title: Cytohistologic discrepancies: a means to improve pathology practice and patient outcomes.
abstract: The use of cytohistologic discrepancies to investigate and reduce error seldom is studied. All gynecologic discrepancies (n = 283; 0.87% and 7.37% of all cytologic and histologic cases, respectively) and nongynecologic discrepancies (n = 146; 2.26% and 0.44% of all cytologic and histologic cases, respectively) for 26 months were classified as sampling or interpretive. Specimen type and pathologist discrepancy percentages, effect of discrepancies on patient outcome, and interobserver agreement of discrepancies were evaluated. Discrepancies were interpretive in 67% and 34% of gynecologic and nongynecologic cases, respectively. Statistically significant associations were seen between individual pathologist and discrepancy percentages. Breast (1.2%) and bronchial (0.8%) cytologic diagnoses had the highest discrepancy percentages. The kappa scores ranged from 0.02 to 0.45 for pairwise agreement of discrepant cases. Of nongynecologic interpretive discrepancies available for review, 63% (27/43) and 14% (6/43) were of no or minor clinical significance, respectively. Cytohistologic correlation is a useful tool to monitor performance and to identify specimen types prone to error.
authors.affiliation: Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Clary
authors.forename: Jan F
authors.initials: JF
authors.lastname: Silverman
authors.forename: Yulin
authors.initials: Y
authors.lastname: Liu
authors.forename: Charles D
authors.initials: CD
authors.lastname: Sturgis
authors.forename: Dana M
authors.initials: DM
authors.lastname: Grzybicki
authors.forename: Laura K
authors.initials: LK
authors.lastname: Mahood
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Raab
mesh_terms: D001706:Biopsy; D001707:Biopsy, Needle; D001921:Brain / Q000473:pathology; D001941:Breast Diseases / Q000473:pathology; D001982:Bronchial Diseases / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology; D003581:Cytodiagnosis / Q000592:standards*; D003951:Diagnostic Errors; D005260:Female; D005831:Genital Diseases, Female / Q000473:pathology; D006653:Histology / Q000592:standards*; D006801:Humans; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D010336:Pathology / Q000592:standards*