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Lozada WA, Enokihara MM, Pedrosa MS, Gonzaga AL, Wainstein AJ, Drummond-Lage AP. Impact of second histopathological review of melanocytic skin lesions at a melanoma reference center in Brazil. Ital J Dermatol Venerol 2023; 158:49-54. [PMID: 36800805 DOI: 10.23736/s2784-8671.23.07494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND After the biopsy of a suspicious melanocytic lesion, patients depend on the pathologist's precision of specimen evaluation. METHODS We assessed the agreement between histopathological reports made by general pathologists and reviewed by a dermatopathologist to evaluate the impact on the patient's management. RESULTS In 79 cases analyzed, underdiagnosis was observed in 21.6% and overdiagnosis in 17.7%, resulting in changes in the patients' conduct. The assessment of the Clark level, ulceration and histological type showed mild agreement (P<0.001); the Breslow thickness, surgical margin, and staging showed moderate agreement (P<0.001). CONCLUSIONS A dermatopathologist's review should be incorporated into the routine of reference services for pigmented lesions.
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Affiliation(s)
- Walter A Lozada
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Milvia M Enokihara
- Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Moises S Pedrosa
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Ana L Gonzaga
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Alberto J Wainstein
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | - Ana P Drummond-Lage
- Department of Post-Graduation, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil -
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Tizhoosh HR, Diamandis P, Campbell CJV, Safarpoor A, Kalra S, Maleki D, Riasatian A, Babaie M. Searching Images for Consensus: Can AI Remove Observer Variability in Pathology? THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1702-1708. [PMID: 33636179 DOI: 10.1016/j.ajpath.2021.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
One of the major obstacles in reaching diagnostic consensus is observer variability. With the recent success of artificial intelligence, particularly the deep networks, the question emerges as to whether the fundamental challenge of diagnostic imaging can now be resolved. This article briefly reviews the problem and how eventually both supervised and unsupervised AI technologies could help to overcome it.
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Affiliation(s)
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Clinton J V Campbell
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Amir Safarpoor
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
| | - Shivam Kalra
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
| | - Danial Maleki
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
| | | | - Morteza Babaie
- Kimia Laboratory, University of Waterloo, Waterloo, Canada
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Lopez-Beltran A, Canas-Marques R, Cheng L, Montironi R. Histopathologic challenges: The second OPINION issue. Eur J Surg Oncol 2018; 45:12-15. [PMID: 30360986 DOI: 10.1016/j.ejso.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/06/2018] [Indexed: 01/12/2023] Open
Abstract
Classification and definition criteria for rare cancer is still an open issue in clinical practice due to several factors, which include the limited available molecular data to better defining specific tumor groups or "families" of interest. An important issue related to the proper management of these entities is the correct diagnosis and subtyping of a given entity. The high complexity associated with the histopathologic diagnosis and eventual molecular analysis may suggest the use of a histopathologic second opinion from a specialized pathologist. Diagnostic inaccuracies and difference between primary diagnosis and second opinion are expected at the population level: however, the magnitude of this difference is remarkably high and calls for implementation of second opinion in routine practice outside reference centers.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Surgery and Pathology, University of Cordoba Medical School, Cordoba, Spain; Champalimaud Clinical Center, Lisbon, Portugal.
