A retrospective audit of skin biopsies done in a tertiary care center in India.

Abstract

Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome. The aim of this study was to retrospectively assess the quality of data included in the pathology request forms and reports and to assess the level of clinicopathological correlation in the reported biopsy specimens. We retrospectively analyzed 3006 histopathology request forms and reports of skin, mucosal, and nail biopsies to assess the quality of data included in them and assessed the level of clinicopathological correlation in these biopsies. Two hundred discordant histopathology slides were randomly reviewed by a pathologist in the presence of a dermatologist to analyze the causes for discordance. The pathological diagnosis was concordant with clinical diagnosis in 1798 (59.8%) biopsies, partially concordant in 228 (7.6%) biopsies, and discordant in 929 (30.9%) biopsies. In a clinicopathologically concordant category, the duration for reporting the biopsies was significantly shorter, and the definitive pathologist's diagnosis was frequently mentioned. Of the 200 discordant slides reviewed randomly by a pathologist in the presence of a dermatologist, 7.5% slides afterward turned out to be consistent and 15% partially consistent with the diseases in doubt. Several deficits were identified that need to be rectified to improve the diagnostic accuracy of skin biopsy. A portion of discordant slides showing features compatible with the disease when reviewed by a pathologist and dermatologist together emphasizes the importance of a joint review by both in doubtful cases.