Solivas Jocelyn Sharmaine Cyda T, Diwa Michele H
Department of Laboratories, Philippine General Hospital, University of the Philippines Manila.
Department of Pathology, College of Medicine, University of the Philippines Manila.
Acta Med Philipp. 2024 Sep 13;58(16):42-49. doi: 10.47895/amp.v58i16.3493. eCollection 2024.
There is a mandatory intradepartmental peer review algorithm in the University of the Philippines - Philippine General Hospital (UP-PGH) Department of Laboratories wherein specific cases are required to be reviewed by another pathologist before the release of results. The main objective of this study was to determine the rate of diagnostic change in surgical pathology reports after undergoing the said review.
All surgical pathology cases which underwent the review from 2015 to 2018 were retrieved from the records of the Section of Surgical Pathology. The cases were classified as concordant or discordant. A case was considered concordant if the reviewing pathologist had agreed with the primary pathologist's diagnosis. A case was considered discordant if the reviewing pathologist had disagreed with the primary pathologist's diagnosis.
Out of 5,377 cases included in this study, there were 5,209 concordant cases and 168 discordant cases, with the rate of discordance computed to be 3.1%. Out of the 168 discordant cases, 107 were revised for diagnostic change. Rate of diagnostic change was computed to be 2.0% (107 out of 5,377 cases for review). The most common criterion satisfied for meriting a mandatory review is being under the category of biopsies or cytology cases with malignant or borderline diagnoses (49.4%). The most common category of diagnostic change is change in immunohistochemistry recommendations (24.3%). Most of the discordant cases and cases revised for diagnostic change fall under the categories of gastrointestinal, gynecology, and head & neck pathology.
The low rate of diagnostic change in our institution might be attributed to good diagnostic accuracy. However, it is also possible that reviewing pathologists tended to agree with the diagnosis made by their colleagues because of the element of peer pressure. Data from the study may imply that special courses/ lectures or institutional standard practice guidelines on interpreting biopsy and cytology cases as well as on the utility of immunohistochemistry studies, especially those focused on gastrointestinal, gynecology, and head & neck pathology are needed by the pathologists and the doctors training to become pathologists in our institution.
菲律宾大学-菲律宾总医院（UP-PGH）实验室部门有一项强制性的部门内同行评审算法，要求在发布结果之前，特定病例需由另一位病理学家进行评审。本研究的主要目的是确定经过上述评审后手术病理报告中的诊断更改率。
从手术病理科的记录中检索出2015年至2018年期间接受评审的所有手术病理病例。这些病例被分类为一致或不一致。如果评审病理学家同意初级病理学家的诊断，则该病例被视为一致。如果评审病理学家不同意初级病理学家的诊断，则该病例被视为不一致。
本研究纳入的5377例病例中，有5209例一致病例和168例不一致病例，不一致率计算为3.1%。在168例不一致病例中，有107例因诊断更改而进行了修订。诊断更改率计算为2.0%（5377例接受评审的病例中有107例）。值得进行强制性评审的最常见标准是活检或细胞学病例类别中具有恶性或临界诊断（49.4%）。最常见的诊断更改类别是免疫组化建议的更改（24.3%）。大多数不一致病例和因诊断更改而修订的病例属于胃肠、妇科和头颈病理学类别。
我们机构中诊断更改率较低可能归因于良好的诊断准确性。然而，也有可能由于同行压力因素，评审病理学家倾向于同意其同事做出的诊断。该研究的数据可能意味着我们机构的病理学家和正在接受培训成为病理学家的医生需要关于解释活检和细胞学病例以及免疫组化研究效用的特别课程/讲座或机构标准实践指南，尤其是那些专注于胃肠、妇科和头颈病理学的指南。
