The Value of Second Opinion Review of Cytologic Specimens from the Head and Neck
Vijay A George, Chase M Heaton, David W Eisele, Annemieke van Zante. University of California, San Francisco, CA
Background: As a quality assurance practice, review of cytopathologic specimens from the original institution can refine the cytologic diagnosis and guide clinical management of patients referred for surgical evaluation of lesions in the head and neck. Routine review of cytologic specimens can allow for the identification of diagnostic errors, obviate repeat fine needle aspiration, and guide proper treatment. The frequency of clinically significant diagnostic discrepancies in cytopathology at a large referral hospital is unknown.
Design: All cytopathologic specimens submitted by the Department of Otolaryngology-Head and Neck Surgery to the Division of Cytology between January 1, 2000 and May 1, 2011 were reviewed. The diagnosis made by the original pathologist was compared to that rendered at the referral hospital. A diagnostic discrepancy was defined as any change in diagnosis that would likely result in significant modification of clinical management.
Results: A diagnostic discrepancy was identified in 89 of 512 of cases (17%). Specimens prone to diagnostic discrepancy include thyroid and lymph node aspirates. The most common discrepancy was the change from an “atypical” or “suspicious” diagnosis rendered on a thyroid aspirate to a definitive diagnosis of papillary, medullary, or anaplastic thyroid carcinoma. Lymph node aspirates with a “benign,” “atypical,” or “suspicious” diagnosis were frequently given a frankly malignant diagnosis on second review. Histologic evaluation confirmed the second opinion diagnosis in every discrepant case where a cytologic diagnosis of thyroid carcinoma or malignancy within a lymph node was rendered. Definitive cytologic diagnosis in these cases frequently obviates repeat fine needle or excisional biopsy and facilitates definitive surgical or medical management.
Conclusions: Routine review of cytologic specimens for patients referred for surgical evaluation of lesions in the head and neck results in a potentially clinically significant change of diagnosis in 17% of cases. Even “minor” changes in interpretation result in significant modifications of surgical planning.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 69, Wednesday Afternoon