Understanding the Pathology Practice

Your specimen arrives to the pathology lab from your surgeon or physician office and usually gets accessioned in the computer system that assigns it a case number. Your case is then examined by naked eye and a report termed 'Gross Examination Report' is issued. After grossing the specimen your tissue would be patched with other specimens tagged with your case number to the processing machine and further hand embedded in Paraffin wax. Thin sections are then made and placed on glass slides which are subsequently stained and submitted to one of the assigned pathologists for microscopic review.

At least six people will be involved in the processing of your case in the lab before a pathology report is issued. Many errors could occur at each step of the processing procedure.

Commonly Encountered Errors

Diagnostic Errors in reading pathology slides could be grouped into one of the following categories:

• Over Diagnosis: (overcalling) usually occur when an over interpretation occur because of a close resemblance of your case with a more aggressive one (e.g. a lesion that would show overgrowth of certain tissue elements that alerts the examiner to potential malignancy). These types of errors could be costly, especially when a major surgical procedure with long term effect takes place, obviously for the wrong reasons.

• Under Diagnosis: (missing diagnosis) usually occurs when the examiner rushes in reviewing the slides and misses a small area on the slides that have clear evidence of malignancy (e.g. where most of the slides show a non-malignant lesion, except one slide, where clear evidence of malignancy is evident). These types of errors could also be very costly, when a malignant lesion could be treated to a cure if attention was drawn to it early before it has advanced and became out of control.

• Human-type errors: (unavoidable lab errors) usually occur when any human performs repetitive tasks such as entering data (such as patient names) or number (such as case numbers) over a hundred of times a day. Multiply that by the number of personnel that the data has to pass through in the lab and you get a sense of how vast these types of errors would reach. Human makes mistakes, and only a second look would discover that an error has occurred and addresses it accordingly. 

   

A simple error such as paperwork/slides swap would have a catastrophic effect and usually results in giving a cancer diagnosis to the wrong patient, and at the same time someone else would get a negative study while truly having cancer.

Your case deserves an allocated time and a dedicated expert review to confirm your pathology diagnosis because having the correct diagnosis for your case is very important to you and an aim for us at ConfirmPath.