Objectives: To undertake a retrospective study of the rate of diagnostic discrepancy for patient/clinician-initiated second opinions in anatomic pathology at our institution and determine if this rate has changed and whether the change could be explained.
Methods: We reviewed all patient/clinician-initiated consults (incoming and outgoing) handled by our institution over a 6¾-year (27 quarters) period in which the original and consult reports were available.
Results: The rate of disagreement from the first 14 to the second 13 quarters declined from 20.4% to 15.4% (P = .004) for incoming consults and from 9.7% to 4.1% (P < .001) for outgoing consults. Significant decreases in the rate of immunohistochemistry, percentage of reports with 2 pathologists' names, and percentage of cytology and endocrine cases were noted for incoming consults. Only a decrease in the percentage of cases with 2 pathologists' names was identified in outgoing consultations.
Conclusions: Disagreements in interlaboratory anatomic pathology consults decreased over time, and some but not all changes had features associated with increased agreement.
Keywords: Accuracy; Anatomic pathology; Continuous quality improvement; Diagnosis; Quality assurance; Second opinion; Sensitivity; Surgical pathology.