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Blinded review as a method for quality improvement in surgical pathology
Andrew A Renshaw1, Nat E Pinnar, Michael R Jiroutek
1Department of Pathology, Baptist Hospital of Miami, Miami, FL 33176, USA. andrewr@bhssf.org
Context:
Several studies have shown that blinded review, because it is less biased and may improve vigilance, is an excellent method for detecting errors and improving performance in gynecologic cytology. The value of blinded review in surgical pathology is not known.
Objective:
To determine the value of blinded review in surgical pathology.
Methods:
Five hundred ninety-two biopsy cases were reviewed without knowledge of the original diagnosis or history, and the results were compared with those of the original diagnosis.
Results:
Complete agreement was obtained in 567 (96%) of 592 cases. The technique of blinded review of biopsy material had a sensitivity of 98%, failing to identify a lesion in 7 cases; no cases of malignancy were missed. The specificity was 100%. Differences in diagnostic threshold were the most common source of disagreement. False-negative cases were identified by the technique and were clinically significant. Power studies show that the number of cases requiring review to identify significant errors are large, but potentially achievable by blinded review.
Conclusion:
Blinded review is a sensitive and effective method for identifying areas of disagreement, including false-negative cases, and for decreasing errors in surgical pathology biopsy material.