Quality Assurance of Histopathologic Diagnosis in the British Army: Role of the Army Histopathology Registry in Completed Case Review

Abstract

The purpose of this study was to assess the clinical and pathological value of reports resulting from review of all completed surgical pathology cases submitted to the Army Histopathology Registry (AHR). All histopathological cases completed in the British Army are sent to the AHR for archiving; prior to placing cases in the archive both microscopic material and submitted reports are reviewed by staff of the AHR. A "nonagreed" report is produced for those cases in which the reviewing pathologist has a dissenting opinion or for which he thinks other comments may be helpful. All nonagreed reports produced over a 19 month period were subjected to a further pathological and clinical review. The original surgical pathology reports were compared with AHR reports and the significance of the differences in diagnosis assessed. During the study interval, 4.0% of total cases reviewed were identified as nonagreed record cases. The clinical and pathological reviews placed the nonagreed cases into significant categories in 2.1% and 1.9% of instances respectively. These findings suggest that nonselected review of completed surgical pathology cases identifies a significant proportion of cases for which dissenting opinions may have important clinical and pathological consequences.

Errors in histopathology reporting: detection and avoidance

“…In 19 of these cases (1.4%) the error was such that it was considered likely to affect patient management. These figures broadly agree with an earlier study in which 12 934 cases submitted to the Army Histopathology Registry were reviewed 50 . In 521 cases (4.0%) the reviewing pathologist did not agree with the original diagnosis and in 141 cases (1.1%) the changes made were classed as ‘clinically and pathologically significant’.…”

“…In 10.3% the original diagnosis was refined and in 8.9% it was altered, although there was no significant change to clinical management in the majority (92.6%) of these cases. These figures are higher than the error rates detected in routine audit programmes, 24,[50][51][52] probably reflecting the complex and highly selected nature of the cases. This high level of preselection and the variation in the selection criteria mean that the clinicopathological meeting does not usually reflect the diagnostic performance of the department as a whole or that of individual pathologists.…”

“…These figures broadly agree with an earlier study in which 12 934 cases submitted to the Army Histopathology Registry were reviewed. 50 In 521 cases (4.0%) the reviewing pathologist did not agree with the original diagnosis and in 141 cases (1.1%) the changes made were classed as 'clinically and pathologically significant'. In one US study an extra pathologist was specifically appointed to review all the cases over a 1-year period.…”

Routine Review of Surgical Pathology Cases as a Method by Which to Reduce Diagnostic Errors in a Community Hospital

“…[2][3][4][5][6]11,[13][14][15][16][17][18] Unfortunately, none of these rates are comparable. The conditions under which these studies were performed have varied significantly, especially with regard to the manner in which reporting errors and misdiagnoses were defined; the categories under which errors were tallied; the manner in which data were collected; the types of cases which were studied; and the practice settings in which the studies were performed.…”

Histopathology departments already audit diagnostic errors

“…The research that has already taken place, both in Britain and in the United States, seems to have been overlooked. In 1986 a review of 12 934 cases in the British Army Histopathology Registry detected 521 diagnoses (4.0%) that contained an error; 141 of these errors (1.1%)were classed as “clinically significant” and were likely to have affected the patient's care 2. In an audit of 518 cases in Southampton in 1993, errors were found in 20 cases (3.8%), and in six (1.2%) theerror was judged to be clinically significant 3.…”