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Mandatory second opinion in cytopathology.

Nathan Lueck¹, Chris Jensen, Michael B Cohen

¹Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.

|May 26, 2009

Summary

Mandatory second opinion cytology reviews are crucial for detecting significant interpretive errors. This study found that while major disagreements occurred in 7.4% of cases, they often led to improved diagnoses and clinical management changes, supporting the value of this practice in patient care.

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Area of Science:

Pathology
Cytopathology
Medical Diagnostics

Background:

Mandatory review of outside pathologic material aims to identify clinically significant interpretive errors.
University of Iowa Carver College of Medicine requires review of outside pathology before definitive treatment for referred patients.
This study evaluated the measurable impact of this local practice on patient care.

Purpose of the Study:

To determine if the mandatory review of outside pathologic material has a measurable impact on patient care.
To assess the frequency and clinical significance of diagnostic disagreements in second opinion cytology.

Main Methods:

Reviewed 499 second opinion cytology cases from the University of Iowa Carver College of Medicine.
Classified second opinions as "no diagnostic disagreement," "minor disagreement," or "major disagreement."

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Determined clinical impact of major disagreement cases through pathologic and clinical follow-up.

Main Results:

Major diagnostic disagreements occurred in 37 cases (7.4%).
In 30 major disagreement cases with follow-up, the second opinion diagnosis was better supported in 22 cases.
Six major disagreement cases prompted changes in clinical management.

Conclusions:

Major disagreements in second opinion cytology are common, reflecting interpretation challenges.
Mandatory second opinions prompted clinical management changes in 1.2% of cases, similar to surgical pathology.
These findings support mandatory second opinion policies as an important component of patient care.