A pathology case may be sent for outside consultation for a number of reasons. It may be the result of, or result in, diagnostic discordance.
Prior to or concurrent with the release of the initial final report:
(1) primary pathologist uncertain
(2) uncertainty after prospective review by two or more pathologists
(3) request of the attending or consultant physician
Soon after release of initial final report:
(1) request of attending or consultant physician
(2) request of patient
(3) retrospective review by one or more pathologists
(4) availability of new information, including a new specimen or discrepancy with prior diagnosis
Late after release of initial final report:
(1) request of attending or consultant physician
(2) request of patient
(3) per protocol of clinical trial or tumor registry
(4) availability of new information, including a new specimen or discrepancy with prior diagnosis
(5) request of a referral hospital
Impact of outside review:
(1) relative to pathology diagnosis
(2) significance for patient outcome
|
Pathology Diagnosis
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Impact Patient Outcome
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Overall Significance
|
|
unchanged
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unchanged
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none
|
|
minor change
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unchanged
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none
|
|
major change
|
unchanged or minor change
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minor, may be major for patient
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|
major change
|
major change
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major
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Major impact:
(1) malignant disease called benign, with delay in diagnosis
(2) benign disease called malignant, with exposure to chemoradiation
(3) significant difference in therapeutic regimen