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Rodolfo Montironi
- Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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Hui TH, Zhou ZL, Fong HW, Ngan RKC, Lee TY, Au JSK, Ngan AHW, Yip TTC, Lin Y. Characterizing the malignancy and drug resistance of cancer cells from their membrane resealing response. Sci Rep 2016; 6:26692. [PMID: 27225309 PMCID: PMC4880901 DOI: 10.1038/srep26692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/06/2016] [Indexed: 11/08/2022] Open
Abstract
In this report, we showed that two tumor cell characteristics, namely the malignancy and drug-resistance status can be evaluated by their membrane resealing response. Specifically, membrane pores in a number of pairs of cancer and normal cell lines originated from nasopharynx, lung and intestine were introduced by nano-mechanical puncturing. Interestingly, such nanometer-sized holes in tumor cells can reseal ~2-3 times faster than those in the corresponding normal cells. Furthermore, the membrane resealing time in cancer cell lines exhibiting resistance to several leading chemotherapeutic drugs was also found to be substantially shorter than that in their drug-sensitive counterparts, demonstrating the potential of using this quantity as a novel marker for future cancer diagnosis and drug resistance detection. Finally, a simple model was proposed to explain the observed resealing dynamics of cells which suggested that the distinct response exhibited by normal, tumor and drug resistant cells is likely due to the different tension levels in their lipid membranes, a conclusion that is also supported by direct cortical tension measurement.
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Affiliation(s)
- T. H. Hui
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
- HKU-Shenzhen Institute of Research and Innovation (HKU-SIRI), Shenzhen, Guangdong, China
| | - Z. L. Zhou
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - H. W. Fong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Roger K. C. Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - T. Y. Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Joseph S. K. Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - A. H. W. Ngan
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Timothy T. C. Yip
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Y. Lin
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
- HKU-Shenzhen Institute of Research and Innovation (HKU-SIRI), Shenzhen, Guangdong, China
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Soofi Y, Khoury T. Inter-Institutional Pathology Consultation: The Importance of Breast Pathology Subspecialization in a Setting of Tertiary Cancer Center. Breast J 2015; 21:337-44. [DOI: 10.1111/tbj.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yousef Soofi
- Department of Pathology; Roswell Park Cancer Institute; Buffalo New York
| | - Thaer Khoury
- Department of Pathology; Roswell Park Cancer Institute; Buffalo New York
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Medicolegal Issues with Regard to Melanoma and Pigmented Lesions in Dermatopathology. Dermatol Clin 2012; 30:593-615, v-vi. [DOI: 10.1016/j.det.2012.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Pignol JP, Rakovitch E, Zeppieri J, Hanna W. Accuracy and Completeness of Pathology Reporting — Impact on Partial Breast Irradiation Eligibility. Clin Oncol (R Coll Radiol) 2012; 24:177-82. [DOI: 10.1016/j.clon.2011.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
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Palmieri B, Iannitti T. The Web Babel syndrome. PATIENT EDUCATION AND COUNSELING 2011; 85:331-333. [PMID: 21450437 DOI: 10.1016/j.pec.2011.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 05/30/2023]
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Santillan AA, Messina JL, Marzban SS, Crespo G, Sondak VK, Zager JS. Pathology Review of Thin Melanoma and Melanoma in Situ in a Multidisciplinary Melanoma Clinic: Impact on Treatment Decisions. J Clin Oncol 2010; 28:481-6. [DOI: 10.1200/jco.2009.24.7734] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Patients with thin melanoma (≤ 1.0 mm) and melanoma in situ (MIS) represent the majority of newly diagnosed melanoma. We estimated the impact of expert review of outside pathology material on the staging and thus treatment decisions affecting patients referred to a multidisciplinary clinic with early-stage melanoma. Patients and Methods We studied patients with a diagnosis of thin melanoma or MIS referred to H. Lee Moffitt Cancer Center from 2006 to 2009. After comparing the referring laboratory and in-house dermatopathologic interpretations, we calculated any differences in diagnosis and tumor staging and the potential impact of differences in diagnosis and staging on prognosis and surgical treatment using the National Comprehensive Cancer Network clinical guidelines. Results The overall pathologic discordance rate in diagnosis was 4% (15 of 420 patients; 95% CI, 2% to 6%). The overall change in tumor staging rate was 24% (97 of 405 patients; 95% CI, 20% to 28%). Pathology review led to changes in surgical excision margins in 12% of patients (52 of 420 patients; 95% CI, 9% to 16%) and in the decision about whether to perform a sentinel lymph node biopsy in 16% of patients (67 of 420 patients; 95% CI, 13% to 20%). Key pathologic factors, particularly mitotic rate, were frequently missing from outside pathology reports. Conclusion Our data suggest that review of thin melanoma or MIS by an expert dermatopathologist results in frequent, clinically meaningful alterations in diagnosis, staging, prognosis, and surgical treatment. Referral of these patients to a multidisciplinary melanoma clinic is appropriate, and management of such patients should include review of the biopsy whenever feasible.
