title: Improvement of diagnostic agreement among pathologists in resolving an "atypical glands suspicious for cancer" diagnosis in prostate biopsies using a novel "Disease-Focused Diagnostic Review" quality improvement process.
abstract: One of the major goals of an anatomic pathology laboratory quality program is to minimize unwarranted diagnostic variability and equivocal reporting. This study evaluated the utility of Miraca Life Sciences' "Disease-Focused Diagnostic Review" (DFDR) quality program in improving interobserver diagnostic reproducibility associated with classification of "atypical glands suspicious for adenocarcinoma" (ATYP) in prostate biopsies. Seventy-one selected prostate biopsies with a focus of ATYP were reviewed by 8 pathologists. Participants were blinded to the original diagnosis and were first asked to classify the ATYP as benign, atypical, or limited adenocarcinoma. DFDR comprised a "theoretical consensus" (in which pathologists first reached consensus on the morphological features they considered relevant for the diagnosis of limited prostatic adenocarcinoma), a didactic review including relevant literature, and "practical consensus" (pathologists performed joint microscopic sessions, reconciling each other's observations and positions evaluating a separate unique slide set). Participants were finally asked to reclassify the original 71 ATYP cases based on knowledge gleaned from DFDR. Pre- and post-DFDR interobserver reproducibility of overall diagnostic agreement was assessed. Interobserver reproducibility measured by Fleiss κ values of pre- and post-DFDR was 0.36 and 0.59, respectively (P=.006). Post-DFDR, there were significant improvement for "100% concordance" (P=.011) and reduction for "no consensus" (P=.0004) categories. Despite a lower pre-DFDR reproducibility for non-uropathology fellowship-trained (n=3, κ=0.38) versus uropathology fellowship-trained (n=5, κ=0.43) pathologists, both groups achieved similarly high post-DFDR κ levels (κ=0.58 and 0.56, respectively). DFDR represents an effective tool to formally achieve diagnostic consensus and reduce variability associated with critical diagnoses in an anatomic pathology practice.
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039. Electronic address: rajalbshah@gmail.com.
authors.forename: Rajal B
authors.initials: RB
authors.lastname: Shah
authors.affiliation: IRCC De Bellis, Gastroenterology, Castellana Grotte, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Leandro
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: Gloria
authors.initials: G
authors.lastname: Romerocaces
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: James
authors.initials: J
authors.lastname: Bentley
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: Jiyoon
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: Savvas
authors.initials: S
authors.lastname: Mendrinos
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Tadros
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: Wei
authors.initials: W
authors.lastname: Tian
authors.affiliation: Division of Pathology, Miraca Life Sciences, Irving, TX 75039.
authors.forename: Richard
authors.initials: R
authors.lastname: Lash
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology*; D001707:Biopsy, Needle / Q000592:standards; D032921:Consensus; D006801:Humans; D008297:Male; D015588:Observer Variation; D010338:Pathology, Clinical / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011471:Prostatic Neoplasms / Q000145:classification / Q000473:pathology*; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D009626:Terminology as Topic; D057188:Workflow
keywords: Atypical glands suspicious for cancer (ATYP); Continuous quality improvement; Disease-focused diagnostic review; Interobserver variation; Prostate cancer