Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA.
SC/ACL Laboratories, Great Lakes Pathologists, 8901 W Lincoln Avenue, West Allis, WI 53227, USA.
Int J Qual Health Care. 2021 Mar 11;33(1). doi: 10.1093/intqhc/mzab032.
Second opinion review of pathology cases can identify diagnostic errors that impact patient care.
We sought out to determine discrepancy rates and clinical impact of review of pathology cases to reassess our policy of review on all second opinion cases.
All second opinion pathology cases over 1 year (2018) were retrospectively reviewed for discrepancy, multiple pathologist review and clinicopathologic features via chart and slide review. Cases were categorized as no significant discordance, major discordance without management change and major discordance with management change.
Among 4239 second opinion cases, 3.7% (156/4239) had major discordance with no change in management and 1% (42/4239) had major discordance with change in management. Discordance was significantly associated with multiple pathologist review at our institution (P < 0.001). Highest rates of discordance were observed for thyroid fine needle aspiration (15.3%, 26/170), tissue biopsy of bone/soft tissue (9.6%), endocrine (8.8%), genitourinary (6.7%), gynecologic (6.2%), hematopathology (4%), gastrointestinal/liver (3.7%) and thoracic (3%) sites.
Our study showed a 1% major discordance rate with resulting significant change in clinical management, spread across nearly all subspecialties. Thus, we support recommendations for review of relevant outside pathology material for all patients for which review has the potential to illicit management change such as instituting a major medical or surgical therapy.
对病理病例进行二次诊断审查可以发现影响患者治疗的诊断错误。
我们旨在确定审查病理病例的差异率和临床影响，以重新评估我们对所有二次诊断病例进行审查的政策。
通过图表和幻灯片回顾，对超过 1 年（2018 年）的所有二次诊断病理病例进行差异、多病理学家审查和临床病理特征的回顾性审查。病例分为无明显差异、无管理变更的主要差异和有管理变更的主要差异。
在 4239 例二次诊断病例中，3.7%（156/4239）有重大差异但无管理变更，1%（42/4239）有重大差异并改变管理。差异与我们机构的多病理学家审查显著相关（P<0.001）。差异率最高的是甲状腺细针抽吸（15.3%，26/170）、骨/软组织组织活检（9.6%）、内分泌（8.8%）、泌尿生殖（6.7%）、妇科（6.2%）、血液病理学（4%）、胃肠道/肝脏（3.7%）和胸部（3%）。
我们的研究显示，1%的主要差异率导致临床管理发生重大变化，几乎涉及所有亚专业。因此，我们支持对所有有审查潜力的患者进行相关外部病理材料的审查，以改变管理，例如实施主要的医疗或手术治疗。
