How do surgical pathologists evaluate critical diagnoses (critical values)?

After introduction of the concept of critical value (CV) in laboratory medicine, some efforts were performed to define possible critical values in surgical pathology. Critical diagnosis (critical value) is a concept recently established in surgical pathology and is a challenging issue among pathologists and clinical specialists. The concept may be the subject of variation according to the geographical or work setting differences. The current study was performed to bring the contribution of the Iranian pathologists to the evolving concept of critical diagnoses (critical values) in surgical pathology.

During annual meeting of Iranian Pathologist Society, November 2006, Tehran, Iran, anonymous questionnaires were distributed among participants. They were requested to openly name conditions in which a pathologist should communicate the results immediately with clinicians.

147 pathologists completed the questionnaire. They were varied in their level of experience and setting of workplace. Each participant referred to 1-7 (mean 3) conditions as CV. About 90 different conditions which were considered as CV by participants were extracted from the questionnaires.

The list of conditions obtained through this survey as CVs in surgical pathology covered most items previously described in literature. Major differences are low number (or lack) of refers to some relatively routine and potentially important conditions and considering many unimportant conditions as CV by participants of present survey. Almost all conducted surveys have been performed on this issue so far (including the present survey) suffer from lack of supportive scientific evidences and based mainly on experience and common sense of participants in survey. Potential problems with application of CV concept in daily routine work flow of pathology, particularly in developing countries like Iran, were discussed.