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Use of a New Method in Reaching Consensus on the Cause of Cytologic-Histologic Correlation Discrepancy

Stephen S. Raab MD, Chad H. Stone MD, Eva M. Wojcik MD, Kim R. Geisinger MD, Laila Dahmoush MD, Fernando U. Garcia MD, Dana Marie Grzybicki MD, PhD, Janine E. Janosky PhD, Frederick A. Meier MD, Richard J. Zarbo MD, DMD
DOI: http://dx.doi.org/10.1309/1790JN2YWCG833VU 836-842 First published online: 1 December 2006


Pathologists exhibit very poor agreement in adjudicating the cause of cytologic-histologic correlation discrepancies, which contributes to problems in designing interventions to reduce discrepancy frequency. In this observational study, we developed a visual method of adjudicating discrepancy cause, termed the No-Blame Box method, which consisted of initially assessing specimen interpretability by separately evaluating specimen quality and the presence of tumor. Five pathologists blindly adjudicated the cause of discrepancy in pulmonary specimens from 40 patients. The statistic of all pathologist pairs in adjudicating discrepancy cause using the No-Blame Box method ranged from 0.400 to 0.796, indicating acceptable to excellent agreement. Pathologists ranged in their assessment of specimen interpretability from 13% to 20%, and in no case did all 5 pathologists concur that a specimen was interpretable. Most discrepancies resulted from pathologists diagnosing noninterpretable samples. Pathologists who used the No-Blame Box showed significant agreement in the adjudication of discrepancy cause.

Key Words:
  • Diagnostic error
  • Pathology
  • Patient safety
  • Cancer
  • Interobserver agreement
  • Consensus