Quality assurance of second opinion pathology in gynecologic oncology

Objective: To determine the effect of routine second review of pathologic m aterial that was sent to Ohio State University before initiation of therapy . Methods: All the gynecologic-oncologic histopathology review diagnoses made during a 1-year period were compared with original pathologic diagnoses. W hen there was a discrepant diagnosis with the second interpretation, the ca se was reviewed by at least two pathologists. Discrepancies were coded as n o diagnostic disagreement, no diagnostic disagreement but pertinent informa tion not included, diagnostic disagreement without clinical consequences, d iagnostic disagreement with minor clinical significance, or diagnostic disa greement with major clinical significance. proportions and confidence inter vals were calculated. Results: Pathology reports from 295 referred patients were reviewed. Two hu ndred forty-five (83.1%) showed no discrepancy. Discrepancies were found in 50 cases (16.9%). There was significant information missing in four cases (1.4%), diagnostic disagreement with no clinical significance in 22 cases ( 7.5%), and diagnostic disagreement with minor clinical significance in 10 c ases (3.4%). In 14 cases (4.7%, 95% confidence interval 2.28, 7.12) the cha nges in diagnoses had major therapeutic or prognostic implications that inc luded changes from malignant or low malignant potential to benign (seven ca ses), malignant to low malignant potential (three cases), change in tumor t ype (two cases), and assessment of invasion (two cases). The cost of review ing 295 specimens was approximately $39,235. The cost of identifying each m ajor discrepancy was about $2802. Conclusion: Routine pathology review of gynecologiconcologic cases before d efinite treatment revealed notable discrepancies in diagnoses. In 4.7% of c ases, the change in diagnosis had a major effect on proper treatment planni ng or a significant prognostic implication. (C) 1999 by The American Colleg e of Obstetricians and Gynecologists.