Second opinion pathology in liver biopsy interpretation

OBJECTIVE: Clinical management of liver diseases is often based on the inte rpretation of the pathologist examining liver biopsies. Many pathologists h ave little formal training and experience with these tissues. The magnitude of this problem is not determined yet. The goal of this study was to deter mine the diagnostic discrepancies that surfaced after a second opinion by e xperienced hepatopathologists interpreting liver biopsy tissues. METHODS: All 178 consecutive liver biopsy tissue glass slides provided to h epatology consultants in 1996 and 1997 were selected for evaluation. Specim ens with neoplasms, transplant-related indications, or those specifically r eferred by a community-based pathologist for consultation were excluded. Di agnosis and interpretations were compared with the reports from the origina l institutions. Discordant interpretations were grouped in major (descripti on or diagnosis that would change management decisions) and minor (not like ly to alter management) categories. Monetary cost of the pathology studies was analyzed. RESULTS: A total of 125 specimens corresponding to 124 patients met inclusi on criteria. Thirty-five (28%) and 47 (37.6%) biopsies had major and minor discrepancies, respectively. Full agreement was obtained in 43 (34.4%) case s. Fifteen (42.8%) of the major interpretation errors were on patients with chronic cholestatic disorders, nine (25.7%) with hepatocellular processes, and 11 (31.4%) were related to establishing the presence or absence of cir rhosis. Reviewing the 125 liver biopsies of this study by the consultants r esulted in a 46% increase in monetary cost. CONCLUSIONS: Practitioners making clinical decisions based on liver biopsy interpretation need to be aware that in a significant number of cases, path ologists are not able to arrive at a correct diagnosis, and thus seeking se cond opinions on the patients' behalf from experienced pathologists on live r diseases would be prudent. General pathologists should become more famili ar with the abnormalities involving interlobular bile ducts and the diagnos tic value of certain ancillary histological stains. Clinicians should provi de pathologists with sufficient clinical information in terms of laboratory evaluations and clinical findings, so that accurate diagnosis might be fac ilitated. (C) 2001 by Am. Coll. of Gastroenterology.