Document Detail

Mandatory second opinion in cytopathology.
MedLine Citation:
PMID:  19466754     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Mandatory review of outside pathologic material is intended to detect interpretive errors that may have a clinically significant impact on patient care. Prior to definitive treatment of referred patients, the University of Iowa Carver College of Medicine requires a review of pertinent pathologic material previously obtained at outside institutions. The aims of this study were to determine if this local standard of practice has a measurable impact on patient care.
METHODS: The pathologic diagnoses of 499 second opinion cytology cases seen at the University of Iowa Carver College of Medicine were studied. Each second opinion was classified as "no diagnostic disagreement", "minor disagreement", or "major disagreement" with respect to the originating institution's interpretation. The clinical impact of major disagreement cases was determined by pathologic and clinical follow-up via chart review.
RESULTS: Second opinion cytology resulted in 37 cases (7.4% of total cases) with major diagnostic disagreements. Clinical and pathologic follow-up was available in 30 of the major disagreement cases; second opinion diagnosis was better supported in 22 of these cases compared to the outside diagnosis. The second opinion in 6 major disagreement cases prompted changes in clinical management.
CONCLUSIONS: Major disagreements in second opinion cytology are common, likely reflective of the challenges inherent in the interpretation of cytologic specimens. Although mandatory second opinion of outside cytologic material prompted changes in clinical management in only a small fraction of cases (1.2%), this rate was similar to those previously published for surgical pathology second opinion. These findings support the notion that mandatory second opinion policy as an important part of patient care.
Nathan Lueck; Chris Jensen; Michael B Cohen; Jamie A Weydert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cancer     Volume:  117     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-06-23     Revised Date:  2011-02-14    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-91     Citation Subset:  IM    
Copyright Information:
(c) 2009 American Cancer Society.
Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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MeSH Terms
Academic Medical Centers
Diagnosis, Differential
Diagnostic Errors / prevention & control*
Follow-Up Studies
Neoplasm Staging / methods
Neoplasms / diagnosis*,  therapy
Pathology, Clinical / methods*
Referral and Consultation*

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