Interinstitutional Consultation in Fine Needle Aspiration Cytopathology
PE Bomeisl, SM Alam, PE Wakely, Jr. The Ohio State University Medical Center, Columbus, OH
Background: The importance of interinstitutional consultation has been documented across a variety of surgical pathology organ systems. Few studies exist regarding this practice within cytopathology, specifically, fine needle aspiration cytology (FNAC).
Design: All FNAC cases between 9/02 and 1/07 were reviewed. Original and 2nd opinion diagnoses were categorized as: no diagnostic disagreement, minor diagnostic disagreement, or major diagnostic disagreement, with the latter defined as either a 2-step deviation on a scale of unsatisfactory, benign, atypical, suspicious, and malignant or a change in treatment and/or prognosis. Outcome was determined by review of the electronic medical record.
Results: 742 outside FNAC cases showed minor disagreements in 132 cases (17.8%), and major disagreement in 69 cases (9.3%) with follow-up available for 60/69 major discrepancies. The 2nd opinion diagnosis was better supported upon follow-up in 65% and the initial diagnosis better supported in 33% of major discrepancies. However, 55% of cases where the original institution diagnosis was better supported were ones where either the entire case slides were not received, or slides were deemed extremely hypocellular and non-diagnostic on 2nd opinion. A 2nd opinion diagnosis prompted change in clinical management in 32/742 (4.3%) of cases. Aspirates most prone to change in management or therapy were from: thyroid (12), lymph node (9), salivary gland (4), and liver (2). Of 60 major diagnostic disagreements, board certified cytopathologists rendered 2nd diagnoses in 44 cases, with 75% better supported by follow-up while pathologists not board-certified in cytopathology had only 38% of 2nd opinion diagnoses supported.
Conclusions: Interinstitutional review of FNAC cases resulted in major discrepancies in 9.3% and a change in clinical management of 4.3% of cases. Fine needle aspiration presents unique diagnostic challenges, and review by a board-certified cytopathologist may lead to further error reduction.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 71, Wednesday Afternoon