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The effect of interinstitution anatomic pathology consultation on patient care
1Department of Pathology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
Insights
Routine anatomic pathology consultations changed patient evaluation or treatment in 5.8% of cases. This diagnostic review offers valuable insights for improving patient care, especially when discrepancies arise.
Area of Science:
- Pathology
- Medical Diagnostics
- Patient Care
Background:
- Interinstitution anatomic pathology consultations are crucial for diagnostic accuracy.
- Reviewing external pathology diagnoses can impact patient management.
- Understanding the impact of these consultations is vital for healthcare quality improvement.
Purpose of the Study:
- To evaluate the effect of routine interinstitution anatomic pathology consultation on patient diagnosis and treatment.
- To quantify the frequency of diagnostic discrepancies and their clinical significance.
Main Methods:
- Compared 777 interinstitution anatomic pathology consultation diagnoses with original diagnoses over one year.
- Assessed changes in patient therapy or medical evaluation for discrepant cases after a one-year follow-up.
- Analyzed diagnostic concordance rates between cytology/fine-needle aspiration and surgical pathology specimens.
Main Results:
- Identified 71 (9.1%) discrepant diagnoses among 777 consultations.
- Therapy or clinical evaluation changed in 45 (63%) of discrepant cases.
- Discordant diagnoses were significantly higher in cytology/fine-needle aspiration (21%) versus surgical pathology (7.8%).
Conclusions:
- Routine interinstitution anatomic pathology consultation altered patient evaluation or treatment in 5.8% of reviewed cases.
- The consultation process provides beneficial diagnostic information, potentially improving patient care.
- Further evaluation is recommended when diagnostic discrepancies are identified to ensure optimal patient outcomes.
Objective:
To determine the effect of routine interinstitution anatomic pathology consultation on patient evaluation and treatment.
Design:
All interinstitution anatomic pathology consultation diagnoses made during a 1-year period were compared with the original pathologic diagnoses. Patients with discrepant diagnoses were evaluated after an interval of 1 year to determine the correct clinical diagnosis. The relevance of the pathologic consultation to furthering medical evaluation and treatment was determined from a review of the medical record and when necessary from consultation with the patient's physician.
Setting:
Patients referred to a university hospital.
Main Outcome Measures:
We determined the number of patients with discrepant pathologic diagnoses and whether these diagnoses changed the planned surgical procedure, chemotherapy, radiation therapy, or medical evaluation.
Results:
Seventy-one (9.1%) discrepant diagnoses were identified among the 777 patients. Of these 71 patients, 45 (63%) demonstrated a change in therapy or clinical evaluation as a result of the interinstitution anatomic pathology consultation. In five of these patients the consultation diagnosis was in error. There was a significantly greater percentage of discordant diagnoses among the cytology and fine-needle aspiration biopsies (21%) as compared with the surgical pathology specimens (7.8%; P < .001).
Conclusions:
Routine interinstitution anatomic pathology consultation resulted in a change in patient evaluation or treatment in 45 (5.8%) of the 777 cases reviewed. Our interinstitution anatomic pathology consultation policy appears to provide useful diagnostic information, which should contribute to improved patient care. However, when a discrepancy is identified, additional consultation or evaluation should be considered.