Concordance Rate of Institutional Pathology Consultation Cases in Philippine Children&rsquo;s Medical Center From January 2000 to December 2007

Manuelito  A. Madrid,; Lloyd  A. Mercado,

Concordance Rate of Institutional Pathology Consultation Cases in Philippine Children’s Medical Center From January 2000 to December 2007

Abstract:

BACKGROUND: Histopathologic evaluation is important in the field of medicine and therapeutics. To ensure that the highest quality of health care is given to patients with surgical pathology readings rendered in another institution, Institutional Pathology Consultation (IPC) is essential to reduce diagnostic variability. OBJECTIVE: To review the concordance rate of IPC cases in Philippine Children’s Medical Center. The sources of discrepancies are enumerated and the effects of changes in histopathologic reading on the management of patients are reviewed. METHOD: PCMC-IPC cases from January 1, 2000 to December 31, 2007 were collected and categorized as follows: (A) No diagnostic disagreement, (B) Non-specific diagnoses, and (C) Major diagnostic disagreement which is further subdivided into: (C1) Change from benign to malignant reading; (C2) Change from malignant to benign diagnosis; (C3) different type of neoplasm; (C4) ganglion cells assessment discrepancy. RESULTS: Slide review disagreements are largely from private laboratories (50%) and most commonly involve lymphoid tissues (65%). Reclassification of tumor under a totally different category from the previous reading comprises most of the diagnostic discordance (47%), while malignant to benign (33%) and vice-versa (9%) IPC readings followed. Ganglion cell evaluation inconsistencies are also noted (11%). Most cases (97%) with an altered IPC reading underwent therapeutic modification. CONCLUSION: There was a 38% discordance rate among cases reviewed for IPC at PCMC. Majority of diagnostic disparities are from private laboratories and involve the lymphoid system. Most of the discordant cases were reclassified as tumors. Many patients with altered IPC reading underwent a significant change in the therapeutic protocol after review.

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