자문 재판독을 통한 외과 병리에서의 진단 불일치에 관한 연구: 서울아산병원의 경험
Second Opinion Diagnostic Discrepancy in Surgical Pathology: Asan Medical Center Experience
김영민, 강신광, 노재윤, 조경자, 전선영, 최미선,
소속 상세정보
김영민 ( Kim Young-Min )
울산대학교 의과대학 서울아산병원 병리과
강신광 ( Khang Shin-Kwang )
울산대학교 의과대학 서울아산병원 병리과
노재윤 ( Ro Jae Y. )
울산대학교 의과대학 서울아산병원 병리과
조경자 ( Cho Kyung-Ja )
울산대학교 의과대학 서울아산병원 병리과
전선영 ( Jun Sun-Young )
울산대학교 의과대학 서울아산병원 병리과
최미선 ( Choe Mi-Sun )
울산대학교 의과대학 서울아산병원 병리과
KMID : 0357920030370050301
Abstract
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.
키워드
Referral and Consultation;Pathology;Surgical;Quality Assurance
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