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Original Articles
- Review of Medical Advisory Services by the Korean Society of Pathologists from 2003 to 2014
- Min Hye Jang, Geon Kook Lee, Han Seong Kim, Wan Seop Kim
- J Pathol Transl Med. 2016;50(1):37-44. Published online November 17, 2015
- DOI: https://doi.org/10.4132/jptm.2015.09.18
- 7,533 View
- 57 Download
- 1 Web of Science
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Abstract
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Supplementary Material - Background
Since 2003, the Korean Society of Pathologists (KSP) has been officially providing medical advisory services (MAS). We reviewed the cases submitted to the KSP between 2003 and 2014. Methods: In total, 1,950 cases were submitted, most by private health insurance companies. The main purposes of the consultations were to clarify the initial diagnoses and to assign a proper disease classification code. We comprehensively reviewed 1,803 consultation cases with detailed information. Results: In spite of some fluctuations, the number of submitted cases has been significantly increasing over the 12 study years. The colon and rectum (40.3%), urinary bladder (14.2%), and stomach (6.9%) were the three most common tissues of origin. The most common diagnoses for each of the three tissues of origin were neuroendocrine tumor (50.7%), non-invasive papillary urothelial carcinoma (70.7%), and adenocarcinoma (36.2%). Regardless of the tissue of origin, neuroendocrine tumor of the digestive system was the most common diagnosis (419 of 1,803). Conclusions: In the current study, we found that pathologic consultations associated with private health insurance accounted for a large proportion of the MAS. Coding of the biologic behavior of diseases was the main issue of the consultations. In spite of the effort of the KSP to set proper guidelines for coding and classification of tumors, this review revealed that problems still exist and will continue to be an important issue.
- Second Opinion Diagnoses of Cytologic Specimens on Consultation : Asan Medical Center Experience.
- Sohyung Park, Jae Y Ro, Kyung Ja Cho, Gyungyub Gong, Yong Mee Cho, Shin Kwang Khang
- Korean J Cytopathol. 2008;19(2):99-106.
- DOI: https://doi.org/10.3338/kjc.2008.19.2.99
- 2,039 View
- 12 Download
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Abstract
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- BACKGROUND
Second opinion diagnosis of outside pathology slides is a common practice for efficient and proper patient management. We analyzed cytology slides from outside hospitals submitted for a second opinion diagnosis to determine whether the second opinion diagnosis had any influence on patient care.
METHODS
We reviewed 1,153 outside cytology slides referred to Asan Medical Center for second opinions from January, 2007, to December, 2007. All cases were categorized into three groups; no diagnostic discrepancy, minor diagnostic discrepancies (no impact on the management), and major diagnostic discrepancies (significant impact on the management and subsequent follow-up).
RESULTS
The thyroid was the most common organ system (933 cases, 80.9%). Forty cases (3.6%) belonged to the major diagnostic discrepancy group and 149 cases (12.8%) to the minor discrepancy group. For validation of second opinion diagnoses in major discrepancy cases, subsequent biopsy or surgical resection specimens and clinical information were reviewed, which were available in 29 cases. The second opinion diagnoses resulted in alteration of clinical management in 21 of 29 cases.
CONCLUSION
For all referred patients, second opinion diagnosis is important and mandatory for appropriate patient care.
- Quality Assurance of Intraoperative Consultation Review Analysis of 2,392 frozen sections.
- Dong Hae Chung, Jae Hee Suh, On Ja Kim
- Korean J Pathol. 1997;31(4):332-341.
- 2,046 View
- 47 Download
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Abstract
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- A retrospective quality assurance study of intraoperative consultation (frozen section) was carried out to assess the accuracy and to determine the reasons of discordance. Of 14,977 surgical pathology cases accessioned over a 6-month period in Asan Medical Center, frozen sections were done on 1,270 (8.5%) patients and 2,392 frozen sections (1.88 frozen sections/case) were performed. Discordance was noted in 106 cases (4.4%) and diagnosis was deferred in 26 cases (1.1%). All deferred cases were reviewed with the result of 53.8% justified and 46.2% unjustified. The discordant cases were divided into three categories as to their clinical significances: category A (no affect on patient care) 61.3%, B (minimal affect) 9.4%, and C (major affect) 29.2%. Of 31 category C cases, 7 cases were false positive and 24 cases were false negative. Misinterpretation (70.8%) was the leading cause of discordance, followed by sampling error (15.1%), failure to identify lesion (8.5%), and technical problem (5.7%). More than one-third (35.8%) of all discordances were of central nervous system cases. Total central nervous system cases were 403 (16.8%) with a significantly higher disordance rate (9.8%) and deferral rate (2.5%) in comparison to the other cases with 3.4% discordance rate and 0.8% deferral rate. There were 43 colorectal cancer cases of intraoperative consultation for adequacy of resectional margins. The surgical margins were between 0.4 cm and 28 cm (mean: 6.7 cm) away from the tumor and there was no tumor-positive case. The study indicates surgical pathology should 1) promote interpretative skills in cases involving minute fragments of neurosurgical cases, 2) defer the diagnosis and ask for more tissue on inadequate or inappropriate specimens and 3) give only gross opinions without unnecessary frozen section procedures in the event of simple, clear-cut cases.
- Second Opinion Diagnostic Discrepancy in Surgical Pathology: Asan Medical Center Experience.
- Young Min Kim, Kyung Ja Cho, Sun Young Jun, Mi Sun Choe, Shin Kwang Khang, Jae Y Ro
- Korean J Pathol. 2003;37(5):301-306.
- 2,055 View
- 35 Download
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Abstract
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- BACKGROUND
Review of the outside pathology material is an important practice that provides useful information on patient managements and improves the diagnostic quality in surgical pathology. We report our experience with the frequency and types of diagnostic discrepancies in patients referred to the Asan Medical Center for treatment or a second opinion.
METHODS
All referral pathology diagnoses (867 surgical cases) made from October 2001 to July 2002 at Asan Medical Center were compared with outside pathology diagnoses.
RESULTS
Of the 867 surgical cases reviewed, 231 (26.7%) cases had a diagnostic discrepancy, which included 49 (5.7%) major and 182 (21.0%) minor discrepancies. The contents of the major discrepancies were a change in the diagnosis (34 cases), a change in the type of malignancy including small cell carcinoma and non-small cell carcinoma of the lung (10), a diagnosis of a metastasis as the primary lesion (4), and errors in interpreting the invasiveness (1). The causes or reasons for the major discrepancy were a difference in interpretation (81.6%), the availability of special studies (10.2%), a failure to identify the lesions (4.1%), and a lack of clinical information (4.1%).
CONCLUSIONS
The major discrepancy rate (5.7%) was comparable to that of the other reports from western countries. Among the major discrepancies, a change in diagnosis was most commonly observed and difference in interpretation was the most common reason. A routine review of all the patients pathology material is recommended for all referral patients for an improvement in the pathologic diagnoses and to provide better medical care.
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