Thursday, November 28, 2013

From Andy Renshaw and Edwin Gould: Reducing False-Negative and False-Positive Diagnoses in Anatomic Pathology Consultation Material


Andrew A. Renshaw MDEdwin W. Gould MD
From the Department of Pathology, Baptist Hospital of Miami, Miami, Florida.
Context.—Previous studies have shown that there are disagreements in interlaboratory consultation, including false-negative and false-positive diagnoses. To date, methods to reduce false-negative and false-positive diagnoses have been poorly documented.
Objective.—To identify features associated with false-negative and false-positive diagnoses in anatomic pathology.
Design.—We reviewed the results of interlaboratory consultation in our institution during a 9-year period. For false-negative and false-positive diagnoses, methods that might have prevented the error were identified.
Results.—Disagreements were identified in 810 of 8082 consults (10%). Fifty-four false-negative cases (0.7% of all consults) and 27 false-positive cases (0.3%) were identified. False-negative cases were more common in breast (20 of 1131; 1.8%), genitourinary (16 of 970; 1.7%), hematologic (3 of 242; 1.3%), and cytology (3 of 404; 0.8%) than in all other sites combined (P < .001); no significant difference in sites were identified for false-positive cases. Overall, there was no difference in the percentage of cases that were reviewed by more than one pathologist in either false-negative cases (109 of 810; 13.5%) or false-positive cases (135 of 810; 16.7%), compared with all other consults (858 of 7272; 11.8%) (P = .74 and .59, respectively). However, on review, 12 of all 27 false-positive cases (44%) might have been prevented by the use of immunohistochemistry alone, and 36 of all 54 false-negative cases (67%) might have been prevented by the use of a second review; special stains, including immunohistochemistry; additional levels; changes in processing; and hedges.
Conclusion.—Approximately one-half of false-negative and false-positive cases (48 of 81; 59%) might be preventable by the use of a combination of pathologic methods.

No comments:

Post a Comment