No abstract

A large‐scale postmortem auditing of antemortem imaging diagnoses has yet to be accomplished in veterinary medicine. For this retrospective, observational, single‐center, diagnostic accuracy study, necropsy reports for patients of The Schwarzman Animal Medical Center were collected over a 1‐year period. Each necropsy diagnosis was determined to be either correctly diagnosed or discrepant with its corresponding antemortem diagnostic imaging, and discrepancies were categorized. The radiologic error rate was calculated to include only clinically significant missed diagnoses (lesion was not reported but was retrospectively visible on the image) and misinterpretations (lesion was noted but was incorrectly diagnosed). Nonerror discrepancies, such as temporal indeterminacy, microscopic limitations, sensitivity limitations, and study‐type limitations were not included in the error rate. A total of 1099 necropsy diagnoses had corresponding antemortem imaging; 440 diagnoses were classified as major diagnoses, of which 176 were discrepant, for a major discrepancy rate of 40%, similar to reports in people. Seventeen major discrepancies were diagnoses that were missed or misinterpreted by the radiologist, for a calculated radiologic error rate of 4.6%, comparable with error rates of 3%–5% reported in people. From 2020 to 2021, nearly half of all clinically significant abnormalities noted at necropsy went undetected by antemortem imaging, though most discrepancies owed to factors other than radiologic error. Identifying common patterns of misdiagnosis and discrepancy will help radiologists refine their analysis of imaging studies to potentially reduce interpretive error.

Background: Warthin tumor is a common benign salivary gland lesion. Its optimal treatment mode is controversial. We analyze the accuracy of Warthin tumor pre-operative fine-needle aspiration (FNA)-based diagnosis and reassess the treatment paradigm. The risk of missing malignant tumors, falsely demonstrating a cytological benign Warthin tumor in the pre-operative FNA, is to be explored. Methods: Retrospective cohort study in a tertiary university hospital. Data on all parotidectomy cases between 1996 and 2010 (n=238) was analyzed. Cytological accuracy was calculated in 2 different opposing ways. First, we considered cases with a correct pre-operative identification of histologically proven Warthin tumors as true positives. The second assessment was done by gathering all cytological examinations suggesting a Warthin tumor, which were later excised. The histological identification of a malignant tumor was considered as a false negative. Results: FNA was found to be accurate in 48 out of the 61 patients who had a final pathologic diagnosis of Warthin tumor, i.e. a 78.7% sensitivity. In the second step, there were 50 FNA's suggesting a Warthin tumor, One case turned out to be malignant: a low-grade muco-epidermoid carcinoma. The negative predictive value was therefore 98%. Conclusions:The overall accuracy of FNA suggesting Warthin tumor in a tertiary university hospital is high. We offer, in selected patients, observation as a reasonable alternative treatment to surgery. However, we also advise a repeat ultrasound-guided FNA to confirm the initial diagnosis.

Development of this fulminant head and neck congestion in patients with advanced CTCL heralds a progressively deteriorating clinical course with a poor prognosis.