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Affiliation(s)
- Alfredo A. Santillan
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Jane L. Messina
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Suroosh S. Marzban
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Gema Crespo
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Vernon K. Sondak
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Jonathan S. Zager
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
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10
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High WA. Malpractice in Dermatopathology—Principles, Risk Mitigation, and Opportunities for Improved Care for the Histologic Diagnosis of Melanoma and Pigmented Lesions. Clin Lab Med 2008; 28:261-84, vii. [DOI: 10.1016/j.cll.2007.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pawlik TM, Laheru D, Hruban RH, Coleman J, Wolfgang CL, Campbell K, Ali S, Fishman EK, Schulick RD, Herman JM. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol 2008; 15:2081-8. [PMID: 18461404 DOI: 10.1245/s10434-008-9929-7] [Citation(s) in RCA: 201] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 03/26/2008] [Accepted: 03/27/2008] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the impact of a multidisciplinary clinic on the clinical care recommendations of patients with pancreatic cancer compared with the recommendations the patients received prior to review by the multidisciplinary tumor board. METHODS The records of 203 consecutive patients referred to the Johns Hopkins pancreatic multidisciplinary clinic were prospectively collected from November 2006 to October 2007. Cross-sectional imaging, pathology, and medical history were evaluated by a panel of medical/radiation oncologists, surgical oncologists, pathologists, diagnostic radiologists, and geneticists. Alterations in treatment recommendations between the outside institution and the multidisciplinary clinic were recorded and compared. RESULTS On presentation, the outside computed tomography (CT) report described locally advanced/unresectable disease (34.9%), metastatic disease (17.7%), and locally advanced disease with metastasis (1.1%). On review of submitted imaging and imaging performed at Hopkins, 38 out of 203 (18.7%) patients had a change in the status of their clinical stage. Review of the histological slides by dedicated pancreatic pathologists resulted in changes in the interpretation for 7 of 203 patients (3.4%). Overall, 48 out of 203 (23.6%) patients had a change in their recommended management based on clinical review of their case by the multidisciplinary tumor board. Enrollment into the National Familial Pancreas Tumor Registry increased from 52 out of 106 (49.2%) patients in 2005 to 158 out of 203 (77.8%) with initiation of the multidisciplinary clinic. CONCLUSION The single-day pancreatic multidisciplinary clinic provided a comprehensive and coordinated evaluation of patients that led to changes in therapeutic recommendations in close to one-quarter of patients.
