title: The Utility of Expert Diagnosis in Surgical Neuropathology: Analysis of Consultations Reviewed at 5 National Comprehensive Cancer Network Institutions.
abstract: The aim of this study was to characterize the type and degree of discrepancies between non-expert and expert diagnoses of CNS tumors to identify the value of consultations in surgical neuropathology. Neuropathology experts from 5 National Comprehensive Cancer Network (NCCN) member institutions participated in the review of 1281 consultations selected based on inclusion criteria. The consultation cases were re-reviewed at the NCCN headquarters to determine concordance with the original diagnoses. Among all consultations, 249 (19.4%) were submitted for expert diagnoses without final diagnoses from the submitting institution. Within the remaining 1032 patients, the serious/major discrepancy rate was 4.8%, and less serious and minor discrepancies were seen in 19.4% of the cases. The discrepancy rate was higher among patients who were referred to NCCN institutions for consultation compared to those who were referred for treatment only. The discrepancy rates, patient demographics, type of consultations and submitting institutions varied among participating NCCN institutions. Expert consultations identified a subset of cases with significant diagnostic discrepancies, and constituted the initial diagnoses in some cases. These data indicate that expert consultations in glial tumors and all types of pediatric CNS tumors can improve accurate diagnosis and enable appropriate management.
authors.affiliation: MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bruner
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Louis
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: McLendon
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Marc K
authors.initials: MK
authors.lastname: Rosenblum
authors.affiliation: Virtu Stat Ltd, North Wales, Pennsylvania, USA.
authors.forename: W Tad
authors.initials: WT
authors.lastname: Archambault
authors.affiliation: National Comprehensive Cancer Network (NCCN), Fort Washington, Pennsylvania, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Most
authors.affiliation: University of California San Francisco, San Francisco, California, USA.
authors.forename: Tarik
authors.initials: T
authors.lastname: Tihan
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities / Q000592:standards*; D016543:Central Nervous System Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069338:Neuropathology / Q000592:standards*; D000072142:Pathologists / Q000592:standards* / Q000706:statistics & numerical data*
keywords: Brain tumor; Diagnosis tic accuracy; Diagnostic discrepancies; Expert diagnoses; Neuropathology; Pathology consultation