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Kerr KF, Longton GM, Reisch LM, Radick AC, Eguchi MM, Shucard HL, Pepe MS, Piepkorn MW, Elder DE, Barnhill RL, Elmore JG. Histopathological diagnosis of cutaneous melanocytic lesions: blinded and nonblinded second opinions offer similar improvement in diagnostic accuracy. Clin Exp Dermatol 2022; 47:1658-1665. [PMID: 35426450 PMCID: PMC9391266 DOI: 10.1111/ced.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies of second opinions in the diagnosis of melanocytic skin lesions have examined blinded second opinions, which do not reflect usual clinical practice. The current study, conducted in the USA, investigated both blinded and nonblinded second opinions for their impact on diagnostic accuracy. METHODS In total, 100 melanocytic skin biopsy cases, ranging from benign to invasive melanoma, were interpreted by 74 dermatopathologists. Subsequently, 151 dermatopathologists performed nonblinded second and third reviews. We compared the accuracy of single reviewers, second opinions obtained from independent, blinded reviewers and second opinions obtained from sequential, nonblinded reviewers. Accuracy was defined with respect to a consensus reference diagnosis. RESULTS The mean case-level diagnostic accuracy of single reviewers was 65.3% (95% CI 63.4-67.2%). Second opinions arising from sequential, nonblinded reviewers significantly improved accuracy to 69.9% (95% CI 68.0-71.7%; P < 0.001). Similarly, second opinions arising from blinded reviewers improved upon the accuracy of single reviewers (69.2%; 95% CI 68.0-71.7%). Nonblinded reviewers were more likely than blinded reviewers to give diagnoses in the same diagnostic classes as the first diagnosis. Nonblinded reviewers tended to be more confident when they agreed with previous reviewers, even with inaccurate diagnoses. CONCLUSION We found that both blinded and nonblinded second reviewers offered a similar modest improvement in diagnostic accuracy compared with single reviewers. Obtaining second opinions with knowledge of previous reviews tends to generate agreement among reviews, and may generate unwarranted confidence in an inaccurate diagnosis. Combining aspects of both blinded and nonblinded review in practice may leverage the advantages while mitigating the disadvantages of each approach. Specifically, a second pathologist could give an initial diagnosis blinded to the results of the first pathologist, with subsequent nonblinded discussion between the two pathologists if their diagnoses differ.
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Affiliation(s)
- Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Gary M Longton
- Program in Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lisa M Reisch
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Andrea C Radick
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Megan M Eguchi
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Hannah L Shucard
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Margaret S Pepe
- Program in Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Dermatopathology Northwest, Bellevue, WA, USA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond L Barnhill
- Department of Translational Research, Institut Curie, Paris, France
- UFR of Medicine, University of Paris, Paris, France
| | - Joann G Elmore
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
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Bruner JM, Louis DN, McLendon R, Rosenblum MK, Archambault WT, Most S, Tihan T. The Utility of Expert Diagnosis in Surgical Neuropathology: Analysis of Consultations Reviewed at 5 National Comprehensive Cancer Network Institutions. J Neuropathol Exp Neurol 2017; 76:189-194. [PMID: 28395084 DOI: 10.1093/jnen/nlw122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to characterize the type and degree of discrepancies between non-expert and expert diagnoses of CNS tumors to identify the value of consultations in surgical neuropathology. Neuropathology experts from 5 National Comprehensive Cancer Network (NCCN) member institutions participated in the review of 1281 consultations selected based on inclusion criteria. The consultation cases were re-reviewed at the NCCN headquarters to determine concordance with the original diagnoses. Among all consultations, 249 (19.4%) were submitted for expert diagnoses without final diagnoses from the submitting institution. Within the remaining 1032 patients, the serious/major discrepancy rate was 4.8%, and less serious and minor discrepancies were seen in 19.4% of the cases. The discrepancy rate was higher among patients who were referred to NCCN institutions for consultation compared to those who were referred for treatment only. The discrepancy rates, patient demographics, type of consultations and submitting institutions varied among participating NCCN institutions. Expert consultations identified a subset of cases with significant diagnostic discrepancies, and constituted the initial diagnoses in some cases. These data indicate that expert consultations in glial tumors and all types of pediatric CNS tumors can improve accurate diagnosis and enable appropriate management.
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Affiliation(s)
| | - David N Louis
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Roger McLendon
- Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Susan Most
- National Comprehensive Cancer Network (NCCN), Fort Washington, Pennsylvania, USA
| | - Tarik Tihan
- University of California San Francisco, San Francisco, California, USA
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Paterson AL, Allison MED, Brais R, Davies SE. Any value in a specialist review of liver biopsies? Conclusions of a 4-year review. Histopathology 2016; 69:315-21. [DOI: 10.1111/his.12940] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/24/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Anna L Paterson
- Department of Histopathology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Michael E D Allison
- Liver Unit; Cambridge Biomedical Research Centre; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Rebecca Brais
- Department of Histopathology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Susan E Davies
- Department of Histopathology; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
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Nakhleh RE, Nosé V, Colasacco C, Fatheree LA, Lillemoe TJ, McCrory DC, Meier FA, Otis CN, Owens SR, Raab SS, Turner RR, Ventura CB, Renshaw AA. Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology. Arch Pathol Lab Med 2016; 140:29-40. [PMID: 25965939 DOI: 10.5858/arpa.2014-0511-sa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies. OBJECTIVE To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors. DESIGN The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidence-based guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology. RESULTS The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic pathologists should take steps to improve agreement. CONCLUSIONS Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care.