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Affiliation(s)
- Timothy M Pawlik
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA
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Leong ASY, Braye S, Bhagwandeen B. Diagnostic ‘errors’ in anatomical pathology: relevance to Australian laboratories. Pathology 2006; 38:490-7. [PMID: 17393975 DOI: 10.1080/00313020601032477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Failure to recognise that anatomical pathology diagnosis is a process of cognitive interpretation of the morphological features present in a small tissue sample has led to the public misperception that the process is infallible. The absence of a universally accepted definition of diagnostic error makes comparison of error rates impossible and one large study of laboratories in the United States shows a significant error rate of about 5%, most of which have no major impact on patient management. A recent review of the work of one pathologist in New South Wales confirms a lack of appreciation in medical administration that variable diagnostic thresholds result in an inherent fallibility of anatomical pathology diagnoses. The outcome of the review emphasises the need to educate both public and non-pathology colleagues of the nature of our work and brings into consideration the requirement to establish baseline error rates for Australian laboratories and the role of the Royal College of Pathologists of Australasia (RCPA) in developing fair and unbiased protocols for review of diagnostic errors. The responsibility of ensuring that diagnostic error rates are kept to the minimum is a shared one. Area health services must play their part by seeking to ensure that pathologists in any laboratory are not overworked and have adequate support and back-up from pathologists with expertise in specialised areas. It has been clearly enunciated by the Royal College of Pathologists in the United Kingdom that it is not safe for any histopathology service to be operated single-handedly by one histopathologist. Service managers and clinicians have to understand that country pathologists cannot provide the full range and depth of pathology expertise in the many clinical subspecialty areas that are often practised in non-metropolitan areas. Attending clinicians share the responsibility of accepting proffered pathology diagnoses only if it conforms to the clinical context. Pathology laboratories must continue to develop and maintain best-practice protocols and conduct periodic reviews of diagnosis, cytology-histology concordance, frozen section/permanent section correlations, conference reviews, intra and interdepartmental consultations, participate in external quality assurance programs and maintain ongoing education for all laboratory staff.
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Affiliation(s)
- Anthony S Y Leong
- Division of Anatomical Pathology, Hunter Area Pathology Service, Newcastle, New South Wales, Australia.
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Standards, Options et Recommandations 2004 pour une bonne pratique de la consultation personnelle et de la relecture en anatomie et cytologie pathologiques en cancérologie (rapport intégral). Ann Pathol 2005; 25:149-71. [PMID: 16142171 DOI: 10.1016/s0242-6498(05)86183-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONTEXT The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the French Federation of Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE To develop good practice guidelines for second opinion in anatomic and surgical pathology in oncology, in collaboration with the French Society for Anatomic and Surgical Pathology. METHOD The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs using the definitions of the Standards, Options and Recommendations project. Once the guideline has been defined, the document is submitted to independent reviewers for review. RESULTS The working group defined four types of second opinions in anatomic and surgical pathology: personal consultation, inter-institutional consultation, peer review consultation for a scientific survey, intra-departmental consultation in the context of quality control. The main recommendation is that second opinion should respect the patients' rights and the medical ethics code. For each of the four situations defined recommendations have been developed, taking this principle into consideration.
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Abstract
Sun Yat-Sen Cancer Center is the only cancer center in Taiwan. The hospital maintains a policy, and the division of oncology makes a concerted effort to obtain and review pertinent pathologic specimens in all patients who had pathologic diagnosis performed at other institution before rendering therapy. A 1-year retrospective study was undertaken to assess the frequency of discordant diagnosis of our second-opinion pathology slide review and determine its impact on patient care. Discrepancies were classified into four basic categories: A) no diagnostic disagreement; B) no diagnostic disagreement but pertinent information not included, such as tumor size, lymphovascular invasion, perineural invasion, histologic grading, margin status, extracapsular spread in metastatic lymph nodes; and C) major diagnostic disagreement, which was defined as follows; 1) change from benign to malignant, 2) change from malignant to benign, 3) a different type of neoplasm, and 4) change in N and M classification in TMN staging framework. Of 715 cases, a total of 673 (94%) showed no discrepancy. However, 35 of 673 (5.2%) cases failed to offer pertinent information (category B). Major disagreement was found in 42 16%) cases (category C). This study illustrated the fact that second pathology slide review prior to therapy can identify a small group of cases that result in a major change in their therapeutic plan. Admittedly, the review of pathology slides involves additional time and effort for both consulting and referring institutions. It can ensure quality medical care and limit medicolegal liability. As the Association of Directors of Anatomic and Surgical Pathology recommended, second pathology review should be standard practice. It is necessary that our major Pathology Association and Societies adopt a strong position on this matter to influence government or insurance company to pay for this service rendered by pathologists.
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Affiliation(s)
- Jeffrey S H Tsung
- Department of Pathology and Laboratory Medicine, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan.
