Study of parameters to ensure quality control in histopathology reporting: A meta-analysis at a tertiary care center.

Context : When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Measuring the rate at which surgical pathology reports are amended can be used as a tool for assuring quality control in histopathology. Aim : The aim of this study was determine the parameters that can be used as an assessment tool to minimize errors in histopathology. Materials and Methods : This study was carried out at a major histopathology center. The duration of this study was from January 2001 through January 2011(ten years). Following parameters were looked for: Interpretational errors, permanent and frozen section correlation, intradepartmental consultation and cases sent for second opinion, cases brought in tissue committee meetings, audits, and cases discussed in hospital meetings. Results : A total of 28,1931 surgical pathology cases were signed out during the ten-year period. On these, addendums were issued on 5730 cases (2.0%). Additional report issued on 3521 (1.3%). Addendum/corrected report issued for 2209 cases, which was 0.7%, representing the true interpretational error. And out of this number, a second opinion was taken for 5980 cases, and 78 were sent abroad for second opinion. Conclusion : Review by a second pathologist is a strong tool to minimize errors in surgical pathology reporting. This may be done prior to or after the report is dispatched and the case is discussed in the hospital for treatment purposes. This analysis concludes that true interpretational error occurred only in 0.7% of cases, which is an attribute to the strong peer review in the department.

Protocolos de atención de enfermedades quirúrgicas más frecuentes en adultos / Care protocols most common surgical diseases in adults

El Gobierno de Reconciliación y Unidad Nacional a través del Ministerio de Salud, presente el siguiente documento Protocolos de atención de enfermedades quirúrgicas más frecuentes en adultos, que es una recopilación de los servicios de los Hospitales Alemán Nicaraguense y Antonio Lenin Fonseca quienes iniciaron revisión, actualización y elaboración de guías clínicas de las principales patologías atendidas en los servicios. Este trabajo se base en la búsqueda de la unificación de criterios y la mejor utilización de recursos en función de brindar un servicio eficaz y de calidad para nuestros usuarios y usuarias...

Uso prático da imuno-histoquímica em patologia cirúrgica / Practical use of immunohistochemistry in surgical pathology

OBJETIVO: avaliar o motivo para indicação e analisar o grau de auxílio da imuno-histoquímica (IHQ) para o diagnóstico de neoplasias e lesões pseudoneoplásicas. MATERIAL E MÉTODO: avaliação retrospectiva observacional e descritiva de 4.459 casos submetidos a análise no laboratório de IHQ do Departamento de Patologia do Jackson Memorial Hospital, Universidade de Miami, Estados Unidos, em 1999. RESULTADOS: 3.706 casos possuíam dados suficientes para o desenvolvimento dos objetivos propostos. Em 19 por cento dos casos a IHQ foi utilizada para determinar fatores prognósticos ou índices proliferativos; em 17 por cento dos casos teve como objetivo identificar microrganismos, células, estruturas ou materiais; e em 64 por cento dos casos teve aplicação diagnóstica propriamente dita. Em 835 casos desta última categoria a IHQ contribuiu para um diagnóstico específico em 83 por cento das vezes e diminuiu o número de diagnósticos diferenciais em 12 por cento. Em 5 por cento das vezes a IHQ não auxiliou o patologista devido a exigüidade de algumas amostras, presença de necrose extensa ou indiferenciação extrema de algumas neoplasias. Os principais problemas de diagnóstico diferencial para os quais a IHQ foi utilizada foram: determinar o local de origem de carcinomas e adenocarcinomas e diferenciar entre hiperplasia mesotelial reacional, mesotelioma e adenocarcinoma, entre outros. Foram utilizados 4,1 anticorpos por caso, em média. CONCLUSÕES: Quando bem indicada e aplicada, a imuno-histoquímica é um método diagnóstico complementar útil em 95 por cento dos casos e muitas vezes contribui fundamentalmente para as condutas cirúrgica e terapêutica. Amostras muito exíguas ou necróticas e neoplasias extremamente indiferenciadas são situações que comprometem o exame imuno-histoquímico e seus resultados. Quando utilizada de maneira direcionada aos principais diagnósticos diferenciais, a técnica apresenta uma relação custo/benefício alta.

