[Quality management in histopathology. "From biopsy to diagnosis"]

The University Institute of Pathology (IUP), Lausanne, has established a system designed to continuously document and manage the quality of its diagnostic activity in surgical pathology. To realize the system a few tools were created. Several "free codes" were introduced into the general computer system in order to register and evaluate (1) the quality of frozen section diagnoses, (2) the relevance of the use of this type of examination and (3) the frequency of spontaneous "official" internal consultations in search of a second opinion. Further, an evaluation checklist including all steps leading to the diagnosis (some of which were facultative*) was established. Eleven items were evaluated and registered in this way: quality of slides and staining, reporting time, selection of tissue blocks*, macro- and microscopic descriptions*, appropriateness of special stains and/or techniques and their quality*, final diagnosis, accuracy of codes for invoicing and diagnoses, quality of the final report. The relevance of the furnished clinical data was also evaluated and recorded.

Of all registered frozen section examinations (397), 86.6% showed identity of provisional and definitive diagnoses. In 11.6% of cases there was a difference between the two diagnoses without clinical relevance, and in 1.8% the discrepancy was clinically significant. These percentages are comparable with those published in the literature. Internal consultation for second opinion is a current habit in our institution, and 980 cases (4%) were registered as such. Among the 25,249 cases received for histopathological examination during 1998 (each case may concern more than one specimen from the same patient), 495 (2% = 2-3 cases/day) were evaluated in detail by two reviewers throughout the year. The statistical results obtained demonstrate that our diagnostic performance in histopathology is very satisfactory: 43% of the analysed cases bear no deficit and 67.3% present two or less points in deficit; no diagnostic error was evidenced; 70% of the reports are signed-out within 3 days after reception of the material (mean delay < 3 days).

The adopted system represents an excellent tool by which to continuously document and manage the quality of our diagnostic performances. It is reliable, efficient, sensitive and also feasible, as it does not require significant or exaggerated additional investments. The results obtained after one year confirm the high quality of the IUP's diagnostic activity.