Should pathologists send all or only selected slides for patient-requested interlaboratory second opinion?

Area of Science:

• Pathology
• Interlaboratory Diagnostics
• Medical Second Opinions

Background:

• Determining the optimal approach for slide submission in interlaboratory second opinions is crucial for diagnostic accuracy.
• The practice of sending all or selected slides for second opinions is not standardized, leading to uncertainty.

Purpose of the Study:

• To compare the disagreement rates between sending all slides versus selected slides for interlaboratory second opinions.
• To evaluate the impact of slide selection strategy on diagnostic concordance in pathology reviews.

Main Methods:

• A retrospective analysis of 596 interlaboratory second opinion cases over 5 years (4 years selected slides, 1 year all slides).
• Comparison of disagreement rates between the two slide submission strategies.
• Analysis of specific cases contributing to disagreements.

Main Results:

• A lower disagreement rate was observed when sending selected slides (12%) compared to sending all slides (18%) (P = .03).
• Only 5 cases showed disagreement directly related to the method of slide submission (selected vs. all).
• Disagreements when sending all slides included errors in node counts and missed diagnoses like microinvasive ductal carcinoma and ductal carcinoma in situ (DCIS).

Conclusions:

• Sending all slides for pathology second opinions is associated with a higher disagreement rate than sending selected slides.
• While sending all slides may correct some errors, it also introduces new ones, potentially impacting patient care.
• Optimizing slide selection for second opinions may enhance diagnostic accuracy and reduce interlaboratory discrepancies.