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Wetherington RW, Cooper HS, Al-Saleem T, Ackerman DS, Adams-McDonnell R, Davis W, Ehya H, Patchefsky AS, Suder J, Young NA. Clinical significance of performing immunohistochemistry on cases with a previous diagnosis of cancer coming to a national comprehensive cancer center for treatment or second opinion. Am J Surg Pathol 2002; 26:1222-30. [PMID: 12218579 DOI: 10.1097/00000478-200209000-00013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immunohistochemistry (IHC) is an important adjunctive test in diagnostic surgical pathology. We studied the clinical significance and outcomes in performing IHC on cases with a previous diagnosis of cancer who are coming to the Fox Chase Cancer Center (FCCC), a National Cancer Institute designated National Comprehensive Cancer Center (NCCC), for treatment and/or second opinion. We reviewed all the outside surgical pathology slide review cases seen at the FCCC for 1998 and 1999 in which IHC was performed. Cases were divided into the following: confirmation of outside diagnoses without and with prior IHC performed by the outside institution (groups A and B, respectively) and cases with a significant change in diagnosis without and with prior IHC performed by the outside institution (groups C and D, respectively). During 1998 and 1999, 6678 slide review cases were reviewed at the FCCC with an overall significant change in diagnosis in 213 cases (3.2%). IHC was performed on 186 of 6678 (2.7%) slide review cases with confirmation of the outside diagnosis in 152 (81.7%) cases and a significant change in diagnosis in 34 (18.3%) cases. Patient follow-up was obtained in 32 of 34 (94.1%) cases with a significant change in diagnosis (groups C and D), which confirmed the correctness of our diagnosis in 26 of 27 cases (96%; in five cases follow-up was inconclusive). We repeated the identical antibodies performed by the outside institutions in group D (37 antibodies) and group B (133 antibodies) with different results in 48.6% and 13.5%, respectively (overall nonconcordance 21.2%). In group D additional antibody tests beyond that performed by the outside institution were needed in 88.8% of cases to make a change of diagnosis. In the setting of a NCCC, reperforming and/or performing IHC on cases with a previous diagnosis of cancer is not a duplication of effort or misuse of resources. Repeating and/or performing IHC in this setting is important in the care and management of patients with cancer.
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Affiliation(s)
- R Wesley Wetherington
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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16
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Westra WH, Kronz JD, Eisele DW. The impact of second opinion surgical pathology on the practice of head and neck surgery: a decade experience at a large referral hospital. Head Neck 2002; 24:684-93. [PMID: 12112543 DOI: 10.1002/hed.10105] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A second review of histopathologic diagnoses is a quality assurance practice that helps expose diagnostic errors and guide management of patients being referred from outside hospitals. Identification of anatomic regions and specimen types that are prone to diagnostic error will be helpful in guiding policy decisions regarding mandatory second opinion surgical pathology. METHODS All available outside pathology reports were retrieved for patients referred to The Johns Hopkins Hospital Department of Otolaryngology-Head and Neck Surgery between January 1, 1990, and January 1, 2000. The outside diagnosis was compared with diagnosis rendered at the referral hospital. A discrepant diagnosis was regarded as any change resulting in a significant modification in therapy or prognosis. RESULTS Of the 814 cases reviewed, the second opinion surgical pathology diagnosis resulted in 54 (7%) changed diagnoses. Of the changed diagnosis, 13 (24%) involved a change from a benign to a malignant diagnosis; 8 (15%) involved a change from a malignant to a benign diagnosis; and 33 (61%) involved a change in tumor classification. Follow-up information supported the second opinion diagnosis in 41 of 43 cases (95%). CONCLUSIONS In a consequential number of cases, second opinion surgical pathology results in major therapeutic and prognostic modifications for patients sent to large referral hospitals for head and neck oncologic surgery.
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Affiliation(s)
- William H Westra
- Department of Pathology, The Johns Hopkins Medical Institutions, The Weinberg Cancer Center, Room 2242, 410 N. Broadway, Baltimore, MD 21231, USA.
