Variability of practice in anatomic pathology and its effect on patient outcomes

Area of Science:

• Medical practice variability
• Anatomic pathology testing
• Healthcare quality improvement

Background:

• Medical care heterogeneity exists across geographic, provider, institutional, and financial levels.
• Evidence-based clinical practice guidelines are inconsistently adopted to reduce variability.
• Anatomic pathology (AP) testing patterns show considerable inconsistency, affecting outcomes and costs.

Purpose of the Study:

• To highlight variability in anatomic pathology testing.
• To discuss the impact of diagnostic disagreement on patient care.
• To review methods for reducing interpretative variability in AP.

Main Methods:

• Investigated variability in AP testing, including preanalytic and analytic phases.
• Reviewed existing practice guidelines based on "expert" opinion.
• Examined studies measuring interpretative variability using the "kappa statistic."

Main Results:

• Test variability in AP occurs in preanalytic (clinician-dependent) and analytic phases (specimen handling, reporting).
• Existing AP practice guidelines often rely on weak "expert" opinion evidence.
• Few studies have assessed the impact of diagnostic disagreement on patient care or proposed solutions.

Conclusions:

• Inconsistent testing and interpretation in anatomic pathology contribute to suboptimal patient outcomes and increased healthcare costs.
• Current practice guidelines in AP often lack robust evidence.
• More research is needed on the clinical impact of diagnostic disagreement and effective methods to reduce interpretative variability.