PATHOLOGY SLIDE REVIEW IN GYNECOLOGIC ONCOLOGY

Objective: To analyze the diagnostic accuracy and alteration in treatm ent planning from interinstitution (different institution) pathologic consultation. Methods: We reviewed pathologic reports from 720 referre d patients. The diagnosis rendered from a gynecologic pathologist was compared with the original diagnosis. Discrepancies were coded as none , minor, or major. A discrepancy was major if ii: led to treatment alt eration. A discrepancy was minor if it did not lead to treatment alter ation. The judgment to declare a discrepancy was made by a gynecologic pathologist, a gynecologist, and three gynecologic oncologists. The r eview cost was $150 per ease. The Cochran-Mantel-Haenszel test evaluat ed any systematic pattern in discrepancies. Results: Seven hundred twe nty specimens consisted of 113 vulvar, 170 uterine, 289 cervical, 105 ovarian, and 43 vaginal tissues. Six hundred one (84%) pathologic diag noses showed no discrepancy. There were 104 (14%) minor and 15 (2%) ma jor discrepancies. After reviewing 15 major discrepancies, six surgeri es were canceled, two surgeries were modified, one adjuvant radiation treatment was added, one chemotherapy treatment was modified, and five adjuvant chemotherapy treatments were cancelled. No systematic error was identified with regard to the sources (tissue origin) or methods o f obtaining the specimen (P = .675). The cost of reviewing 720 specime ns was $108,000. The cost of identifying each major discrepancy was $7 200. Conclusion: Reviewing pathology slides before definitive treatmen t reveals notable discrepancies in diagnoses. The cost of pathology re view is globally expensive but has consequential impact on proper trea tment planning for the individual patient. (C) 1998 by The American Co llege of Obstetricians and Gynecologists.