Surgical Pathology Case Reviews Before Sign-Out: A College of American Pathologists Q-Probes Study of 45 Laboratories

Context.—To avoid errors many surgical pathology services mandate review of a case by a second pathologist before reports are released (signed out). Objective.—To study the extent and characteristics of such review. Design.—Participants retrospectively examined up to 400 cases to identify a maximum of 30 cases reviewed by at least one additional pathologist before sign-out. For each case, participants documented the organ system, primary disease type, number of additional pathologists consulted, and the reason for case review. The main outcome measure was the fraction of surgical pathology cases that underwent second pathologist review before sign-out. Results.—From 45 laboratories, examination of 18 032 surgical pathology cases yielded 1183 (6.6%) cases that had been reviewed before sign-out. The median laboratory reviewed 8.2% of cases. Three-fifths of reviews focused on 4 organ systems: gastrointestinal (20.5%), breast (16.0%), skin (12.7%), and female genital tract (10.0%). Malignant neoplasm far exceeded all other categories of disease in reviewed cases (45.3%). Cases were reviewed by one additional pathologist 78% of the time. Two dominant reasons for case review emerged: difficult diagnosis (46.2%) and audit required by departmental policy (43.0%). Most laboratories (71%) had departmental policies regarding review of cases. These laboratories reviewed cases about 33% more often than laboratories without policies (9.6% versus 6.5%). Conclusions.—Review of selected surgical pathology cases before sign-out is widely accepted with 71% of participant laboratories following policies to this effect. About 1 case in 15 (6.6%) were reviewed with the median laboratory of participants reviewing about 1 in 12 (8.2%).