Double check up of malignancy biopsy specimens for patient safety.
BACKGROUND
The diagnostic of malignancy in biopsy specimens is very important because it guides to selected treatment option and prognostic prediction. However biopsy specimens usually have small pieces leading to variations of the interpretation by anatomical pathologists.


OBJECTIVE
To detect and correct the errors or the significant discrepancies in the diagnosis of biopsy specimens before sign-out and to determine the frequency of anatomic pathology significant discrepancies.


METHODS
The application of the mutually agreed work instructions (record) for the detection of errors or the significant discrepancies and their process of sign-out. The record of biopsy specimen that received a secondary check (1959 cases, 2005-2007) was analyzed.


RESULTS
After a secondary check, 53 cases of non-malignancy for any reason by a second pathologist were included. However when using our definition on significant discrepancies, only 37 cases were considered. Another seven cases with the opinions with malignancy that were of different cell types that do harm to the patients were added. Therefore, 44 cases (2.25%) had truly significant discrepancies.


CONCLUSIONS
The truly significant discrepancy frequency was 2.25% during the process of pre-sign-out secondary check of malignancy of biopsy specimens. The project has been applied as a routine daily work. It can be an innovative safety program for patient in Thailand.
Department ofPathology, Faculty ofMedicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. p2517s@yahoo.com
Pattana
P
Sornmayura
Yingluck
Y
Visessiri
Mana
M
Rochanawutanon
Vorachai
V
Sirikulchayanonta
Rangsima
R
Aroonroch
Wasana
W
Kanoksil
Noppadol
N
Larbcharoensub
Sansanee
S
Wongwaisayawan
Juvady
J
Leopairut
Panas
P
Chalermsanyakorn
Suchin
S
Worawichawong
Niramol
N
Chanplakorn
Paisan
P
Leelachaikul
Atcharaporn
A
Pongtippan
D001706:Biopsy / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000145:classification / Q000517:prevention & control*; D006801:Humans; D009369:Neoplasms / Q000473:pathology*; D015588:Observer Variation; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D013785:Thailand