title: Consultative issues in surgical neuropathology: a retrospective review of the rationale for submitting cases for expert review.
abstract: OBJECTIVE
  Second opinions on neuropathology cases are sought for a variety of reasons. We investigated the rationales for seeking expert neuropathologic review.
  
  
  METHODS
  A retrospective review was done of the correspondence accompanying neuropathology cases submitted over a 5-year period. The review used a taxonomy of referral reasons, the submitting diagnoses, and requests for ancillary tests.
  
  
  RESULTS
  In total, 508 adult cases were submitted, including glioblastoma (n = 94), anaplastic astrocytoma (n = 49), low-grade glioma (n = 49), oligodendroglioma (n = 48), and pituitary adenoma (n = 12). Thirty-nine cases submitted requested ancillary testing. A taxonomy of four categories revealed the following: preliminary diagnosis (n = 228 cases) was the most common reason for requesting review, followed by no diagnosis rendered (n = 183 cases), second opinion (n = 53), and confirmation/quality assurance (n = 43); the remaining case was "other." Overall, 456 cases were submitted by pathologists, 40 by clinicians and 12 by patients.
  
  
  CONCLUSIONS
  Pathologists who predominately submit cases with a preliminary diagnosis rendered seek expert consultation while clinicians seek a second opinion.
authors.affiliation: From the Department of Surgery, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC;
authors.forename: Eric S
authors.initials: ES
authors.lastname: Lipp
authors.affiliation: Duke Cancer Institute, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC; and.
authors.forename: Alysha C
authors.initials: AC
authors.lastname: Clark
authors.affiliation: Department of Pathology, Duke University School of Medicine, Durham, NC. mclen001@mc.duke.edu.
authors.forename: Roger E
authors.initials: RE
authors.lastname: McLendon
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009462:Neurology / Q000706:statistics & numerical data*; D010336:Pathology / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Consultations; Histology; Neuropathology; Quality assurance; Second reviews