Errors in histopathology reporting: detection and avoidance

Abstract

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.

Diagnostic 'Errors' in a Single Urogenital Pathology Unit

“…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%).…”

“…In pathologic anatomy, similarly to other fields of medicine, errors probably arise from multiple factors (Reason BMJ 2000) [23] (Reason QHC 2001) [24] (Gallagher NEJM 2007) [25]. Institutes of pathologic anatomy use several methods to detect errors (Raab Cancer 2005) [4]; (Nodit AJCP 2005) [9] (Grzybicki AJCP 2005) [10] (Ramsay Histopathology 1999) [26]. The most commonly used is the secondary review, in which a second pathologist reviews slides previously examined by the first [5].…”

Agreement Among Surgical Pathologists Evaluating Routine Histologic Sections of Digits Amputated from Cats and Dogs

“…6,21 However, it is known that histopathology is an imperfect means of diagnosis. 4,13 Unlike most diagnostic tools, it has not been subjected to validation. The reliability of a diagnostic test depends upon the reproducibility of interpretation.…”

What Levels of Agreement Can Be Expected Between Histopathologists Assigning Cases to Discrete Nominal Categories? A Study of the Diagnosis of Hyperplastic and Adenomatous Colorectal Polyps

“…Histopathology is often used as the basis for diagnosis in the treatment of patients, but we know that it is still an imperfect method of diagnosis (1,2). Many studies have emphasised the lack of reproducibility of histopathology diagnosis by studying the assignment into arbitrary categories of cases from a biological spectrum, e.g., the grading of in situ carcinoma of the breast (3), or by selecting a population of "difficult" cases, such as equivocal melanocytic skin tumors (4).…”