Secondary Review of Surgical Pathology Materials for Patient Referred to the Mayo Clinic: An Evaluation of Major Disagreements.
Ryan E Swapp, Wonwoo Shon, Natalie Campbell, Mary E Fidler, Marie C Aubry, Diva R Salomao, David Schembri-Wismeyer, Lynn Padley, Gary L Keeney, John C Cheville. Mayo Clinic, Rochester, MN
Background: Original outside surgical pathology materials are reviewed by Mayo Clinic pathologists for patient referrals. The objective of this study was to identify the rate of major disagreements with diagnoses from outside institutions, categorize them according to organ system, and determine how these major disagreements affected clinical management.
Design: All surgical pathology cases reviewed between 2005 and 2010 were identified to determine the overall frequency of major disagreements. Major disagreements were defined as any change that significantly affected treatment. Furthermore, a subset of cases with major disagrees (reviewed between July, 2009 and September, 2010) were reviewed to determine the specific type of major disagreement and the effect on patient management and prognosis.
Results: After a retrospective review of 66,215 cases, from 2005 to 2010, 429 major disagreements (0.65%) were identified. Most frequent major disagreements occurred in areas of gastrointestinal (78 cases), lymph node (71) and bone/soft tissue pathology (47), followed by genitourinary (41), breast (34), head and neck (27), pulmonary (25), gynecologic (20), endocrine (18), dermatologic (14), neuropathology (10), and cardiovascular pathology (9). In the subset of 94 major disagrees (of a total of 16,462 cases), treatment was affected in 75 cases (79.8%), and prognosis was affected in 79 cases (84.0%). In 20 cases, the diagnosis was changed from benign to malignant, 19 cases were changed from malignant to benign, in 16 cases tumor classification was changed, 5 cases were changed from invasive carcinoma to in-situ, 4 cases were considered non-neoplastic which were previously classified as neoplastic, and 3 were determined to be neoplastic processes which were previously diagnosed as non-neoplastic. Change of tumor grading and staging was changed in two and one cases, respectively. Twenty-four cases were changed for various other reasons that were considered a major disagreement and that affected treatment.
Conclusions: While major disagreements are rare, they often significantly impact patient treatment. This study highlights the value of secondary review of pathologic materials for patient referrals. It further suggests that secondary review is an important quality control activity which detects diagnostic errors and thereby improves patient care.
Category: Quality Assurance
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 236, Monday Morning