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conferenceseries
.com
Volume 3
Diagnostic Pathology: Open Access
ISSN: 2476-2024
Laboratory Medicine 2018
June 25-26, 2018
June 25-26, 2018 | Berlin, Germany
13
th
International Conference on
Laboratory Medicine & Pathology
Second opinion in pathology: Still Not Automated. Evidence Pro and Evidence Against
Nickolas Myles
University of British Columbia, Canada
T
he objective of our study is to: 1. distinguish between error and opinion; contrast accuracy and precision in pathology
in respect to second review process. 2. Critically appraise and grade (Oxford system) core recent examples of published
evidence in support and against second reviews in pathology. 3. Contrast second opinion which is actively sought and “reflex”
second reviews (i.e. “node negative breast cancer etc.). 3. Apply AGREE tool for critical appraisal of guidelines to determine
the strength of the recommendations for second reviews in pathology. 4. Determine the efficient strategy to reduce diagnostic
discrepancies resulted after second reviews in pathology. We have conducted two comprehensive searches PUBMED using the
keywords: “2
nd
opinion, pathology”: 4214 references and “2
nd
opinion, pathology, outcomes: 727”. Of them, we further extracted
41 studies which contained numeric information on agreement, major and minor disagreement and whether pathology second
opinion change outcomes and/or patient management. The following were observed: 1. we identified several trends in the
extracted evidence: 2. lower discrepancy if one institution reviews itself; cases include full spectrum daily pathology; cases
when pathologists actively seek 2nd opinion excluded (i.e. I am uncertain and asking for help, so I refer the case, having no firm
diagnosis in the first place). 3. higher discrepancy if single institution reviews external cases; referred rather than population
based (referral bias due to higher complexity); additional tests performed/ new information given to 2nd pathologist (not
available to 1st pathologist); cases when 1st pathologist was uncertain (and thus referred) included with the others. Despite the
relatively common disagreement between the pathologist, the information whether such disagreements affect patient outcomes
is lacking. We present out data in an organized fashion as for the whole spectrum pathology, as by pathology subspecialty areas.
nmyles@providnecehealth.bc.caDiagn Pathol Open 2018, Volume 3
DOI: 10.4172/2476-2024-C1-003