Agreement and Error Rates Using Blinded Review to Evaluate Surgical Pathology of Biopsy Material

Renshaw, Andrew A.; Cartagena, Norberto; Granter, Scott R.; Gould, Edwin W.

doi:10.1309/dcxaxfvcchvhyu41

Cited by 56 publications

(27 citation statements)

References 7 publications

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“…b Internal refers to reviews of pathology reports within a single institution; external refers to reviews of cases given a diagnosis at a different institution. c [19][20][21][22]25,29,The literature review demonstrated that a review of cases detects discrepancies and errors, and furthermore, that discrepancy or error rates fall in a range that is clinically important. The evidence was inadequate to demonstrate a direct impact on patient safety, because few studies reported the clinical impact on patient outcomes that resulted from interpretive errors.…”

Section: Guideline Statementsmentioning

confidence: 99%

Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology

Nakhleh

Nosé²,

Colasacco³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies.Objective.-To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors.Design.-The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidencebased guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology.Results.-The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic pathologists should take steps to improve agreement.Conclusions.-Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care. (Arch Pathol Lab Med. 2016;140:29-40; doi: 10.5858/ arpa.2014-0511-SA) T he test cycle in surgical pathology and cytology is similar to the test cycle of other laboratory tests. [1][2][3][4] It is composed of the preanalytic, analytic, and postanalytic phases. The preanalytic and postanalytic phases are very similar to tests in the clinical laboratory. The preanalytic phase is composed of specimen acquisition, specimen labeling, and delivery to the laboratory, where the specimen is prepared for the analytic phase. The postanalytic phase begins with report generation and ends with delivery of the report to the clinician.Unlike the other phases of the test cycle, the analytic phase is substantially different in surgical pathology and cytology (versus clinical pathology) in that it involves the inherent judgment of the pathologist at the time of slide interpretation. [5][6][7][8][9] It is therefore more subjective than clinical laboratory tests. There are many factors that contribute to an accurate interpretive diagnosis, including: (1) the patholo-

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Section: Guideline Statementsmentioning

confidence: 99%

Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology

Nakhleh

Nosé²,

Colasacco³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

Self Cite

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“…This is typically the case, as the clinically significant diagnostic error rate has been reproducibly found to be less than 1.2 percent, which, while not perfect, does provide enough reliability for clinical management of patients [3][4][5][6][7][8]. Steps taken by pathologists to mitigate the risk of misdiagnosis include mandatory continuing medical education, institutional quality assurance programs, and utilization of expert consultative services.…”

Section: The Patient-pathologist Relationshipmentioning

confidence: 99%

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Magers

Cinti

2016

AMA Journal of Ethics

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The pathologist rarely interacts with patients face-to-face, but he or she nonetheless maintains a crucial relationship with the patient (i.e., the patient-pathologist relationship). A more tangible relationship, the pathologist-clinician relationship, is typically augmented by the patientpathologist relationship, but at times the two distinct relationships are at odds, creating ethical dilemmas for the pathologist. This case study and discussion highlight some of these potential ethical questions and underscore the need for pathologists and clinicians to have cooperative, collaborative, and professional relationships. Pathologists should feel empowered to guide the clinician's use of appropriate clinical testing to ensure proper management of the patient and responsible use of health care resources.

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“…To have potential positive clinical impact, this must be performed soon after the initial diagnosis is made, and ideally before sign-out [8,9]. The type of cases selected for peer review impacts on the error detection rate.…”

Section: Detection and Frequency Of Diagnostic Discrepanciesmentioning

confidence: 99%

How trustworthy is a diagnosis in head and neck surgical pathology? A consideration of diagnostic discrepancies (errors)

Woolgar

Ferlito

Devaney

et al. 2011

Eur Arch Otorhinolaryngol

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Agreement and Error Rates Using Blinded Review to Evaluate Surgical Pathology of Biopsy Material

Cited by 56 publications

References 7 publications

Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology

Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology

Ordering Stains That Aren't Indicated

How trustworthy is a diagnosis in head and neck surgical pathology? A consideration of diagnostic discrepancies (errors)

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