Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 6077
© 2005 American Society of Clinical Oncology

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Abstract

Disagreement in pathology: Impact in clinical decision-making

Inst Oncológico Henry Moore (IOHM), Buenos Aires, Argentina; Facultad de Medicina, Tucumán, Argentina

6077

Background: The IOHM is an ambulatory cancer center where patients are referred after the diagnosis of cancer is certified elsewhere. From 1997 onwards, all our patients have their pathological diagnosis reviewed in order to assure high clinical quality standards. The pathology files include more than 5000 cases handled according to the recommendations of the Association of Directors of Anatomic and Surgical Pathology of America and the Argentinian Society of Pathology. The aim of this study is to investigate the discrepancies that occurred in the pathology review and their potential clinico-therapeutic implications. Methods: Review of pathology reports of 637 cases of breast cancer on the pathological files of our institution was performed. All cases were analyzed initially by an external pathologist who established the diagnosis and after referral to our center by either two independent pathologists for in-house review. Discrepancy in pathological diagnosis (DPD) were categorized as: DPD 0= No discrepancy, DPD-I= discrepancy about the malignant nature of the tumor, DPD-II: discrepancy in tumor infiltration (in situ vs infiltrating), DPD-III: discrepancy in histological type (lobulillar vs ductal) and DPD-IV: discrepancy in histological subtype. Results: The following discrepancies were observed: DPD-0: 365/637 (57%), DPD-I: 9/637 (1.4%), DPD-II: 23/637 (3.6%), DPD-III: 45/637 (7%), DPD-IV: 195/637 (31%). Conclusions: Severe DPD (I and II) were observed in one case every twenty. Major discrepancies in histological type seen in 7% of the cases and about 30% can be further subtyped after expert pathology revision. The revision of pathology diagnosis by an expert board is essential to assure quality of patient care and for malpractice prevention.

No significant financial relationships to disclose.

Abstract presentation from the 2005 ASCO Annual Meeting