title: Reducing false-negative and false-positive diagnoses in anatomic pathology consultation material.
abstract: BACKGROUND
  Previous studies have shown that there are disagreements in interlaboratory consultation, including false-negative and false-positive diagnoses. To date, methods to reduce false-negative and false-positive diagnoses have been poorly documented.
  
  
  OBJECTIVE
  To identify features associated with false-negative and false-positive diagnoses in anatomic pathology.
  
  
  METHODS
  We reviewed the results of interlaboratory consultation in our institution during a 9-year period. For false-negative and false-positive diagnoses, methods that might have prevented the error were identified.
  
  
  RESULTS
  Disagreements were identified in 810 of 8082 consults (10%). Fifty-four false-negative cases (0.7% of all consults) and 27 false-positive cases (0.3%) were identified. False-negative cases were more common in breast (20 of 1131; 1.8%), genitourinary (16 of 970; 1.7%), hematologic (3 of 242; 1.3%), and cytology (3 of 404; 0.8%) than in all other sites combined (P < .001); no significant difference in sites were identified for false-positive cases. Overall, there was no difference in the percentage of cases that were reviewed by more than one pathologist in either false-negative cases (109 of 810; 13.5%) or false-positive cases (135 of 810; 16.7%), compared with all other consults (858 of 7272; 11.8%) (P = .74 and .59, respectively). However, on review, 12 of all 27 false-positive cases (44%) might have been prevented by the use of immunohistochemistry alone, and 36 of all 54 false-negative cases (67%) might have been prevented by the use of a second review; special stains, including immunohistochemistry; additional levels; changes in processing; and hedges.
  
  
  CONCLUSIONS
  Approximately one-half of false-negative and false-positive cases (48 of 81; 59%) might be preventable by the use of a combination of pathologic methods.
authors.affiliation: From the Department of Pathology, Baptist Hospital of Miami, Miami, Florida.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: Edwin W
authors.initials: EW
authors.lastname: Gould
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003142:Communication; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005189:False Positive Reactions; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007755:Laboratories, Hospital; D010338:Pathology, Clinical / Q000379:methods*; D012189:Retrospective Studies; D014565:Urogenital Neoplasms / Q000175:diagnosis* / Q000473:pathology