The impact of second opinion surgical pathology on the practice of head and neck surgery: a decade experience at a large referral hospital.
BACKGROUND
A second review of histopathologic diagnoses is a quality assurance practice that helps expose diagnostic errors and guide management of patients being referred from outside hospitals. Identification of anatomic regions and specimen types that are prone to diagnostic error will be helpful in guiding policy decisions regarding mandatory second opinion surgical pathology.


METHODS
All available outside pathology reports were retrieved for patients referred to The Johns Hopkins Hospital Department of Otolaryngology-Head and Neck Surgery between January 1, 1990, and January 1, 2000. The outside diagnosis was compared with diagnosis rendered at the referral hospital. A discrepant diagnosis was regarded as any change resulting in a significant modification in therapy or prognosis.


RESULTS
Of the 814 cases reviewed, the second opinion surgical pathology diagnosis resulted in 54 (7%) changed diagnoses. Of the changed diagnosis, 13 (24%) involved a change from a benign to a malignant diagnosis; 8 (15%) involved a change from a malignant to a benign diagnosis; and 33 (61%) involved a change in tumor classification. Follow-up information supported the second opinion diagnosis in 41 of 43 cases (95%).


CONCLUSIONS
In a consequential number of cases, second opinion surgical pathology results in major therapeutic and prognostic modifications for patients sent to large referral hospitals for head and neck oncologic surgery.
Department of Pathology, The Johns Hopkins Medical Institutions, The Weinberg Cancer Center, Room 2242, 410 N. Broadway, Baltimore, MD 21231, USA. wwestra@jhmi.edu
William H
WH
Westra
Joseph D
JD
Kronz
David W
DW
Eisele
D001859:Bone Neoplasms / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D019300:Medical Errors; D009062:Mouth Neoplasms / Q000473:pathology; D009367:Neoplasm Staging; D010340:Pathology, Surgical; D010610:Pharyngeal Neoplasms / Q000473:pathology; D011379:Prognosis; D012017:Referral and Consultation; D012468:Salivary Gland Neoplasms / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology; D012983:Soft Tissue Neoplasms / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology