Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Am J Clin Pathol. 2022 May 4;157(5):724-730. doi: 10.1093/ajcp/aqab182.
The value of consultation in pathology has been well documented in surgical pathology, but there are few comprehensive studies of consultation cases in cytopathology. Here we report our experience with cytopathology consultation cases at a large academic center.
A review of consultation cases at our institution was performed by searching our laboratory information system. The contributing institution's diagnosis was compared with that rendered by the reviewing cytopathologist to assess major and/or minor diagnostic discrepancies.
In total, 928 cases were reviewed with the following distribution: fine-needle aspiration (FNA, 79.4%), exfoliative nongynecologic cytology (18.3%), and cases with both FNA and nongynecologic cytology (2.3%). There were 379 (40.8%) true consults and 549 (59.2%) confirming consults. A total of 586 (63.1%) cases were in agreement with the outside pathologist, 78 (8.4%) cases had major discrepancies, and 264 (28.4%) cases had minor discrepancies. Major discrepancies were most common for pancreas (38.5%), lymph node (11.5%), and soft tissue sites (9.0%).
Of the cases, 8.4% had major diagnostic discrepancies between the original diagnosis and the consultation diagnosis, which is consistent with reported values in surgical pathology consultation studies. The findings support the importance of second-opinion consultation in cytopathology to guide patient care.
病理学咨询的价值在外科病理学中已有充分的记录，但在细胞学病理学中，对咨询病例的综合研究较少。在此，我们报告了我们在一个大型学术中心进行细胞学病理学咨询病例的经验。
通过检索我们的实验室信息系统，对我们机构的咨询病例进行了回顾。将送检机构的诊断与复核细胞病理学家的诊断进行比较，以评估主要和/或次要诊断差异。
共回顾了 928 例病例，分布如下：细针抽吸（FNA，79.4%）、非妇科脱落细胞学检查（18.3%）以及同时进行 FNA 和非妇科细胞学检查的病例（2.3%）。有 379 例（40.8%）为真正的咨询病例，549 例（59.2%）为证实的咨询病例。共有 586 例（63.1%）与外院病理医生的诊断一致，78 例（8.4%）存在主要差异，264 例（28.4%）存在次要差异。在胰腺（38.5%）、淋巴结（11.5%）和软组织部位（9.0%）中，主要差异最为常见。
在这些病例中，8.4%的病例在原始诊断和咨询诊断之间存在主要诊断差异，这与外科病理学咨询研究中的报告值一致。这些发现支持在细胞学病理学中进行二次咨询以指导患者治疗的重要性。
