Assessing diagnostic errors: when is suspension of a pathologist justified?

Lesna, M.

doi:10.1136/jcp.51.9.649

Cited by 7 publications

(9 citation statements)

References 9 publications

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“…The altogether unacceptable frequency of unjustifiable discordance we found in the surgical specimens would probably be avoided if pathology units strictly followed the diagnostic criteria stated in the current guidelines (Eble IARC 2004) [34] (Murphy AFIP 2004) [35] (Fuhrmann AJSP 1982) [36] (Bostwick USP 1997) [37]. In urogenital biopsies the high incidence of discordance with consequences for patients with prostatic and bladder cancer (76.92% and 87.50%) are in line with previous reports in specific areas of surgical pathology such as skin, lymphoreticular and gastrointestinal systems, prostate and bladder biopsies, describing a "failure to diagnose" category (oversight errors) in 87% of the medicolegal claims (Raab APLM 2005) [7] (Lesna JCP 1998) [8] (Ramsay Histopathology 1999) [26] (Furness JCP 1997) [42]. The highest incidence of diagnostic discordances in our study was related to tumor histotype (37.86%) and TNM staging (21.35%).…”

Section: Discussionsupporting

confidence: 72%

“…The effect of these errors is unknown mainly owing to the lack of uniform measurement processes and pathologists' fear that their errors could have medico-legal implications, thus causing their suspension, and ultimately destroying their professional reputation and private life (Lesna JCP 1998) [8]. In the diagnosis of cancer *Address correspondence to this author at the Department of Experimental Medicine (Section of Pathologic Anatomy), University "La Sapienza", Policlinico Umberto I, 324 Viale Regina Elena, 00161 Rome, Italy; Tel: 0039.06.49972417; Fax: 0039.06.4454820; E-mail: mariarosaria.cardillo@uniroma1.it or maria.rosaria.cardil@alice.it these errors reach about 11.8% (Raab Cancer 2005) [4] (Raab CLM 2004) [5] (Raab APLM 2005) [7] (Nodit AJCP 2005) [9] (Grzybicki AJCP 2005) [10].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic 'Errors' in a Single Urogenital Pathology Unit

Cardillo¹

2008

TOPATJ

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Abstract:To understand better the factors that contribute to diagnostic errors in urogenital pathology units, as part of our ongoing research into urogenital cancers, from a consecutive series of 6304 histologic reports for the years 2003 to 2006 we selected for review those containing more than one evident error. We reviewed 1746 urogenital histopathologic diagnoses, 1459 (83.56%) referred to biopsies and 287 (16.43%) to surgical specimens. Of the 1746 reports reviewed, 1643 diagnoses (94.10%) were in agreement and 103 (5.89%) in disagreement with the reviewer's rating. Among these 103 diagnoses, 77 (70.75%) had justifiable and 27 (26.21%) unjustifiable discordances. Of these 27 discordances, 23 were unjustifiable discordances containing errors with consequences that affected patient management. The poor diagnostic efficiency found in a single anatomopathological unit raises concern and suggests considerable room for improvement. Efficiency could be substantially improved if pathological services strictly applied the existing international measures for quality control.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Diagnostic 'Errors' in a Single Urogenital Pathology Unit

Cardillo¹

2008

TOPATJ

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“…The public and administrators have an unreasonable expectation of zero error concerning cancer screening programmes. They are unaware that errors are unavoidable, even in the hands of experts, and the fear of litigation following a false‐negative diagnosis is beginning to threaten various programmes43. In 1996, the College of American Pathologists developed guidelines after a conference on liability and quality issues in cervical cytology44.…”

Section: Discussionmentioning

confidence: 99%

Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis

et al. 2001

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Histological dysplasia is the cornerstone of colorectal cancer surveillance in ulcerative colitis (UC). Recently, pathologists have received unfavourable media attention concerning other cancer screening programmes. The aim of this study was to determine whether colonic biopsy specimens should be examined by gastrointestinal pathologists as opposed to generalists, by examining inter-observer variation between the two groups. Fifty-one coded slides showing varying degrees of dysplasia were mailed to seven gastrointestinal and six general histopathologists. Pathologists allocated each biopsy into one of four categories without the benefit of a clinical history or an opportunity to use the 'indefinite' category that is included in the Riddell classification. The responses were analysed using kappa statistics. The overall kappa statistic for gastrointestinal pathologists was 0.30 [95% confidence interval (CI)=0.26-0.34] and for general pathologists 0.28 (95% CI=0.23-0.32). Agreement was best for high-grade dysplasia (kappa of 0.54 and 0.61 for GI and general pathologists, respectively). There was total concordance of the 13 pathologists in only four of the 51 slides (7.8%) (95% CI=0.4-15.2%). It is concluded from these results that gastrointestinal pathologists are no better than generalists when grading dysplasia in UC and that agreement is poor in both groups. There is therefore no evidence that there would be any benefit in having specialist histopathology centres concentrating specifically on the interpretation of all surveillance colonoscopy biopsies from around the UK. It must be made clear to the public that surveillance and screening programmes carry a significant rate of histological error and that perfection cannot be expected or achieved with present methods.

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“…Histopathology therefore differs from the other pathology disciplines where audit assesses the accuracy of a chemical analysis method or automated blood cell counter. Perceived problems or inaccuracies in histopathology reports can imply incompetence and lead to re‐training, suspension or retirement 15 …”

Section: Introductionmentioning

confidence: 99%

Errors in histopathology reporting: detection and avoidance

Ramsay

1999

Histopathology

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The histopathological diagnosis is the bedrock of modern oncology, and plays a major role in the treatment of many other types of disease. Errors in these reports can critically affect patient care and may become the subject of media concern. This article considers how audit in histopathology can provide information about errors and inconsistencies in the diagnosis of surgical specimens. The use of audit to generate information about the background level of errors in pathology reports is reviewed, along with findings about the nature of these errors and the types of specimens more commonly affected. Generic audit strategies that can be used to minimize the risk of errors in reports are discussed, together with the use of audit to evaluate diagnostic criteria and pathological scoring or grading systems. The role of audit in determining the informational content of reports is included, and there is consideration of the relationship between sample size and error rates. The limited extent to which audit can be used to assess the performance of individual pathologists is also covered.

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Assessing diagnostic errors: when is suspension of a pathologist justified?

Cited by 7 publications

References 9 publications

Diagnostic 'Errors' in a Single Urogenital Pathology Unit

Diagnostic 'Errors' in a Single Urogenital Pathology Unit

Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis

Errors in histopathology reporting: detection and avoidance

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