Department of Dermatology, University of California-San Francisco, San Francisco, California.
Department of Dermatology, University of California-San Francisco, San Francisco, California.
J Am Acad Dermatol. 2021 May;84(5):1385-1392. doi: 10.1016/j.jaad.2020.12.022. Epub 2021 Jan 13.
Second-opinion review is linked to error reduction and treatment changes in anatomic pathology.
We sought to establish the rate of diagnostic discrepancy identified by second-opinion dermatopathologic review and the effect on surgical treatment.
Cases referred for treatment of a malignant neoplasm diagnosed by an outside pathologist were reviewed. The external and internal second-opinion dermatopathologic reports were compared. Discordance in diagnosis, subtype, and treatment change owing to second-opinion review was recorded. The referring pathologist's level of dermatopathologic training was also documented.
A total of 358 cases were included. Dermatopathologic second-opinion diagnosis was discordant with the outside diagnosis in 37 of 358 cases (10.3%). In 32 of 358 cases (8.9%), second-opinion review resulted in a change in treatment, with 28 of 32 (87.5%) of these changes resulting in cancelled surgery. Dermatologists without dermatopathologic fellowship training had the highest rate of discordant diagnoses compared with pathologists and dermatopathologists.
This was a retrospective study at a tertiary care facility.
Second-opinion dermatopathologic review is associated with identification of discordant diagnoses and a substantial influence on treatment, with both cancellation of surgery and augmented management. Secondary pathologic review should be considered in high-volume surgical practices.
第二意见审查与解剖病理学中的错误减少和治疗改变有关。
我们旨在确定通过第二意见皮肤病理审查发现的诊断差异率以及对手术治疗的影响。
回顾了由外部病理学家诊断为恶性肿瘤的治疗转诊病例。比较了外部和内部第二意见皮肤病理报告。记录了因第二意见审查而导致的诊断、亚型和治疗改变的差异。还记录了转诊病理学家的皮肤病理培训水平。
共纳入 358 例病例。在 358 例病例中，37 例（10.3%）第二意见皮肤病理诊断与外部诊断不一致。在 358 例病例中，有 32 例（8.9%）因第二意见审查导致治疗改变，其中 28 例（87.5%）的改变导致手术取消。与病理学家和皮肤病理学家相比，没有皮肤病理研究金的皮肤科医生的诊断不一致率最高。
这是一家三级保健机构的回顾性研究。
第二意见皮肤病理审查与诊断不一致的发现以及对治疗的重大影响有关，包括手术取消和增强管理。在高容量手术实践中应考虑二次病理审查。
