Second Opinion Diagnostic Discrepancy in Surgical Pathology: Asan Medical Center Experience

Kim, Young Min; Cho, Kyung Ja; Jun, Sun Young; Choe, Mi Sun; Khang, Shin Kwang; Ro, Jae Y

Abstract

BACKGROUND: Review of the outside pathology material is an important practice that provides useful information on patient managements and improves the diagnostic quality in surgical pathology. We report our experience with the frequency and types of diagnostic discrepancies in patients referred to the Asan Medical Center for treatment or a second opinion.
METHODS
All referral pathology diagnoses (867 surgical cases) made from October 2001 to July 2002 at Asan Medical Center were compared with outside pathology diagnoses.
RESULTS
Of the 867 surgical cases reviewed, 231 (26.7%) cases had a diagnostic discrepancy, which included 49 (5.7%) major and 182 (21.0%) minor discrepancies. The contents of the major discrepancies were a change in the diagnosis (34 cases), a change in the type of malignancy including small cell carcinoma and non-small cell carcinoma of the lung (10), a diagnosis of a metastasis as the primary lesion (4), and errors in interpreting the invasiveness (1). The causes or reasons for the major discrepancy were a difference in interpretation (81.6%), the availability of special studies (10.2%), a failure to identify the lesions (4.1%), and a lack of clinical information (4.1%).
CONCLUSIONS
The major discrepancy rate (5.7%) was comparable to that of the other reports from western countries. Among the major discrepancies, a change in diagnosis was most commonly observed and difference in interpretation was the most common reason. A routine review of all the patients pathology material is recommended for all referral patients for an improvement in the pathologic diagnoses and to provide better medical care.