Impact of second-opinion dermatopathology reviews on surgical management of malignant neoplasms.
J Am Acad Dermatol
; 84(5): 1385-1392, 2021 May.
Article
in En
| MEDLINE
| ID: mdl-33333152
ABSTRACT
BACKGROUND:
Second-opinion review is linked to error reduction and treatment changes in anatomic pathology.OBJECTIVE:
We sought to establish the rate of diagnostic discrepancy identified by second-opinion dermatopathologic review and the effect on surgical treatment.METHODS:
Cases referred for treatment of a malignant neoplasm diagnosed by an outside pathologist were reviewed. The external and internal second-opinion dermatopathologic reports were compared. Discordance in diagnosis, subtype, and treatment change owing to second-opinion review was recorded. The referring pathologist's level of dermatopathologic training was also documented.RESULTS:
A total of 358 cases were included. Dermatopathologic second-opinion diagnosis was discordant with the outside diagnosis in 37 of 358 cases (10.3%). In 32 of 358 cases (8.9%), second-opinion review resulted in a change in treatment, with 28 of 32 (87.5%) of these changes resulting in cancelled surgery. Dermatologists without dermatopathologic fellowship training had the highest rate of discordant diagnoses compared with pathologists and dermatopathologists.LIMITATIONS:
This was a retrospective study at a tertiary care facility.CONCLUSION:
Second-opinion dermatopathologic review is associated with identification of discordant diagnoses and a substantial influence on treatment, with both cancellation of surgery and augmented management. Secondary pathologic review should be considered in high-volume surgical practices.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Referral and Consultation
/
Skin
/
Skin Neoplasms
/
Diagnostic Errors
/
Dermatologic Surgical Procedures
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
J Am Acad Dermatol
Year:
2021
Document type:
Article