黑素细胞肿瘤、非黑素细胞肿瘤、炎症性和其他。为每个病例记录了外部病理学家的皮肤病理培训水平。任何导致治疗或预后发生重大改变的诊断变化，均按照公认的护理标准，被认为是主要差异。
共审查了 405 例病例。在 51 例（13%）病例中，外部机构没有给出初步诊断。转诊诊断与外部诊断不一致的有 226 例（56%），并确定了 91 例（22%）主要差异。在这 91 例中，有 84 例来自未接受皮肤病理培训的外部病理学家，有 7 例来自具有皮肤病理培训的病理学家。91 例主要差异病例分类为：36 例非黑素细胞肿瘤（40%）、30 例炎症性（33%）、23 例黑素细胞肿瘤（25%）和 2 例其他（2%）。
这是一项回顾性研究，仅限于学术转诊中心的 2 位顾问皮肤科病理学家，该中心通常接收和审查特定病例。
皮肤病理专业 fellowship培训与主要诊断差异的显著减少有关。没有皮肤病理专业 fellowship培训的病理学家倾向于成功识别出最需要专家咨询的病例。