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Affiliation(s)
- Raouf E Nakhleh
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Dr Nakhleh); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Nosé); Governance (Ms Colasacco) and the Pathology and Laboratory Quality Center (Mss Fatheree and Ventura), College of American Pathologists, Northfield, Illinois; Hospital Pathology Associates, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Lillemoe); the Department of Medicine, Duke University, Durham, North Carolina (Dr McCrory); the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Dr Meier); the Department of Pathology, Baystate Medical Center, Springfield, Massachusetts (Dr Otis); the Department of Pathology, University of Michigan Medical School, Ann Arbor (Dr Owens); the Department of Pathology, Memorial University of Newfoundland/Eastern Health Authority, St John's, Newfoundland, Canada (Dr Raab); the Department of Pathology, St John's Health Center, Santa Monica, California (Dr Turner); and the Department of Pathology, Homestead Hospital, Homestead, Florida (Dr Renshaw). Dr Meier is currently with the Department of Pathology, Massachusetts General Hospital, Boston
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Wang S, Ding C, Tu J. Malignant glomus tumor of the lung with multiple metastasis: a rare case report. World J Surg Oncol 2015; 13:22. [PMID: 25888833 PMCID: PMC4336763 DOI: 10.1186/s12957-014-0423-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 12/23/2014] [Indexed: 12/03/2022] Open
Abstract
Malignant glomus tumor, or glomangiosarcoma, is a very rare mesenchymal neoplasm that, when seen, occurs in visceral organs. Despite having histologic features of malignancy, these tumors usually do not metastasize. However, when metastasis occurs, this disease is often fatal. Our report presents the case of a 59-year-old female patient with a highly aggressive and widely metastatic glomus tumor of the lung.
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Affiliation(s)
- Saibin Wang
- Department of Pneumology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, 321000, Jinhua, China.
| | - Chuanbiao Ding
- Department of Internal Medicine, Jinhua Municipal Central Hospital Pan-an Branch, 1# Luoshan Road, Pan-an, 322300, China.
| | - Junwei Tu
- Department of Pneumology, Zhejiang University Jinhua Hospital, Jinhua Municipal Central Hospital, 321000, Jinhua, China.
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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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Abstract
The 5-tier Gleason grading system for prostate cancer, introduced in 1966, has been proven to be one of the main independent predictors of prostate cancer outcome. This review addresses interobserver concordance in Gleason grading; the persistence of grading discrepancies with frequent upgrading from the biopsy to the prostatectomy specimen; the 2005 International Society of Urologic Pathologists' modifications to Gleason grading; the impact of this modified grading on grade migration and outcome prediction; and molecular correlates of cancer morphology. Data from the most recent years are emphasized.
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Affiliation(s)
- Kenneth A Iczkowski
- Department of Pathology, University of Colorado Denver School of Medicine, RC-1 North, 12800 East 19th Avenue, Campus Mail Stop 8104, Aurora, CO 80045, USA.
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Kishimoto R, Saika T, Bekku K, Nose H, Abarzua F, Kobayashi Y, Araki M, Yanai H, Nasu Y, Kumon H. The clinical impact of pathological review on selection the treatment modality for localized prostate cancer in candidates for brachytherapy monotherapy. World J Urol 2011; 30:375-8. [PMID: 21847658 DOI: 10.1007/s00345-011-0738-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022] Open
Abstract
AIM To evaluate the impact of pathological review by pathologist with genitourinary expertise (PGU) on treatment modality of localized prostate cancer, we analyzed Gleason grade (GG) migration and the final treatment decision in a cohort of patients designated for permanent prostate brachytherapy (PPB). METHODS From February 2005 to July 2010, a total of 247 patients with localized prostate cancer diagnosed by local community hospitals were referred to our hospital for PPB monotheray. All pathologic slides of prostate biopsies were reviewed by a single PGU. Patients ultimately selected their treatment modality from our recommendations based on the review. Indication for PPB monotherapy was the NCCN classification of patients as good or intermediate risk. In addition, patient with Primary GG 4 was regarded as unadapted case. RESULTS Six cases were reinterpreted as no cancer (2.4%). GG change occurred in 94 cases (38.1%) of which 77 (81.9%) were upgraded and 17 (18.1%) downgraded. Of the total 247 patients, 86 (34.8%) changed therapies and 30 (12.1%) did so based on the pathologic slide review. CONCLUSIONS Pathological review of biopsy specimens is mandatory for the determination of treatment modality especially in candidates for monotherapy of permanent prostate brachytherapy.
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Affiliation(s)
- Ryo Kishimoto
- Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan
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Jara-Lazaro AR, Thike AA, Tan PH. Is the second opinion always better than the first?: authors’ reply. Pathology 2010. [DOI: 10.3109/00313025.2010.494297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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