Clinical impact and frequency of anatomic pathology errors in cancer diagnoses
Clinical impact and frequency of anatomic pathology errors in cancer diagnoses
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DOI：
10.1002/cncr.21431
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发表时间：
2005-11-15
期刊：
影响因子：
6.2
通讯作者：
Geyer, SJ
中科院分区：
文献类型：
--
作者：
Raab, SS;Grzybicki, DM;Geyer, SJ
背景。据作者所知，到目前为止，癌症解剖病理诊断错误的频率和临床影响已经被汇总和表征。作者检查了在四家医院进行解剖病理学检查以确定是否存在癌症或癌前病变的患者的错误。他们分析了通过标准化细胞学-组织学相关过程（其中比较患者同一部位的细胞学和组织学标本）检测到的1年回顾性错误。进行医疗记录审查以确定患者的预后。作者还测量了机构频率、原因（即病理学家解释或抽样）和诊断癌症错误的临床影响。发现癌症诊断的错误率与机构有关（P < 0.001），在所有相关妇科和非妇科病例中分别为1.79-9.42%和4.87-11.8%。制度与错误原因有统计学显著相关（P < 0.001）；病理误读导致的错误占5.0% ~ 50.7%（其余为临床抽样）。在制度和临床错误影响分配之间发现有统计学意义的关联（P < 0.001）；汇总数据表明，对于妇科和非妇科的错误，分别有45%和39%与伤害相关。观察者间一致性和误差原因的两两kappa统计量范围为0.118 ~ 0.737。据报道，在所有已审查的细胞学-组织学标本对中，癌症诊断错误发生率高达11.8%。就作者所知，关于病理错误是否继发于对组织的误解或临床取样不当，以及病理错误是否会导致严重伤害，目前还没有达成一致意见。
BACKGROUND. To the authors' knowledge, the frequency and clinical impact of errors in the anatomic pathology diagnosis of cancer have been pool-IN, characterized to date.METHODS. The authors examined errors in patients who underwent anatomic pathology tests to determine the presence or absence of cancer or precancerous lesions in four hospitals. They analyzed 1 year of retrospective errors detected through a standardized cytologic-histologic correlation process (in which patient same-site cytologic and histologic specimens were compared). Medical record reviews were performed to determine patient outcomes. The authors also measured the institutional frequency, cause (i.e., pathologist interpretation or sampling), and clinical impact of diagnostic cancer errors.RESULTS. The frequency of errors in cancer diagnosis was found to be dependent on the institution (P < 0.001) and ranged from 1.79-9.42% and from 4.87-11.8% of all correlated gynecologic and nongynecologic cases, respectively. A statistically significant association Was found between institution and error Cause (P < 0.001); the Cause of errors resulting from pathologic misinterpretation ranged front 5.0-50.7% (the remainder were due to clinical sampling). A statistically significant association was found between institution and assignment of the clinical impact of error (P < 0.001); the aggregated data demonstrated that for gynecologic and nongynecologic errors, 45% and 39%, respectively, were associated with harm. The pairwise kappa statistic for interobserver agreement oil cause of error ranged from 0.118-0.737.CONCLUSIONS. Errors in cancer diagnosis are reported to Occur in up to 11.8% of all reviewed cytologic-histologic specimen pairs. To the authors' knowledge, little agreement exists regarding whether pathology errors are secondary to misinterpretation or poor clinical sampling Of tissues and whether pathology errors result in serious harm.