Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel
Understanding diagnostic variability in breast pathology: lessons learned from an expert consensus review panel
复制标题
DOI：
10.1111/his.12387
复制
发表时间：
2014-08-01
期刊：
影响因子：
6.4
通讯作者：
Elmore, Joann G.
中科院分区：
文献类型：
--
作者：
Allison, Kimberly H.;Reisch, Lisa M.;Elmore, Joann G.
目的：为了更好地了解诊断变异的原因，以减少这种现象。方法和结果：在准备一项关于乳房标本解释(B-Path)的研究中，一个由三名经验丰富的乳房病理学家组成的小组回顾了336例病例，以形成一致的参考诊断。经过独立评估后，在协商一致会议上讨论被编码为诊断不一致的病例。通过使用定性数据分析技术，对201个病例子集的16小时共识会议的记录进行了分析。诊断可变性可归因于三个总体根源：(1)与病理学家有关；(2)与诊断编码/研究方法有关；(3)与标本有关。大多数与病理学家相关的根本原因可归因于病理学家对特定诊断的诊断标准是否得到满足的专业意见差异，最常见的是在非典型性病例中。与诊断编码/研究方法有关的根本原因主要是描述性文本诊断的错误分类，这导致了标准化电子诊断表(BPATH-Dx)的发展。与标本相关的根本原因包括伪影、有限的诊断材料和较差的幻灯片质量。结论：诊断变异性与多种因素有关，但可以采用共识会议、标准化的电子报告格式和对次优标本质量的评论来降低诊断变异性。
Aims: To gain a better understanding of the reasons for diagnostic variability, with the aim of reducing the phenomenon.Methods and results: In preparation for a study on the interpretation of breast specimens (B-PATH), a panel of three experienced breast pathologists reviewed 336 cases to develop consensus reference diagnoses. After independent assessment, cases coded as diagnostically discordant were discussed at consensus meetings. By the use of qualitative data analysis techniques, transcripts of 16 h of consensus meetings for a subset of 201 cases were analysed. Diagnostic variability could be attributed to three overall root causes: (i) pathologist-related; (ii) diagnostic coding/study methodology-related; and (iii) specimen-related. Most pathologist-related root causes were attributable to professional differences in pathologists' opinions about whether the diagnostic criteria for a specific diagnosis were met, most frequently in cases of atypia. Diagnostic coding/study methodology-related root causes were primarily miscategorizations of descriptive text diagnoses, which led to the development of a standardized electronic diagnostic form (BPATH-Dx). Specimen-related root causes included artefacts, limited diagnostic material, and poor slide quality. After re-review and discussion, a consensus diagnosis could be assigned in all cases.Conclusions: Diagnostic variability is related to multiple factors, but consensus conferences, standardized electronic reporting formats and comments on suboptimal specimen quality can be used to reduce diagnostic variability.