Errors by surgical pathologists in India: results of a questionnaire survey.

BACKGROUND: Data from the United Kingdom show that most surgical pathologists are aware of about one serious mistake in their reports every year. There are no corresponding data from India or the developing world. I made an attempt to determine the rate of error made by Indian pathologists. METHODS: A postal questionnaire was sent to 96 pathologists and 71 clinicians in different cities. The questions included some related to their experience with error in histopathology, as well as a few on the respondents' views on the legal and ethical aspects in the case of medical error. RESULTS: Fifty pathologists and 47 clinicians responded. Of the evaluable responses, 32 pathologists were aware of 86 errors in the past 5 years, while 30 clinicians recalled 162 errors. Most mistakes that pathologists remembered were cases related to lymphoid disease (n = 15) while for clinicians, gastrointestinal tract (n = 12) and lymphoid tissue (n = 9) were common sites of error. Benign-malignant errors were the most common type of error. CONCLUSION: The discrepancy between the rates of error between the two groups suggests that better pathologist-clinician communication is required. Medical councils and related governing bodies should consider introducing a quality control programme for anatomic pathology.

Relatório anatomopatológico em carcinoma da mama: fatores morfológicos tradicionais / Anatomopathological report in breast carcinoma: traditional morphological factors

A autora descreve o relatório anatomopatológico que serviu de base para a 8ª Reunião de Consenso da Sociedade Brasileira de Mastologia, realizado em 28 de abril de 2001 em Gramado

The role of pathologist during surgery non palpable lesions and safety ressection in quadrantectomy

The value of frozen section examination of non-palpable lesions and surgical margins in conserving-surgery is discussed. Although the aplication of such examination is controversial, we present the advantages of this method based on our experience in 95 wire-localized biopsies of nonpalpable mammographic abnormality and 60 conserving-surgery. The intra-surgical examination permitted the definitive diagnosis in 64 (86,5 per cent) of the cases of nonpalpable abnormality and determined the better extension of surgical procedure in 48,3 per cent of the quadrantectomies. The intra-surgical examination performed by qualified personell permits the control of adequade ressection avoiding the re-excision due to persistence of the radiological image or involved margins.

Patología infecciosa en personal de quirófano / Infectious diseases in the surgical team

Las enfermedades infecciosas son uno de los principales riesgos a los que se expone el personal de quirófano. La probabilidad de adquirirlas es mayor en centros de investigación y hospitales, y está en relación a las categorías de trabajo y los servicios. Las principales son la hepatitis B, C y D, y el síndrome de inmunodeficiencia adquirida. Los principales factores de riesgo son el contacto frecuente con sangre y otros líquidos y secreciones de pacientes infectados, pérdida de la continuidad de la piel o mucosas, tipo y tiempo de la cirugía, y la perforación accidental de los guantes. El tamizaje para el virus de la inmunodeficiencia humana, de los pacientes sometidos a cirugía se ha postulado como medida para disminuir el riesgo. Su indicación como medida sistemática se ha cuestionado. Es probable que cambios en la técnica quirúrgica, como el evitar el contacto simultáneo del instrumental punzocortante por el instrumentista y el cirujano, sean una mejor medida para evitar la contaminación accidental en quirófano. El uso de campos estériles desechables e impermeables puede incrementar la protección. El uso de doble guante puede estar indicado en cirugías de larga duración o cuando se maneje hueso, pero es más importante el ajuste adecuado del guante. La vacunación contra la hepatitis B está indicada en todo el personal de quirófano. La observancia de las medidas preventivas debe ser sistemática y seguida por todo el equipo quirúrgico.