Error Reduction and Prevention in Surgical Pathology by Raouf E. Nakhleh

Error Reduction and Prevention in Surgical Pathology by Raouf E. Nakhleh

Author:Raouf E. Nakhleh
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Subspecialty Diagnostic Threshold and Error

Subspecialized sign-out and specialist review may improve error rates and help to optimize patient care, particularly in challenging diagnoses. However, the threshold of certain diagnosis may differ amongst experts in the subspecialty . It is known that soft tissue tumors, melanocytic tumors, and breast epithelial lesions are common sources of discrepancy, not only between general pathologists and specialists but also amongst subspecialists.

To examine variability between academic specialist pathologists further, we reviewed surgical pathology reports (167) on 119 patients who were first seen at the MGH and subsequently seen at the Brigham and Women’s Hospital (BWH). Amongst the 119 patients, there were 13 major discrepancies (11 %), which included changes in tumor grade, stage, or margin status. One case was a change in the type of sarcoma. One case was downgraded from malignant (melanoma) to having uncertain malignant potential, one from atypical (flat epithelial atypia of the breast) to benign, and one from suspicious (lymphoma) to benign with the aid of hindsight after resection done at the BWH (Table 7.1).Table 7.1Discrepancy rates between academic hospitals by subspecialty


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