Why won’t the Pathologist give me a diagnosis? Interpreting uncertainty in Head and Neck pathology reports

2021 ◽  
Author(s):  
I.S. Stephens-LaBorde ◽  
D.J Brierley
Keyword(s):  
Head And Neck ◽  
Head And Neck Pathology ◽  
Pathology Reports

Diagnostic Discrepancies in Mandatory Slide Review of Extradepartmental Head and Neck Cases: Experience at a Large Academic Center

2015 ◽  
Vol 139 (12) ◽  
pp. 1539-1545 ◽  
Author(s):  
Mitra Mehrad ◽  
Rebecca D. Chernock ◽  
Samir K. El-Mofty ◽  
James S. Lewis
Keyword(s):  
Head And Neck ◽  
The United States ◽  
Second Opinion ◽  
Invasive Squamous Cell Carcinoma ◽  
Risk Area ◽  
High Risk Area ◽  
Academic Center ◽  
Head And Neck Pathology ◽  
Pathology Reports

Context Medical error is a significant problem in the United States, and pathologic diagnoses are a significant source of errors. Prior studies have shown that second-opinion pathology review results in clinically major diagnosis changes in approximately 0.6% to 5.8% of patients. The few studies specifically on head and neck pathology have suggested rates of changed diagnoses that are even higher. Objectives To evaluate the diagnostic discrepancy rates in patients referred to our institution, where all such cases are reviewed by a head and neck subspecialty service, and to identify specific areas with more susceptibility to errors. Design Five hundred consecutive, scanned head and neck pathology reports from patients referred to our institution were compared for discrepancies between the outside and in-house diagnoses. Major discrepancies were defined as those resulting in a significant change in patient clinical management and/or prognosis. Results Major discrepancies occurred in 20 cases (4% overall). Informative follow-up material was available on 11 of the 20 patients (55.0%), among whom, the second opinion was supported in 11 of 11 cases (100%). Dysplasia versus invasive squamous cell carcinoma was the most common (7 of 20; 35%) area of discrepancy, and by anatomic subsite, the sinonasal tract (4 of 21; 19.0%) had the highest rate of discrepant diagnoses. Of the major discrepant diagnoses, 12 (12 of 20; 60%) involved a change from benign to malignant, one a change from malignant to benign (1 of 20; 5%), and 6 involved tumor classification (6 of 20; 30%). Conclusions Head and neck pathology is a relatively high-risk area, prone to erroneous diagnoses in a small fraction of patients. This study supports the importance of second-opinion review by subspecialized pathologists for the best care of patients.

Outcomes of intubation in difficult airways due to head and neck pathology

2009 ◽  
Vol 119 (S3) ◽  
pp. S242-S242 ◽  
Author(s):  
Tim A. Iseli ◽  
Claire E. Iseli ◽  
J. Blake Golden ◽  
Virginia L. Jones ◽  
Arthur M. Boudreaux ◽  
...  
Keyword(s):  
Head And Neck ◽  
Head And Neck Pathology ◽  
Difficult Airways

scholarly journals Actinomycotic Osteomyelitis of Mandible Masquerading Periapical Pathology

2011 ◽  
Vol 5 (2) ◽  
pp. 97-99 ◽  
Author(s):  
Parul Goel ◽  
Veena Gupta ◽  
Anjali Narwal ◽  
Jigyasa Duhan
Keyword(s):  
Infectious Disease ◽  
Head And Neck ◽  
Success Rate ◽  
Clinical Picture ◽  
Surgical Complication ◽  
Bone Destruction ◽  
Metastatic Tumour ◽  
Number Of Patients ◽  
Head And Neck Pathology ◽  
Head And Neck Infections

ABSTRACT Actinomycosis is an infectious disease characterized by chronic granulomatous and suppurative lesions often caused by Actinomyces group. Actinomycosis has been referred to as the chameleon of head and neck pathology because of its varied clinical picture which can resemble various pathologies ranging from benign infection to metastatic tumour. Nowadays, the diagnosis of the same may be difficult because the number of patients with typical symptoms has decreased, and there is a low success rate in culturing the microorganism. Mandibular osteomyelitis is also underappreciated by many clinicians in their assessment of head and neck infections. Most cases are traced to an odontogenic source, with periapical tooth abscess and posttraumatic or surgical complication as key antecedent events. A case of osteomyelitis of mandible initiated from a vital but peridontally compromised tooth is reported. Radiography of this case revealed bone destruction, and H & E of the biopsied tissue showed branching filaments resembling ray fungus.

PRODUCTIVITY OF INTERDISCIPLINARY INTERACTION IN TREATMENT OF PATIENTS WITH HEAD AND NECK DISEASES (RESULTS OF AN ORGANIZATIONAL EXPERIMENT OF 2021)

2021 ◽  
pp. 162-167
Author(s):  
Lebedev M.V. ◽  
Zakharova I.Yu. ◽  
Kerimova K.I.
Keyword(s):  
Head And Neck ◽  
Maxillofacial Surgery ◽  
Interdisciplinary Approach ◽  
Integrated Approach ◽  
Work Capacity ◽  
Medical Organization ◽  
Diagnostic Measures ◽  
Head And Neck Pathology ◽  
Specialized Care ◽  
Interdisciplinary Interaction

In 2021, an organizational experiment was conducted to improve the provision of specialized care to patients with head and neck pathology using the example of the Center for Maxillofacial Surgery at the N. N. Burdenko. The chief freelance specialist of the Ministry of Health of the Penza region, the head and doctors of the department, the deputy chief physician for the medical and surgical part, doctors of the quality control department of the N. N. Burdenko evaluated the treatment and diagnostic measures, the feasibility of attracting consultants of related specialties. Taking into account the results obtained, in 2021, on the basis of the Center for Maxillofacial Surgery, an organizational experiment was conducted to optimize the provision of medical care to patients of all ages with head and neck pathology, followed by an assessment of its effectiveness. The organizational experiment consisted of an interdisciplinary approach in the treatment of 15 patients in the conditions of the Center for Maxillofacial Surgery of the N.N. Burdenko. Doctors of related specialties (otorhinolaryngologist, plastic surgeon, oncologist, endoscopist, psychiatrist) participated in the provision of specialized care. The hospitalization of the patient and his treatment are provided at the optimum time by the same specialists. As a result of the experiment, patients saved time, received an integrated approach, reduced risks of postoperative complications, full work capacity or faster recovery and rehabilitation. The experiment showed that for one inpatient treatment, the patient receives an integrated approach to the problem, subject to close interaction of specialists from medical organizations, with the possibility of using specialized equipment without the cost of purchasing it for a medical organization. The conducted organizational experiment improves and improves the quality of care for patients with head and neck pathology. This experiment should be implemented in multidisciplinary medical organizations providing assistance in the field of "maxillofacial surgery".

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