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Ramaswamy S, Tamayo P, Rifkin R, Mukherjee S, Yeang CH, Angelo M, Ladd C, Reich M, Latulippe E, Mesirov JP, Poggio T, Gerald W, Loda M, Lander ES, Golub TR. Multiclass cancer diagnosis using tumor gene expression signatures. Proc Natl Acad Sci U S A 2001; 98:15149-54. [PMID: 11742071 PMCID: PMC64998 DOI: 10.1073/pnas.211566398] [Citation(s) in RCA: 1092] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The optimal treatment of patients with cancer depends on establishing accurate diagnoses by using a complex combination of clinical and histopathological data. In some instances, this task is difficult or impossible because of atypical clinical presentation or histopathology. To determine whether the diagnosis of multiple common adult malignancies could be achieved purely by molecular classification, we subjected 218 tumor samples, spanning 14 common tumor types, and 90 normal tissue samples to oligonucleotide microarray gene expression analysis. The expression levels of 16,063 genes and expressed sequence tags were used to evaluate the accuracy of a multiclass classifier based on a support vector machine algorithm. Overall classification accuracy was 78%, far exceeding the accuracy of random classification (9%). Poorly differentiated cancers resulted in low-confidence predictions and could not be accurately classified according to their tissue of origin, indicating that they are molecularly distinct entities with dramatically different gene expression patterns compared with their well differentiated counterparts. Taken together, these results demonstrate the feasibility of accurate, multiclass molecular cancer classification and suggest a strategy for future clinical implementation of molecular cancer diagnostics.
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Affiliation(s)
- S Ramaswamy
- Whitehead Institute/Massachusetts Institute of Technology Center for Genome Research, Cambridge, MA 02138, USA
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Baloch ZW, Hendreen S, Gupta PK, LiVolsi VA, Mandel SJ, Weber R, Fraker D. Interinstitutional review of thyroid fine-needle aspirations: impact on clinical management of thyroid nodules. Diagn Cytopathol 2001; 25:231-4. [PMID: 11599106 DOI: 10.1002/dc.2044] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Routine interinstitution pathology consultation can result in change in pathologic diagnosis in up to 10% of patients. In this study, we compared the outside cytopathologic diagnosis of thyroid fine-needle aspiration (FNA) specimens with the in-house diagnosis at the University of Pennsylvania Medical Center over an 18-mo period and its effect on patient management. One hundred ten (60%) diagnostic disagreements were identified among 183 patients. In 16 cases, the diagnosis was changed from benign to malignant, and in 12, the diagnosis was reversed from neoplastic/malignant to benign. Histologic follow-up was available in 109 cases; the overall accuracy of outside diagnosis was 73%, and that of inside diagnosis was 85%. In conclusion, we strongly recommend interinstitution cytology consultation on referred thyroid FNA cases, since our data showed a significant change in diagnosis, thus affecting patient management.
