The clinicopathological meeting. A means of auditing diagnostic performance

The clinicopathological meeting is one of the major areas of contact between clinician and pathologist, and the review of histology reports at such meetings can be regarded as an aspect of quality control for diagnostic pathology. To assess the effects of this review, we have conducted a formal analysis of clinicopathological meetings in the Southampton University Hospitals. Over a 14-week period, 416 cases were reviewed at 58 meetings. Seven categories of meeting were involved; Breast; Dermatology; Ear, Nose, and Throat (ENT) and Oral Surgery; Gastroenterology; General Surgery; Oncology; and Urology. A proforma was completed for each case that was reviewed, evaluating changes in diagnosis, the reason for such changes, and the effect, if any, on patient management. Participating consultants, both clinicians and pathologists, were questioned regarding the aims of their particular meeting, and how successful they felt the meeting to be. Histological review resulted in an altered diagnosis in 9% of cases, a refined diagnosis in 10% of cases, and no diagnostic change in 81%. Most (88.1%) of the diagnostic changes were attributable to the specialist expertise of the reviewing pathologist, and only 4.8% resulted from the clinicians providing extra information. Amended diagnoses led to major management changes in 16 cases (3.8%), minor management changes in 12 cases (2.9%), and no management change in 388 cases (93.3%). The Gastroenterology meeting showed the highest figures for clinically significant diagnostic changes; there was an amended diagnosis in 44.2% of cases reviewed, 83.3% of which altered patient management. These figures were related to the specialist review of endoscopic biopsy specimens. Although the variation in the methods used to select cases for review and the different roles of individual meetings prevent their adoption into a formal systematic audit scheme, analysis of case review at clinicopathological meetings can yield valuable information concerning departmental diagnostic performance.