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This survey on errors in surgical pathology was commissioned by the Association of Directors of Anatomic and Surgical Pathology Council to explore broad perceptions and definitions of error in surgical pathology among its membership and to get some estimate of the perceived frequency of such errors. Overall, 41 laboratories were surveyed, with 34 responding to a confidential questionnaire. Six small, 13 medium, and 10 large laboratories (based on specimen volume), predominantly located in the United States, were surveyed (the remaining 5 laboratories did not provide this particular information). The survey questions, responses, and associated comments are presented. It is clear from this survey that we lack uniformity and consistency with respect to terminology, definitions, and the identification/documentation of errors in surgical pathology. An appeal is made for the urgent need to reach some consensus in order to address these discrepancies as we prepare to combat the issue of errors in surgical pathology.
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Three recommendation articles proposed by the Association of Directors of Anatomic and Surgical Pathology in the United States were presented as to serve as the baseline of the quality assurance in the pathomorphological diagnosis. The first article was related to the internal quality assurance in the pathology laboratories. The prospective and retrospective methods were presented for daily and monthly bases. The importance of the turnaround time was stressed in addition to the reliable diagnosis. The second article was concerned about the standardization of the surgical pathology report. This was accepted nationwide in the United States like the Bethesda System in cytology. The third article covered the consultation in surgical pathology. The Association divided the consultation into personal and institutional consultations. The role of the institutional consultation has increased markedly in recent years. This is related to the new trend of the patients and their families seeking the second opinion in the clinical diagnosis. In these situations, the clinician frequently requested the new diagnostic impressions of their own pathologists. The second opinion is very important in recent practice in medicine along with informed consent. The pathologists should also be aware of these subjects.
Actual opinions concerning the application of the surgical-pathological staging of patients with carcinoma of the uterine cervix are presented. On account of the analysis of the data taken from pertinent literature concerning among others the benefits of more precise diagnoses applying the diagnostic laparotomy, the author presents the opinion that surgical-pathologic staging appears to be expedient in early stages of clinical advancement of the neoplasms in association with radical surgical intervention. The expediency of this staging in more advanced cases is at present questionable in view of the inadequacy of so far applicable programmes of chemotherapy.
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Sentinel lymph node biopsy has been shown to be an accurate predictor of axillary nodal status in invasive breast cancer and is a useful alternative to axillary dissection for some patients. Because radioactive materials are often used to identify the sentinel lymph node, concerns have been raised regarding the safe handling of tissue specimens obtained by this technique. The Surgical Pathology Committee of the College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the safe handling of radioactive specimens obtained by sentinel lymphadenectomy.
Quality in surgical pathology may be defined as accurate, timely, and complete reports. Achieving quality requires substantial investment in the basic structure and in the people who undertake surgical pathology. Quality assurance and improvement works best when it is woven into the systems of surgical pathology with well informed, well trained, and knowledgeable staff.
Development of surgical pathology is documented, chiefly by reference to key publications in the field, beginning with the seventeenth century. Also included is a brief historical review of technical developments basic to progress in surgical pathology.
Modern surgical treatment of people according with legislation and health care law has to consider defining of tissue viability. The paper deals with the technique directed to evaluate specific tissue viability by structure functional alterations indices of mitochondrion crista. The technique can be introduced into clinic practice for above mentioned purposes.
Analogous to critical values (CVs) in clinical pathology, occasional diagnoses in surgical pathology could require immediate contact of the physician to rapidly initiate treatment. However, there are no established CV guidelines in surgical pathology. We studied the incidence of CVs in surgical pathology by retrospective review of 2,659 surgical pathology reports and surveyed the perceptions of 5 clinicians and 11 pathologists about CVs in surgical pathology. We identified 13 CV cases (0.49%); 4 of the 13 reports documented phone calls to the clinician (most at least 1 day before final sign-out), and in 2 other reports the requisition included clinical history that implied previous knowledge of the diagnosis. The survey results indicated that for most diagnoses there was a range of opinions about whether immediate treatment was necessary and the need for a stat phone call. CVs occur in surgical pathology, but often there is no documented phone call in the surgical pathology report. Because there is little agreement about which diagnoses require a phone call and the degree of urgency, a consensus conference might prove useful for establishing surgical pathology CV guidelines and could represent a practice improvement.
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