Reducing False-Negative and False-Positive Diagnoses in Anatomic Pathology Consultation Material

Abstract

Context.-Previous studies have shown that there are disagreements in interlaboratory consultation, including false-negative and false-positive diagnoses. To date, methods to reduce false-negative and false-positive diagnoses have been poorly documented.Objective.-To identify features associated with falsenegative and false-positive diagnoses in anatomic pathology.Design.-We reviewed the results of interlaboratory consultation in our institution during a 9-year period. For false-negative and false-positive diagnoses, methods that might have prevented the error were identified.Results.-Disagreements were identified in 810 of 8082 consults (10%). Fifty-four false-negative cases (0.7% of all consults) and 27 false-positive cases (0.3%) were identified. False-negative cases were more common in breast (20 of 1131; 1.8%), genitourinary (16 of 970; 1.7%), hematologic (3 of 242; 1.3%), and cytology (3 of 404; 0.8%) than in all other sites combined (P , .001); no significant difference in sites were identified for falsepositive cases. Overall, there was no difference in the percentage of cases that were reviewed by more than one pathologist in either false-negative cases (109 of 810; 13.5%) or false-positive cases (135 of 810; 16.7%), compared with all other consults (858 of 7272; 11.8%) (P ¼ .74 and .59, respectively). However, on review, 12 of all 27 false-positive cases (44%) might have been prevented by the use of immunohistochemistry alone, and 36 of all 54 false-negative cases (67%) might have been prevented by the use of a second review; special stains, including immunohistochemistry; additional levels; changes in processing; and hedges.Conclusion.-Approximately one-half of false-negative and false-positive cases (48 of 81; 59%) might be preventable by the use of a combination of pathologic methods.

The value of second opinion in thyroid cytology: A review

“…Several studies addressed the role of a second opinion in surgical pathology material and analyzed the discordances between the initial (outside) and reviewed (in‐house) diagnoses. According to these studies, diagnostic discrepancies that resulted in change of clinical management and/or therapy for the referred patient ranged from 1.2% to 5.8% …”

“…There are some anatomical sites that are more prone to diagnostic disagreements, including the gastrointestinal, genitourinary, female genital tract, hematolymphoid system, serosal surface, skin, and breast sites. The thyroid gland is the anatomic site that showed the highest rate of disagreement in a study that analyzed the second‐opinion diagnosis of head and neck lesions .…”

Estimate of false-positive breast cancer diagnoses from accuracy studies: a systematic review

“…Twelve studies included consecutively recruited or randomly selected or stratified samples;9 13 19 23 25 32 33 43 51 53 55 60 six studies included enriched samples;20 21 27 42 45 56 nine studies included only cases selected for a second opinion 30 31 34 37 40 44 57–59…”

“…Two studies assessed the agreement between two readers;33 43 in 1 study19 three readers reviewed slides; in 15 studies this information was not reported;9 23 30 31 34 37 40 44 45 53 55 57–60 in 9 studies, the same set of slides were reviewed by 10,32 12,20 27 31,21 47,13 26,51 220–46625 and 186–251 pathologists 42. Elmore et al reported agreement among the initial independent diagnoses of three expert consensus panel members (CPM), and the concordance between 115 pathologists and the consensus-derived reference diagnosis 56.…”

“…All but one studies with consecutive or random or stratified samples were judged at low risk of cases selection bias; Palli et al 33 was judged at unclear risk for what concern selection of cases because the sample was consecutively recruited for the Swedish series, but it was unclear for the Italian series; all the six studies with enriched samples were judged at high risk of cases selection bias; among the studies with cases selected for a second opinion, six studies were judged at low;31 37 44 57–59 the other ones at high risk of cases selection bias. Routine clinical data were available for interpretation only in five studies; 13 21 23 31 43 they were not available in three studies;27 32 33 it was unclear in the other studies.…”