Anatomic Pathology / MEASURING AND REPORTING ERRORS IN SURGICAL PATHOLOGY

Substantial improvements in measuring and reporting errors in gynecologic cytology have been made during the last decade. Measuring and reporting errors in surgical pathology recently has gained renewed interest. However, review of current literature demonstrates mistakes in how these data are measured and reported. Error rates have been reported from review of consecutive material, biopsy material, and consultation material and range from 0.25% to 43%. Errors have been divided into anatomic regions and specimen types and separated according to their clinical significance. However, to be comparable, errors must be reported in reference to the incidence of disease and not to overall caseload. Blinding and reviewer error have been addressed only rarely, and the true incidence of errors is almost certainly higher than reported. “Gold standards” are not well defined. In addition, available data strongly suggest that the greatest source of error is with false-negative diagnoses, which are detected only rarely by review of consultation material. Most of these issues have been addressed in the gynecologic cytology literature. Errors in surgical pathology are more common than generally believed, and efforts should be made to define methods that allow appropriate interlaboratory comparisons. Measuring quality in surgical pathology is extremely difficult. In a way, it is like pornography: pathologists know quality when they see it, but they have been unable to define it. All pathologists know of laboratories and pathologists that they would consider high quality and those they would not. Yet defining criteria to measure and support their beliefs remains elusive. Gynecologic cytology has been through an agonizing decade as it continues to search to define acceptable standards of practice. Although the focus has been more on legal than quality assurance measures, the fundamental issues are the same: how does one define an error, and what are acceptable and unacceptable individual errors and overall error rates? The central causes of the pain of the last decade have been a massive underestimation of the error rate, extremely poor and inaccurate methods to measure this rate, and reluctance to face the fact that error is an unavoidable part of the task.1-3 Nevertheless, there is much cause for hope in gynecologic cytology, with more accurate methods of defining errors becoming increasingly available, for both legal and quality assessment purposes. Can surgical pathology benefit from the experience of gynecologic cytology? This article reviews the available literature on errors in surgical pathology and focuses on methodologic problems with this literature that previously have been dealt with in gynecologic cytology.