Interinstitutional Pathology Consultations

Abstract

We retrospectively determined the clinical impact of 1,000 randomly selected interinstitutional pathology consultations (IPCs). An IPC included all specimens from the patient. IPCs were classified as concordant or discordant with the original diagnosis. Discordant IPCs were classified as having a clinical impact or no impact. Discordant IPCs owing to interpretation differences were subclassified further. The IPCs included 1,522 specimens (1,204 histology, 318 cytology); 923 (92.3%) were concordant, 9 (0.9%) indeterminate, and 68 (6.8%) discordant (clinical impact, 37; no impact, 31). Reasons for discordant IPCs were interpretation differences, 45; additional sectioning, 7; ancillary testing, 1; clerical error, 5; or a combination, 10. Reasons for 26 discordant IPCs with clinical impact owing to interpretation differences were overdiagnosis, 11; tumor subtype change, 4; stage change, 4; underdiagnosis, 3; resection margin status change, 2; undergrading, 1; and understaging with resection margin status change, 1. IPC may identify diagnostic discrepancies that impact management for some patients. The prevalence of a clinical impact of IPC on management varies according to body site. Mandatory IPC does ensure identification of clinically significant diagnostic discrepancies; targeted IPC by body site or specimen type may represent an alternative strategy after further data accumulation. Discordant IPCs may be due to factors other than interpretation difference.

Inter-Institutional Pathology Consultations for Breast Cancer: Impact on Clinical Oncology Therapy Recommendations

“…A review performed at the only cancer centre in Taiwan observed major discordance in 6% of mandatory interinstitutional pathology consultations 5 . Weir et al at the University Health Network in Toronto observed a 6.8% discordance rate in 1000 randomly selected consultations 4 . In both the Iowa City and Toronto studies, approximately half the discordant findings had clinical impact.…”

“…In practice, however, inter-institutional pathology consultation is variably applied 11,12 . Suggested reasons for variability in the adoption of routine second-opinion pathology include workload constraints 5 , financial costs 6 , uncertainty about the value of reviews, and concerns about treatment delay 4 . Our institution had a policy of routine review upon referral in all cases of breast cancer patients with original pathology reported at an outside institution.…”

“…In four large studies of inter-institutional pathology consultations in general pathology, rates of major discordance ranged from 1.4% to 9.0% [3][4][5][6] . The lower value is from a study of 6171 cases referred to the Johns Hopkins Hospital, which mandates second opinion for surgical pathology from outside hospitals 3 .…”

“…Previous studies of inter-institutional pathology consultations for a cancer diagnosis have reported overall discordance rates ranging from 1.4% to 9.0% [3][4][5][6][7] . Discordance rates for breast cancer pathology have ranged from 1.4% to 6.3% [3][4][5] , and breast cancer-specific pathology reviews performed as part of a dedicated multidisciplinary tumour board have observed a 4%-29% discordance rate 8,9 .…”

“…Discordance rates for breast cancer pathology have ranged from 1.4% to 6.3% [3][4][5] , and breast cancer-specific pathology reviews performed as part of a dedicated multidisciplinary tumour board have observed a 4%-29% discordance rate 8,9 . In most of these series, information regarding the specific discordant elements and the potential clinical impact of the discordant findings is limited.…”