Consultative (Expert) Second Opinions in Soft Tissue Pathology

Abstract

We reviewed 500 consecutive soft tissue lesions referred for expert consultation to determine types of lesions and/or situations in which major discrepancies occur. Of 266 cases (53.2%) accompanied by a diagnosis, essential agreement with the second opinion was noted in 68%, minor discrepancy in 7%, and major discrepancy in 25%. The 65 major discrepancies were distributed proportionally to the referring sources and could be divided into 4 groups: benign mesenchymal lesions diagnosed as sarcomas (45%), sarcomas diagnosed as benign tumors (23%), nonmesenchymal lesions diagnosed as sarcoma (20%), and major grading discrepancies (12%). Relatively few lesions accounted for a major proportion of major discrepancies. Problematic lesions were lipoma and fasciitis and their variants and desmoplastic-neurotropic melanoma. Needle biopsy specimens were somewhat more likely to be associated with a discrepant opinion. With the exception of nonmesenchymal lesions, the diagnosis for all major discrepant cases could be made on the basis of the H&E-stained slides, suggesting that failure to perform immunostains did not account for discrepancies. Lack of familiarity with rare or unusual lesions is probably more significant in explaining diagnostic discrepancies than is the increasing use of needle biopsy or the failure to perform immunohistochemical analysis.

Extra‐departmental anatomic pathology expert consultation inTaiwan: A research grant supported 4‐year experience

“…Because all these were conducted in private, there was no formal record concerning the details of this consultation practice among the pathology society in Taiwan. Because expert consultation is one of the methods to improve patient safety, the Department of Health, Executive Yuan, Taiwan, Republic of China had funded the Taiwan There were several reports in the literature concerning extradepartmental anatomic pathology expert consultation [2][3][4][5][6][7][8][9]. Most of them were based on single organ or single institutional experience [2,[5][6][7][8][9], data of nationwide consultation was only available in one article [3].…”

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

“…5,[10][11][12][13][14][15] Several of these factors contribute to establishing a precise diagnosis, but the pathologist's knowledge and experience remain the essential factors in interpretive diagnosis. Although numerous studies have shown that case reviews help detect interpretive diagnostic errors, there have been no efforts to formalize this practice as a strategy to reduce errors.…”

Tumoren des Retroperitoneums

“…Verschiedene In Deutschland werden von 1200 Pathologen pro Jahr von einem lediglich zwei Weichteilsarkome diagnostiziert. In einem Viertel der Fälle muss eine Korrektur der Primärdiagnose erfolgen [1]; wird der Tumor von einem Referenzzentrum nachbegutachtet, stiegt diese Quote sogar auf 70 % an [14].…”