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Affiliation(s)
- Z W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA
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Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, Lawton T, Conant EF, Orel SG, Schuchter L, Fox KR, Zieber N, Glick JH, Solin LJ. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer 2001; 91:1231-7. [PMID: 11283921 DOI: 10.1002/1097-0142(20010401)91:7<1231::aid-cncr1123>3.0.co;2-k] [Citation(s) in RCA: 242] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advances in the diagnosis and treatment of breast carcinoma have led to a multidisciplinary approach to management for patients with breast carcinoma. To assess the effect of this approach, the authors performed an evaluation for a cohort of patients examined in a multidisciplinary breast cancer center. METHODS An analysis was performed for the records of 75 consecutive women with 77 breast lesions examined in consultation in a multidisciplinary breast cancer center between January and June 1998. Each patient's case was evaluated by a panel consisting of a medical oncologist, surgical oncologist, radiation oncologist, pathologist, diagnostic radiologist, and, when indicated, plastic surgeon. A comprehensive history and physical examination was performed, and the relevant mammograms, pathology slides, and medical records were reviewed. Treatment recommendations made before this evaluation were compared with the consensus recommendations made by the panel. RESULTS For the 75 patients, the multidisciplinary panel disagreed with the treatment recommendations from the outside physicians in 32 cases (43%), and agreed in 41 cases (55%). Two patients (3%) had no treatment recommendation before consultation. For the 32 patients with a disagreement, the treatment recommendations were breast-conservation treatment instead of mastectomy (n = 13; 41%) or reexcision (n = 2; 6%); further workup instead of immediate definitive treatment (n = 10; 31%); treatment based on major change in diagnosis on pathology review (n = 3; 9%); addition of postmastectomy radiation treatment (n = 3; 9%); or addition of hormonal therapy (n = 1; 3%). CONCLUSIONS The multidisciplinary breast cancer evaluation program provided an integrated program in which individual patients were evaluated by a team of physicians and led to a change in treatment recommendation for 43% (32 of 75) of the patients examined. This multidisciplinary program provided important second opinions for many patients with breast carcinoma.
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Affiliation(s)
- J H Chang
- Department of Radiation Oncology, University of Pennsylvania Cancer Center and School of Medicine, Philadelphia, Pennsylvania, USA
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Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, Lawton T, Conant EF, Orel SG, Schuchter L, Fox KR, Zieber N, Glick JH, Solin LJ. The impact of a multidisciplinary breast cancer center on recommendations for patient management. Cancer 2001. [DOI: 10.1002/1097-0142(20010401)91:7%3c1231::aid-cncr1123%3e3.0.co;2-k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Chafe S, Honore L, Pearcey R, Capstick V. An analysis of the impact of pathology review in gynecologic cancer. Int J Radiat Oncol Biol Phys 2000; 48:1433-8. [PMID: 11121644 DOI: 10.1016/s0360-3016(00)00791-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the impact of pathology review in gynecologic malignancies. METHODS AND MATERIALS For all new gynecologic patients seen between December 2, 1993 and January 4, 1996, we conducted a retrospective chart review to determine if a pathology review by the institute's consultant pathologist changed the diagnosis, and if so whether the change altered patient management. A total of 514 patients were seen, of whom 120 had cervical cancer, 226 had endometrial cancer, 122 had a primary ovarian or peritoneal malignancy, 9 had a vaginal malignancy, 28 had vulvar cancer, and 9 had a miscellaneous gynecologic malignancy. RESULTS On pathology review the diagnosis changed for 200 of 599 specimens (33%). This altered management for 63 of 514 patients (12%). For patients with cervical cancer, the grade of tumor was the main change in pathologic diagnosis, with occasional change in the presence of lymph vascular invasion. These did not translate into patient management alterations. Eight patients (1.5%) had management alterations. The changes in depth of invasion and vascular invasion altered management for 3 patients. Changes in pap smears resulted in two management alterations, and changes in histologic diagnoses altered management for 3 cases. For endometrial primaries the changes in pathologic diagnosis included grade, depth of invasion, and the presence of cervical involvement. This did alter management in 40 cases (8%). For the ovarian malignancies, the main changes were grade, extent of disease, or histologic classification, some of which (10 patients, 2%) resulted in altered management. One patient with a vaginal lesion had the diagnosis changed, which did alter management. Of the patients diagnosed with vulvar cancer, the pathologic diagnosis changed for 11 patients. This included changes in grade and depth of invasion. This altered management of 2 patients. The remaining miscellaneous gynecologic malignancies had only two diagnosis changes that altered management. CONCLUSIONS Pathologic review of gynecologic malignancies is justified as it can alter patient management. In addition, the process facilitates cooperation of the multidisciplinary team and provides a valuable educational forum to enhance patient care.
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Affiliation(s)
- S Chafe
- Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada.
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