Prospective peer review in fine needle aspiration cytology. Another step toward quality assurance.
OBJECTIVE
To analyze the effects of a prospective peer review program on diagnostic accuracy in a routine cytopathology laboratory.


METHODS
For the study, 4,836 consecutive cases subjected to fine needle aspiration cytology (FNAC) over a one-year period were used. Nine pathologists performed both reporting and peer review functions. Disagreements were classified into "diagnostic errors" and "diagnostic discrepancies," depending on their impact on patient care. The effect of this review on turnaround time was statistically analyzed. A retrospective review of 4,025 cases from the preceding year was performed for comparison.


RESULTS
Sixty-six cases with diagnostic disagreements were detected by prospective review. There were 28 diagnostic errors and 38 diagnostic discrepancies. The initial turnaround time for diagnostic FNAC in 90% of total cases was < 24 hours; mean delay for the remainder was 3.3 days. Prospective peer review added a further delay of 1 and 1.5 days, respectively. The number of diagnostic disagreements was significantly higher in the retrospective review (P < .01).


CONCLUSIONS
Prospective peer review of diagnostic FNAC resulted in improved accuracy of diagnosis and reduced potential for inappropriate therapy; however, turnaround time was significantly increased.
Department of Pathology, University College of Medical Sciences, Delhi, India.
A
A
Bhatia
N
N
Singh
V K
VK
Arora
K
K
Gupta
D001707:Biopsy, Needle / Q000592:standards; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary; D008223:Lymphoma / Q000175:diagnosis / Q000473:pathology; D009369:Neoplasms / Q000473:pathology*; D018024:Peer Review, Health Care; D011446:Prospective Studies; D011786:Quality Control; D012189:Retrospective Studies