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Assessing the value of second opinion pathology review
Ayesha Farooq1, Amrou Abdelkader2, Nino Javakhishivili3
1Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Lab Building, Lower Level, Room L69, Milwaukee, WI 53226, USA.
Summary
Pathology case reviews identified a 1% major discrepancy rate, leading to significant changes in patient management. This highlights the importance of second opinions in ensuring accurate diagnoses and appropriate care across various medical subspecialties.
Area of Science:
- Pathology
- Medical Diagnostics
- Patient Care
Background:
- Second opinion pathology case reviews are crucial for identifying diagnostic errors.
- These errors can significantly impact patient care and treatment decisions.
Purpose of the Study:
- To determine the rates of discrepancy in second opinion pathology cases.
- To assess the clinical impact of these discrepancies.
- To re-evaluate the policy of reviewing all second opinion cases.
Main Methods:
- A retrospective review of all second opinion pathology cases from 2018 was conducted.
- Cases were analyzed for discrepancies, involvement of multiple pathologists, and clinicopathologic features.
- Discordance was categorized into no significant discordance, major discordance without management change, and major discordance with management change.
Main Results:
- Out of 4239 cases, 3.7% showed major discordance without management change, and 1% had major discordance with a change in management.
- Discordance was significantly associated with multiple pathologist reviews (P < 0.001).
- Highest discordance rates were observed in thyroid fine needle aspiration (15.3%), bone/soft tissue biopsy (9.6%), and endocrine cases (8.8%).
Conclusions:
- A 1% rate of major discordance with significant clinical management changes was found across most subspecialties.
- The findings support reviewing outside pathology materials when a management change is possible, especially for major medical or surgical therapies.
