Thank you, no.

Abstract

In the special article ‘‘Just Say No to the Use of No: Alternative Terminology for Improving Anatomic Pathology Reports,’’ Andrew Renshaw, MD, and colleagues, showing an admirable concern for patient safety and diagnostic accuracy, make a novel suggestion to exclude the words ‘‘no’’ and ‘‘not’’ from anatomic pathology reports, claiming that these oft-used words are ‘‘dangerous’’ because they are occasionally missed on transcription and not corrected by the pathologist on review prior to sign out. As an alternative, Dr Renshaw and colleagues suggest using ‘‘negative for’’ rather than ‘‘not seen’’ and suggest using the alternative words ‘‘negative,’’ ‘‘benign,’’ or ‘‘unremarkable’’ in place of no and not. The author states that ‘‘[t]he advantage of these terms is that when the negative word is missing [from the final diagnosis] the sentence no longer makes sense,’’ whereas in cases where no was inadvertently left off the final diagnosis, the incorrect diagnosis goes unrecognized by the clinician because it makes sense. One must question though whether the final diagnosis sans no or not actually does make sense. Although the diagnosis used as an example by Dr Renshaw and colleagues, ‘‘lymph node with carcinoma seen,’’ is grammatically appropriate, it is not a phrase many pathologists are likely to use or clinicians to accept without question. In fact, the clinician in the author’s case recognized the oddity of the final diagnosis and ‘‘caught the mistake.’’ 1 The reason that the phrase ‘‘no carcinoma identified’’ makes sense and the (mistranscribed and uncaught by the pathologist’s review prior to signing out) phrase ‘‘carcinoma identified’’ does not is that, with pertinent negatives, once it is stated in the final diagnosis that the disease or condition is not identified, it is not necessary to further elaborate on the issue, whereas where carcinoma is identified (or any of a number of other malignant and nonmalignant conditions such as lymphoma, granuloma, viral cytopathic effect, metastatic carcinoma, foreign material, vasculitis, fungal organisms, etc), the mere rendering of such a diagnosis without further qualification is insufficient and therefore nonsensical. Further description is necessary to determine what type of carcinoma (adenocarcinoma, squamous cell carcinoma, poorly differentiated non–small cell carcinoma, etc), lymphoma, granuloma, and so forth and that description is an integral part of the final diagnosis. As such, in the case referred to by Dr Renshaw and colleagues, a diagnosis of ‘‘carcinoma identified’’ is by itself nonsensical and prompted clinician inquiry. Of the 8 cases referred to in their article for which no or not was not correctly transcribed and not identified upon review by the pathologist, 7 of 8 diagnoses make no sense upon initial reading and should prompt a clinician inquiry: 5 of the 8 final diagnoses stated ‘‘specific pathologic change’’ instead of ‘‘no specific pathologic change,’’ one stated ‘‘carcinoma seen’’ instead of ‘‘no carcinoma seen,’’ and one stated ‘‘monoclonal staining seen’’ rather than ‘‘no monoclonal staining seen.’’ 1 Even with the eighth case noted in the article, although the incorrect final diagnosis is not nonsensical at first glance, it is arguable that the diagnosis ‘‘diagnostic features of celiac disease are seen’’ (rather than ‘‘diagnostic features of celiac disease are not seen’’) might prompt the clinician to examine the microscopic description to see what specific changes are present or how severe the changes are.