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Sources of Error in Neuropathology Intraoperative Diagnosis

Published online by Cambridge University Press:  02 December 2014

Matthew Meyer ,
Julia Keith-Rokosh ,
Hasini Reddy ,
Joseph Megyesi  and
Robert R. Hammond
Matthew Meyer
Affiliation:
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London Health Sciences Centre, London
Julia Keith-Rokosh
Affiliation:
Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Hasini Reddy
Affiliation:
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Joseph Megyesi
Affiliation:
Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, London
Robert R. Hammond*
Affiliation:
Department of Pathology, University of Western Ontario, London Health Sciences Centre, London Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, London
*
Department of Pathology, London Health Sciences Centre, 339 Windermere Road, London, Ontario, N6A 5A5, Canada.
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Abstract

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Objective:

The goal of this study was to optimize intraoperative neuropathology consultations by studying trends and sources of diagnostic error. We hypothesized that errors in intraoperative diagnoses would have sampling, technical, and interpretive sources. The study also audited diagnostic strengths, weaknesses and trends associated with increasing experience. We hypothesized that errors would decline and that the accuracy of “qualified” diagnoses would improve with experience.

Methods:

The pathologist's first 100 cases (P1), second 100 (P2), and most recent 100 (P3, after ten years in practice) formed the data set. Intraoperative diagnoses were scored as correct, minor error or major error using the final diagnosis as the gold-standard. Incorrect diagnoses were re-examined by two reviewers to identify sources of error.

Results:

Among the 300 cases there were 22 errors with 11 in P1, 9 in P2 and 2 in P3. Sampling contributed to 17 errors (77%), technical factors to 7 (32%) and interpretive factors to 16 (73%). Improvement in diagnostic accuracy between P1 and P2 (p=0.8143), or P2 and P3 (p=0.0582) did not reach significance. However, significant improvement was found between P1 and P3 (p=0.0184).

Conclusion:

The present study was a practical and informative audit for the pathologist and trainees. It reaffirmed the accuracy of intraoperative neuropathology diagnoses and informed our understanding of sources of error. Most errors were due to a combination of sampling, technical and interpretive factors. A significant improvement in diagnostic proficiency was observed with increasing experience.

Résumé:

RÉSUMÉ:Objectif:

Le but de cette étude était d’optimiser les consultations neuropathologiques extemporanées en étudiant les tendances et les sources d’erreurs de diagnostic. Nous avons émis l’hypothèse que les sources d’erreurs de diagnostic extemporané proviennent de l’échantillonnage, de la technique et de l’interprétation. L’étude a également vérifié les forces diagnostiques, les faiblesses et les tendances associées à des niveaux croissants d’expérience. Nous avons émis l’hypothèse que le nombre d’erreurs diminuerait et que la précision des diagnostics "vérifiés" s’améliorerait avec l’expérience.

Méthodes:

Les données analysées incluent les 100 premiers cas examinés par un mème pathologiste (P1), les 100 cas suivants (P2) et les 100 cas les plus récents (P3, après 10 ans de pratique). Les diagnostiques extemporanés ont été classifiés comme étant exacts, comportant une erreur mineure ou une erreur majeure par rapport au diagnostic final utilisé comme référence. Les diagnostics incorrects ont été réexaminés par deux réviseurs pour identifier les sources d’erreurs.

Résultats:

Parmi les 300 cas, il y avait 22 erreurs dont 11 dans le groupe P1, 9 dans le groupe P2 et 2 dans le groupe P3. L’échantillonnage a contribué à 17 erreurs (77%), des facteurs techniques à 7 (32%) et des facteurs d’interprétation à 16 (73%). L’amélioration de l’exactitude du diagnostic entre P1 et P2 (p = 0,8143), ou P2 et P3 (p = 0,0582) n’était pas significative au point de vue statistique. Cependant, une amélioration importante a été constatée entre P1 et P3 (p = 0,0184).

Conclusion:

Cette étude constitue une vérification pratique et instructive pour le pathologiste et les résidents. Elle confirme l’exactitude des diagnostics neuropathologiques extemporanés et éclaire notre compréhension des sources d’erreurs. La plupart des erreurs étaient dues à une combinaison de facteurs reliés à l’échantillonnage, à la technique et à l’interprétation. Une amélioration significative de la compétence diagnostique a été observée à mesure que l’expérience croissait.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 620 - 624
Copyright
Copyright © The Canadian Journal of Neurological 2010

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