COMMENTARY

Laboratory Results That Should Be Ignored

Dirk M. Elston, MD

Disclosures

October 11, 2006

Spurious Anatomic Pathology Results

Efforts to classify anatomic pathology errors and assess their influence on clinical outcomes have been hampered by marked differences in reporting practices and lack of a uniform classification scheme for errors in anatomic pathology.[32] As with clinical pathology, quality improvement efforts have traditionally centered on the analytic phase, with an emphasis on peer review of a percentage of cases, correlation of frozen-section and permanent-section diagnoses, case conferences, and consultations. Quality measures of the pre- and postanalytic phases have generally been limited to patient and site verification and turnaround time. Additional gains in quality may be achieved by focusing on the entire testing cycle and patient outcomes.

Interpretative anatomic pathology reports can be of value. An example is the cytologic atypia that is characteristic of so-called "ancient schwannomas." Although the nuclei are strikingly atypical, the tumors behave in a completely benign fashion.[33] The lack of clinical significance must be clearly communicated in order to avoid unnecessarily extensive surgery. Perineuriomas represent another group of benign tumors with a wide spectrum of histologic appearance. Atypia and hypercellularity showed little correlation with clinical behavior.[34] Similar "ancient" atypia occurs in a host of other neoplasms.[35,36,37,38,39] Unambiguous communication of the lack of significance of the finding is essential to avoid overly aggressive treatment.

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