The effect of interinstitution anatomic pathology consultation on patient care.

OBJECTIVE: To determine the effect of routine interinstitution anatomic pathology consultation on patient evaluation and treatment.
DESIGN: All interinstitution anatomic pathology consultation diagnoses made during a 1-year period were compared with the original pathologic diagnoses. Patients with discrepant diagnoses were evaluated after an interval of 1 year to determine the correct clinical diagnosis. The relevance of the pathologic consultation to furthering medical evaluation and treatment was determined from a review of the medical record and when necessary from consultation with the patient's physician.
SETTING: Patients referred to a university hospital. MAIN OUTCOME MEASURES: We determined the number of patients with discrepant pathologic diagnoses and whether these diagnoses changed the planned surgical procedure, chemotherapy, radiation therapy, or medical evaluation.
RESULTS: Seventy-one (9.1%) discrepant diagnoses were identified among the 777 patients. Of these 71 patients, 45 (63%) demonstrated a change in therapy or clinical evaluation as a result of the interinstitution anatomic pathology consultation. In five of these patients the consultation diagnosis was in error. There was a significantly greater percentage of discordant diagnoses among the cytology and fine-needle aspiration biopsies (21%) as compared with the surgical pathology specimens (7.8%; P < .001).
CONCLUSIONS: Routine interinstitution anatomic pathology consultation resulted in a change in patient evaluation or treatment in 45 (5.8%) of the 777 cases reviewed. Our interinstitution anatomic pathology consultation policy appears to provide useful diagnostic information, which should contribute to improved patient care. However, when a discrepancy is identified, additional consultation or evaluation should be considered.