Increasing Agreement Over Time in Interlaboratory Anatomic Pathology Consultation Material

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Abstract

Objectives:

To undertake a retrospective study of the rate of diagnostic discrepancy for patient/clinician-initiated second opinions in anatomic pathology at our institution and determine if this rate has changed and whether the change could be explained.

Methods:

We reviewed all patient/clinician-initiated consults (incoming and outgoing) handled by our institution over a 6¾-year (27 quarters) period in which the original and consult reports were available.

Results:

The rate of disagreement from the first 14 to the second 13 quarters declined from 20.4% to 15.4% (P = .004) for incoming consults and from 9.7% to 4.1% (P < .001) for outgoing consults. Significant decreases in the rate of immunohistochemistry, percentage of reports with 2 pathologists’ names, and percentage of cytology and endocrine cases were noted for incoming consults. Only a decrease in the percentage of cases with 2 pathologists’ names was identified in outgoing consultations.

Conclusions:

Disagreements in interlaboratory anatomic pathology consults decreased over time, and some but not all changes had features associated with increased agreement.

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