Discrepancies in dermatopathology diagnoses: The role of second review policies and dermatopathology fellowship training
Discrepancies in dermatopathology diagnoses: The role of second review policies and dermatopathology fellowship training
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DOI：
10.1016/j.jaad.2012.06.034
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发表时间：
2013-01-01
影响因子：
13.8
通讯作者：
Jukic, Drazen M.
中科院分区：
文献类型：
--
作者：
Gaudi, Sudeep;Zarandona, J. Manuel;Jukic, Drazen M.
背景资料：专家咨询和机构的政策，要求第二次审查的病理诊断过程中的转介一直提倡优化patientcare.Objective：我们试图调查的病理学家与没有皮肤病理学奖学金training.Methods之间的诊断差异率：所有可用的外部病理报告进行了审查的材料发送到匹兹堡大学医学中心皮肤病理学单位在1年。将外部诊断与转诊皮肤病理学服务提供的诊断进行比较。病例分为4类之一：黑素细胞肿瘤、非黑素细胞肿瘤、炎性和其他。对于每例病例，记录外部病理学家的皮肤病理学培训水平。任何诊断的变化，导致治疗或预后的显着改变，由公认的护理标准，被认为是一个重大的discrimination.Results：共405例进行了审查。在51例（13%）中，外部设施未作出初步诊断。226例（56%）转诊诊断与外部诊断不同，91例（22%）发现重大差异。在这91例病例中，84例来自未接受皮肤病理学培训的外部病理学家，7例来自接受过皮肤病理学培训的病理学家。91例存在重大差异的病例被分类为：36例非黑素细胞肿瘤（40%）、30例炎症性肿瘤（33%）、23例黑素细胞肿瘤（25%）和2例其他肿瘤（2%）。局限性：这是一项回顾性研究，仅限于学术转诊中心的2名皮肤病理学家顾问，该中心通常接收和审查选定的病例。结论：皮肤病理学奖学金培训与重大诊断差异的大幅减少有关。没有接受过皮肤病理学奖学金培训的病理学家往往会成功地确定那些专家咨询最有用的病例。（J Am Acad Dermatol 2013;68：119-28.）
Background: Expert consultation and institutional policies mandating second review of pathologic diagnoses in the course of referral have been advocated to optimize patient care.Objective: We sought to investigate the rate of diagnostic discrepancies between pathologists with and without dermatopathology fellowship training.Methods: All available outside pathology reports were reviewed for material sent to the University of Pittsburgh Medical Center Dermatopathology Unit during 1 year. The outside diagnosis was compared with the diagnosis rendered by the referral dermatopathology service. Cases were assigned into 1 of 4 categories: melanocytic neoplasm, nonmelanocytic neoplasm, inflammatory, and other. For each case, the outside pathologist's level of dermatopathology training was noted. Any change in diagnosis resulting in significant alteration in therapy or prognosis, as dictated by the accepted standard of care, was considered a major discrepancy.Results: A total of 405 cases were reviewed. In 51 cases (13%), no preliminary diagnosis was rendered at the outside facility. The referral diagnosis differed from the outside diagnosis in 226 cases (56%), and major discrepancies were identified in 91 cases (22%). Of these 91 cases, 84 were received from outside pathologists who were not dermatopathology trained and 7 were received from pathologists with dermatopathology training. The 91 cases with major discrepancies were categorized as: 36 nonmelanocytic neoplasms (40%), 30 inflammatory (33%), 23 melanocytic neoplasms (25%), and 2 other (2%).Limitations: This was a retrospective study limited to 2 consultant dermatopathologists at an academic referral center, which typically receives and reviews select cases.Conclusion: Dermatopathology fellowship training is associated with a substantial decrease in major diagnostic discrepancies. Pathologists without dermatopathology fellowship training tend to successfully identify those cases for which expert consultation is most useful. (J Am Acad Dermatol 2013;68:119-28.)