Problem Areas in Pathology Practice Uncovered by a Review of Malpractice Claims

Troxel, David B.; Sabella, Joseph D.

doi:10.1097/00000478-199408000-00009

The American Journal of Surgical Pathology

1994

DOI: 10.1097/00000478-199408000-00009

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Problem Areas in Pathology Practice Uncovered by a Review of Malpractice Claims

David B. Troxel¹,

Joseph D. Sabella²

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Cited by 118 publications

(54 citation statements)

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“…Interestingly, in this study, an analysis of defects by organ site confirmed our impressions from the medicolegal and quality literature: breast specimens are among the most prone to error in surgical pathology. [1][2][3][4][5][6][7][8][9] Breast was the second most common organ site for misinterpretations (16.2%) and misidentifications (12.6%) and the most common organ site for specimen defects (41.6%). of detection to identify strategies to reduce these types of errors and their associated clinical consequences.…”

mentioning

confidence: 99%

Quality Assurance in Breast Pathology: Lessons Learned From a Review of Amended Reports

Harrison

Richardson²,

Brock

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-A review of amended pathology reports provides valuable information regarding defects in the surgical pathology process.Objective.-To review amended breast pathology reports with emphasis placed on interpretative errors and their mechanisms of detection.Design.-All amended pathology reports for breast surgical specimens for a 5-year period at a large academic medical center were retrospectively identified and classified based on an established taxonomy.Results.-Of 12 228 breast pathology reports, 122 amended reports were identified. Most (88 cases; 72%) amendments were due to noninterpretative errors, including 58 report defects, 12 misidentifications, and 3 specimen defects. A few (34 cases; 27.9%) were classified as misinterpretations, including 14 major diagnostic changes (11.5% of all amendments). Among major changes, there were cases of missed microinvasion or small foci of invasion, missed micrometastasis, atypical ductal hyperplasia overcalled as ductal carcinoma in situ, ductal carcinoma in situ involving sclerosing adenosis mistaken for invasive carcinoma, lymphoma mistaken for invasive carcinoma, and amyloidosis misdiagnosed as fat necrosis. Nine major changes were detected at interpretation of receptor studies and were not associated with clinical consequences. Three cases were associated with clinical consequences, and of note, the same pathologist interpreted the corresponding receptor studies.Conclusions.-Review of amended reports was a useful method for identifying error frequencies, types, and methods of detection. Any time that a case is revisited for ancillary studies or other reasons, it is an opportunity for the surgical pathologist to reconsider one's own or another's diagnosis.(Arch Pathol Lab Med. 2017;141:260-266; doi: 10.5858/ arpa.2016-0018-OA) R evised pathology reports can be divided into 2 broad categories: amendments and addenda. An amendment is a change in the information of a pathology report after the report has been finalized and released and requires unsigning the original report. In contrast, an addendum represents additional information added to an unchanged original report. An amendment allows editing of the report text, including diagnostic fields, and therefore, requires adequate documentation of all changes and notifications to referring clinicians. It serves as a record of errors in specimen collection, processing, interpretation, and reporting.A review of amended surgical pathology reports is a valuable tool to identify defects in the surgical pathology process and to promote quality assurance and improvement. Meier and colleagues 1 developed and validated a ''taxonomy of defects'' to approach the review of amended reports in a reproducible manner across different practice settings and across different studies in the literature. According to this approach, amended reports are classified by type of error or ''defect'' into 4 categories-misinterpretations, misidentifications, specimen defects, and report defects-and defect rates and fractions are quality measures...

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confidence: 99%

Quality Assurance in Breast Pathology: Lessons Learned From a Review of Amended Reports

Harrison

Richardson²,

Brock

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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“…Together with lymphoma misdiagnosis of melanocytic lesions head the list of malpractice cases. 4,5 Previous studies indicated differences in the patterns of chromosomal aberrations between melanomas and benign nevi that might be diagnostically helpful for ambiguous cases. 6,7 In addition to problems in classifying melanocytic lesions as benign or malignant there is controversy about whether melanoma is one homogenous disease or consists of biologically and histologically distinct subtypes.…”

mentioning

confidence: 99%

Classifying Melanocytic Tumors Based on DNA Copy Number Changes

Bastian

Olshen

LeBoit

et al. 2003

The American Journal of Pathology

432

344

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Melanoma and benign melanocytic nevi can overlap significantly in their histopathological presentation and misdiagnoses are common. To determine whether genetic criteria can be of diagnostic help we determined DNA copy number changes in 186 melanocytic tumors (132 melanomas and 54 benign nevi) using comparative genomic hybridization. We found highly significant differences between melanomas and nevi. Whereas 127 (96.2%) of the melanomas had some form of chromosomal aberration, only 7 (13.0%) of the benign nevi cases had aberrations. All seven cases with aberrations were Spitz nevi, in six of which the aberration was an isolated gain involving the entire short arm of chromosome 11. This aberration was not observed in any of the 132 melanomas. We also analyzed the 132 melanomas for genetic differences depending on anatomical site, Clark's histogenetic type, and sun-exposure pattern. We show that melanomas on acral sites have significantly more aberrations involving chromosomes 5p, 11q, 12q, and 15, as well as focused gene amplifications. Melanomas classified as lentigo maligna melanomas or as occurring on severely sun-damaged skin showed markedly more frequent losses of chromosomes 17p and 13q. This study shows a pattern of chromosomal aberration in melanoma that is distinct from melanocytic nevi and should be further evaluated as a diagnostic test for melanocytic lesions that are now ambiguous. In addition, we show marked differences in the genetic make-up of melanomas that depend on anatomical location and sun-exposure pattern indicating that potential therapeutic targets might vary among melanoma types.

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“…Prostatic biopsy pathology has been identified as a problem area which may lead to litigation. [1][2][3] In my own experience, the most likely patterns giving rise to falsepositive malignant cells are atrophy, post-atrophic hyperplasia, atypical adenomatous hyperplasia (adenosis) and seminal vesicle.…”

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confidence: 99%

Benign mimickers of prostatic adenocarcinoma

2004

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Problem Areas in Pathology Practice Uncovered by a Review of Malpractice Claims

Cited by 118 publications

References 0 publications

Quality Assurance in Breast Pathology: Lessons Learned From a Review of Amended Reports

Quality Assurance in Breast Pathology: Lessons Learned From a Review of Amended Reports

Classifying Melanocytic Tumors Based on DNA Copy Number Changes

Benign mimickers of prostatic adenocarcinoma

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