Impact of Oncologist Initiated Selective Review of Pathology Specimens in Multidisciplinary Onco-pathological Discussions on the Management of Malignancies in a University Hospital in India

Abstract

Aim: Reported discrepancy rates after pathology review of surgical pathology specimens vary widely from 1.3% to as high as 80%. The purpose of this study was to assess the frequency of discordant diagnoses after onco – pathological discussions and to determine whether these contributed to a change in the treatment decision. Methods: All the consecutive cases, whose diagnoses and management were discussed in the onco – pathological discussions from January 2010 to April 2015 at Jawaharlal Institute of Post Graduate Medical Education and Research, (JIPMER) India, were included in the study. Written informed consent was taken from all the participants. The data was collected retrospectively from the onco- pathology register and the hospital records of the patients. The patients were considered to have a change in the diagnoses only when it resulted in a significant change in therapy or prognosis. Results: A total of 353 cases were discussed and analyzed in the onco-pathological discussions. Among these 353 cases, 147 cases (41.75%) were haematological malignancies and 206 cases (58.25%) were solid tumors. Discussions were held on 614 pathological specimens, 354 biopsies, 64 cytology and 196 bone marrow studies. Clinically significant discordances were noted between the initial reports and the impressions after onco – pathological discussions in 33 cases (9.35%). The rate of discordance was 8.1% for heamato lymphoid malignancies and 10.12% for solid tumors. Among these 33 cases, follow-up details were available for 24 patients (72.7%) and the clinical behavior of the diseases correlated with the review diagnoses made at the onco – pathological discussions rather than the initial reports. Conclusions: The onco – pathological discussions have a significant impact on the treatment decisions and outcomes. Onco- pathological discussions should be made as a part of all multidisciplinary boards.