The Diagnostic Black Box: Successful Integration and Performance Validation of Pathologists Using New Lung Non-Small Cell Carcinoma Classification Recommendations
Michael E Stevenson, Paari Murugan, Lewis A Hassell. University of Oklahoma Health Sciences Center, Oklahoma City, OK
Background: The proposed IASL/ATS/ERSIM classification of lung adenocarcinoma presents a paradigm shift for diagnostic pathologists. We sought to validate our ability to apply the new classification recommendations in reporting of non-small cell lung cancer (NSCLC) cases.
Design: A test based on the new NSCLC classification recommendations was administered to 14 pathology faculty members and senior residents or fellows prior to and after major educational interventions, which included circulation of articles, electronic presentations, and live presentations by a prominent pulmonary pathologist. Surgical and cytologic (including cell block material) reports of lung malignancies for representative periods prior and subsequent to the educational interventions were reviewed for compliance with the new recommendations. Cases were scored on a three point scale with 1 indicating incorrect terminology and/or highly inappropriate stain utilization; 2 indicating correct diagnostic terminology with suboptimal stain utilization; and 3 indicating appropriate diagnosis and stain utilization. Error type was also evaluated.
Results: The initial testing average correct score was 62%, increasing to 88% following the educational interventions (42% improvement). Of the 54 reports evaluated pre-intervention 15 were scored 3/3 (28% of total reports), 31 were scored 2/3 (57%), and 7 were scored 1/3 (13%). Incorrect use of stains was noted in 23 of 54 cases (43%), incorrect terminology in 15 of 54 cases (28%), and molecular testing errors in 4 out of 54 cases (7%). Of 34 cases in the post-intervention group, 27 were scored 3/3 (79% of cases), 6 were scored 2/3 (18%), and 1 was scored 1/3 (3%). Incorrect use of stains was the only error identified (7 out of 34 cases, representing 21% of total reports).
Conclusions: The study results demonstrate marked improvement in participants' understanding and application of the new NSCLC classification recommendations sufficient to validate our use of the system in routine practice. The results also affirm the value of intensive education for validation of new classification or diagnostic algorithms.
Category: Quality Assurance
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 302, Monday Morning