Improved cytodiagnostics and quality of patient care through double reading of selected cases by an expert cytopathologist.

Chantal C. H. J. Kuijpers,Daisy M. D. S. Sie-Go,Mathilda J. de Rooij,Mike Visser,Mehdi Jiwa,Henk de Leeuw,Paul J. van Diest

doi:10.1007/s00428-015-1738-3

Chantal C. H. J. Kuijpers, Daisy M. D. S. Sie-Go + Show 5 more

Open Access

https://doi.org/10.1007/s00428-015-1738-3

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Abstract

Double reading may be a valuable tool for improving the quality of patient care by restoring diagnostic errors before final sign-out, but standard double reading would significantly increase costs of pathology. The aim of this study was to assess the added value of routine double reading of defined categories of clinical cytology specimens by specialized cytopathologists. Specialized cytopathologists routinely re-diagnosed blinded defined categories of clinical cytology specimens that had been signed out by routine pathologists from January 2012 up to December 2013. Major and minor discordance rates between initial and expert diagnoses were determined, and both diagnoses were validated by comparison with same-site histological follow-up. Initial and expert diagnoses were concordant in 131/218 specimens (60.1 %). Major and minor discordances were present in 28 (12.8 %) and 59 (27.1 %) specimens, respectively. Pleural fluid, thyroid and urine specimens showed the highest major discordance rates (19.4, 19.2 and 16.7 %, respectively). Histological follow-up (where possible) supported the expert diagnosis in 95.5 % of specimens. Our implemented double reading strategy of defined categories of cytology specimens showed major discordance in 12.8 % of specimens. The expert diagnosis was supported in 95.5 % of discordant cases where histological follow-up was available. This indicates that this double reading strategy is worthwhile and contributes to better cytodiagnostics and quality of patient care, especially for suspicious pleural fluid, thyroid and urine specimens. Our results emphasize that cytopathology is a subspecialization of pathology and requires specialized cytopathologists.

Highlights

There is a growing awareness that pathology diagnosis is not infallible and that diagnostic errors may lead to under- or overtreatment and thereby compromise patient safety
Jiwa (*) Department of Pathology, Alkmaar Medical Centre, Symbiant Pathology Expert Centre, PO Box 501, 1815 JD Alkmaar, The Netherlands e-mail: m.jiwa@mca.nl ported in 95.5 % of discordant cases where histological follow-up was available. This indicates that this double reading strategy is worthwhile and contributes to better cytodiagnostics and quality of patient care, especially for suspicious pleural fluid, thyroid and urine specimens
Our results emphasize that cytopathology is a subspecialization of pathology and requires specialized cytopathologists

Summary

Introduction

There is a growing awareness that pathology diagnosis is not infallible and that diagnostic errors may lead to under- or overtreatment and thereby compromise patient safety. In response to the Institute of Medicine report ‘To err is human; building a safer health system’ from 1999 [1], the American Society for Clinical Pathology (ASCP) recognized second opinion as a key aspect in the assurance of patient safety for histological and cytological diagnoses [2]. They recommended to consider second opinion in several situations, including highly critical or significant cases, problemprone cases and cases suggested for review by clinicians [2]. A smaller number of studies focused on second opinion in cytopathology, of which the majority reported

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