title: Histopathologic diagnosis of pediatric neoplasms: a review of international consultations.
abstract: BACKGROUND
  Correct histopathologic diagnosis is fundamental to defining proper treatment and improving outcomes in children with malignancies. The Department of Pathology at St. Jude Children's Research Hospital (SJCRH) has collaborated with SJCRH International Outreach Program partner sites to improve the accuracy of histopathologic diagnoses in countries with limited resources. Pathologists at SJCRH provide review and evaluation of cases that are considered difficult or complex.
  
  
  OBJECTIVE
  To determine the quality of pathology diagnosis and to identify areas for improvement in our international partner sites, we retrospectively analyzed all the international cases that were submitted for review. A comparison of our data with selected reports of surgical pathology error rates published in the medical literature was performed.
  
  
  METHODS
  From January 2009 through December 2011, SJCRH received 763 cases submitted by international pathologists from 37 countries for histopathologic review and evaluation. Of 763 cases reviewed, 705 (92.4%) met the criteria for inclusion in this study. Rates of concordance between the submitted diagnoses and SJCRH reviewed diagnoses were analyzed.
  
  
  RESULTS
  Overall concordance, minor disagreement, and major disagreement rates between submitted diagnoses and SJCRH reviewed diagnoses were 430 (61.0%), 98 (13.9%), and 177 (25.1%) of the cases, respectively. Major disagreement rates ranged from 13.7% to 37.1% among studied countries.
  
  
  CONCLUSIONS
  The major disagreement rate between referring international sites and SJCRH was substantially higher than the major disagreement rate among US institutions. Lack of the availability of immunohistochemistry and the training of pathologists in the diagnosis of pediatric neoplasms may have contributed to the discrepancies.
authors.affiliation: From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Santiago); and the Department of Pathology, St. Jude Children's Research Hospital, Memphis (Dr Jenkins).
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Santiago
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D003951:Diagnostic Errors; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038622:Internationality; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D012017:Referral and Consultation; D013714:Tennessee; D014481:United States; D055815:Young Adult