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Amended Reports
Development and Validation of a Taxonomy of Defects

Frederick A. Meier MD, CM, Richard J. Zarbo MD, DMD, Ruan C. Varney CT, Mona Bonsal MD, Daniel S. Schultz MD, Colleen M. Vrbin, Dana M. Grzybicki MD, PhD, Stephen S. Raab MD
DOI: http://dx.doi.org/10.1309/9UPELFVQU5WLCUHX 238-246 First published online: 1 August 2008


Amended pathology reports produce rework, confusion, and distrust. To develop a reproducible amendment taxonomy we derived a classification from 141 amended reports, then validated it with 130 new cases before 4 observers independently reviewed 430 cases measuring agreement (κ). Next, agreement in classifying 30 other amended reports in 7 institutions was measured. We further tracked amendment rates, defect categories, defect discoverers, and discovery mechanisms.

In the 430-case validation set agreement was excellent (κ = 0.8780 [range, 0.8416–0.9144]). Among the 7 institutions, agreement was good (κ = 0.6235 [range, 0.3105–0.8975]). Amendment rates ranged from 2.6 to 4.8 per 1,000 reports. Misinterpretation fractions varied least (23%–29%). Misidentification fractions ranged more widely (20%–38%). Specimen defects were least frequent (4%–10%) and report defects most frequent (29%–48%). Misidentifications and report defects inversely correlated. Pathologists discovered most misinterpretations, and clinicians found most misidentifications. Conference review revealed 40% to 80% of misinterpretations. This taxonomy produced excellent reproducibility and good agreement across institutions.

Key Words:
  • Amended reports
  • Defects
  • Pathology specimens
  • Pathology reports
  • Misidentification
  • Misinterpretation
  • Pathology errors