Wednesday, September 14, 2016

CAP16 Abstract Highlights: Accuracy of Central Nervous System Intraoperative Consultation Among Neuropathologists and General Pathologists

The 2016 annual meeting of the College of American Pathlologists (CAP16) is coming up September 25-28 in Las Vegas. I'll be attending the meeting this year. In this series of posts, I'll be featuring poster abstracts of particular interest to neuropathologists.

Timothy Harcom and Patrick Malafronte of the Walter Reed National Military Medical Center address in Poster #202 the accuracy of CNS intraoperative consultation:

Context: The reported accuracy of central nervous system (CNS) intraoperative consultation approaches 90%. Many of these studies, however, only include analysis by neuropathologists. The accuracy of diagnoses among general pathologist has not been extensively studied.

Design: All CNS intraoperative consultations during a consecutive 5-year period were evaluated. The consultations were separated into 2 groups: those consultations evaluated by a neuropathologist and those evaluated by a general pathologist. Four categories of frozen-permanent concordance were created: complete concordance, partial concordance, discordance, and deferral of diagnosis beyond the appraisal of adequate diagnostic tissue.

Results: A total of 170 CNS intraoperative consultations were identified: 91 cases with neuropathology evaluation and 79 cases with general pathologist evaluation only. The results (numbers of cases) were as follows, respectively: total concordance of 43 and 25; partial concordance of 39 and 31; discordance of 5 and 6; deferral of diagnosis of 4 and 17. Two of these comparisons produced statistically significant results (P< .05), complete concordance, showing a 72% increase, and deferral of diagnosis, showing a 76% decrease when the cases were evaluated by a neuropathologist.

Conclusions: The increased reliance on deferral of diagnosis and a reduced concordance rate among general pathologists points to a potential learning deficit that could be overcome through targeted education programs, similar to the ThinPrep Pap Proficiency Test, with the aim of increasing the quality of information provided during CNS intraoperative consultation.

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