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Frozen section diagnosis: is there discordance between what pathologists say and what surgeons hear?
Somak Roy1, Anil V Parwani, Rajiv Dhir
1Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. roys@upmc.edu
Objectives:
Communication in various medical settings is subject to misinterpretation. The frozen section (FS) diagnosis in patient care is dependent on successful communication between pathologists and surgeons. However, very few studies looking at FS errors analyzed postanalytic communication issues.
Methods:
A total of 300 consecutive cases, in which an FS was performed and corresponding surgical note was available, were studied. The FS diagnosis and surgeon's interpretation were recorded for all cases. Discrepancies were classified as major (clinical impact) or minor (no clinical impact).
Results:
We found 8 (2.7%) miscommunications, all with only minor clinical impact. These were attributed mainly to the surgeon's misinterpretation of a deferred diagnosis. Also contributing to miscommunication was the pathologist's use of nonspecific terminology such as "favor" or "scattered."
Conclusions:
We found that the rate of miscommunicated FS diagnoses was low at our institution during the period of our study. However, the rate of miscommunication was similar to the much more widely recognized problem of sampling error.
Insights
Miscommunication in frozen section (FS) diagnoses between pathologists and surgeons is infrequent, with most errors stemming from surgeon misinterpretation or vague pathologist language. This study highlights a low rate of FS miscommunication, comparable to sampling errors.
Area of Science:
- Pathology
- Surgical Oncology
- Medical Communication
Background:
- Effective communication between pathologists and surgeons is crucial for accurate frozen section (FS) diagnosis and patient care.
- Misinterpretations in medical communication can lead to significant patient harm, yet postanalytic communication issues in FS are understudied.
Purpose of the Study:
- To investigate the frequency and nature of miscommunication in frozen section diagnoses.
- To identify factors contributing to miscommunication between pathologists and surgeons regarding FS results.
Main Methods:
- A retrospective review of 300 consecutive cases with available FS and surgical notes was conducted.
- FS diagnoses and surgeon interpretations were recorded, and discrepancies were classified as major or minor based on clinical impact.
Main Results:
- A total of 8 (2.7%) miscommunications were identified, all with minor clinical impact.
- The primary cause was surgeon misinterpretation of deferred diagnoses.
- Pathologist use of nonspecific terms like "favor" or "scattered" also contributed to miscommunication.
Conclusions:
- The rate of miscommunicated FS diagnoses at this institution was low.
- The incidence of FS miscommunication was comparable to the recognized issue of sampling error.
- Improving communication clarity and surgeon interpretation of FS results remains important.
