In-house daily consensus conference: an important quality control/quality assurance activity--experience at a major...

For every practicing histopathologist, improvement of diagnostic accuracy is an important objective. Personal consults are an important component of quality control (QC)/quality assurance (QA) in our Section of Histopathology. In addition, the College of American Pathologists recommends a daily in-house consensus conference, which is a prospective system by which all difficult and problematic cases are reviewed and discussed and signed out by consensus.

In-house consensus conference is held daily using a multi-headed microscope. This collegial session is run by the seniormost consultant in the section and is attended by all histopathology consultants and residents. The consultants and residents present cases of their choice for discussion. The cases may be selected due to diagnostic difficulty, unusual nature of a case, management purposes such as performance of additional biopsies, special studies, etc., or request on the part of clinician or patient. Cases may be shown once or, in case of lack of consensus or difficulty in diagnosis, more than once after additional work-up suggested by the conference.

In a 4-month period, 774 (4.1%) cases of a total of over 14,000 well-mixed surgical cases were brought to the in-house daily consultation conference. Four hundred ninety-three cases (63.7%) were conclusively decided the first time while 198 cases (25.5%) were decided by consensus after being shown twice. In 83 cases (10.7%), a definite diagnosis could not be given. The cases on which a definite diagnosis was not possible represents 0.59% of all cases received in the department during the study period. The most common cases were shown from the gastrointestinal tract (115 cases or 14.8%), lymph nodes (110 cases or 14.2%) and soft tissue (82 cases or 10.6%). In most cases in which a definite diagnosis could not be given, the main reason was scanty material or crushed nature of the tissue.

The in-house daily consensus conference is an extremely useful QC/QA exercise, which is very important in reaching an accurate diagnosis in difficult and challenging cases and minimizing diagnostic errors.