The impact of pathologist experience on liver transplant biopsy interpretation

Abstract

We studied the impact of pathologist experience on liver transplant biopsy interpretation for cases designated 'nonspecific' by pathologists at a nontransplant center. Among 102 consecutive liver transplant biopsies from 92 patients performed at the Foothills Medical Center, 30 liver biopsies from 23 patients were designated 'nonspecific' by the local pathologist. These biopsy slides were independently reviewed by an expert in liver transplant pathology at a major US transplant center. The expert pathologist was given only the information on the original requisition. In seven biopsies from five patients, there was full agreement between the external expert and the local pathologist. In 10 biopsies from six patients, the expert concurred with the initial assessment but emphasized critical negatives such as 'no evidence of rejection or recurrent hepatitis'. A discrepant diagnosis was found in 13 biopsies from 12 patients. In five biopsies from four patients, the revised diagnoses were inaccurate due to insufficient or misleading clinical information on the requisition. In eight biopsies from eight patients, the revised diagnoses were proven to be correct by clinicopathologic correlation. Our study shows that pathology expertise helped to clarify the diagnosis in about 27% of cases, which justifies the cost of obtaining a second opinion in difficult biopsies. Misinterpretation by the expert pathologist in up to 17% of biopsies highlights the importance of direct communication between hepatologist and pathologist in order to achieve a correct diagnosis. Familiarity with those cases with relatively uncommon histology, a diligent search for subtle morphologic changes, and use of standard terminology could improve the quality of liver transplant biopsy interpretation in a nontransplant center.

Automated Biochemical, Morphological, and Organizational Assessment of Precancerous Changes from Endogenous Two-Photon Fluorescence Images

“…These methods are highly time-consuming and subjective; furthermore, accuracy is heavily dependent on the expertise of the pathologist [24]. In this study, we present a novel approach for automated detection of early cancer in tissue based on simultaneous quantification of mitochondrial organization, cellular morphology, metabolic activity, and keratin localization from non-invasively acquired TPEF images.…”

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.…”

Hepatobiliary pathology

“…The value of special expertise in interpreting liver transplant biopsy pathology was pointed up in a study which showed that 'expert' review of specimens originally designated as 'nonspecific' at a nontransplant center resulted in revised diagnoses in 27% of cases [61 ]. Conditions that were missed in this setting included early recurrent chronic hepatitis, the fibrosing cholestatic hepatitis variant of recurrent hepatitis C, nodular regenerative hyperplasia, and de-novo autoimmune hepatitis.…”