In several high-profile cases, pathologists have been criticized for incorrect evaluations of cancer. Pathologists had to leave their workplaces, and in at least one case, their managers had to, too. An existing case has been reported in Article “Pathologist area changed – mentioned again « [1].
I am not familiar with the case at hand, and of course there are unsuitable people even in our guild, but there is often an unreasonable notion of how compatible the medical judgments of different doctors are. So what do we really know about the degree of agreement among pathologists? A reality check is in order.
Research has shown that two pathologists looking at the same part of the same tumor grade prostate cancer differently 22 to 35 percent of the time. [2, 3]. Pathologists also make different judgments about whether a pigmentary skin lesion is a benign nevus or melanoma (which is the extremes of the scale) in about 20 percent of cases. [4].
A pathologist’s evaluations greatly influence a patient’s treatment and prognosis. If a pathologist judges that non-metastatic prostate cancer has a Gleason score of 9, he may warrant radical prostatectomy and initial hormonal therapy, but if others decide that a Gleason score of 6 is usually not needed (depending on other factors).
If the first pathologist’s assessment is used, it results in clinical harm if the second pathologist’s assessment is the most correct. If a second pathologist’s assessment is used, the patient will not receive the vital treatment warranted according to the first pathologist.
When people classify and identify different plant phenotypes, cell shapes, protein expression, and other complex biological processes into a few clinically useful groups, the spread is naturally wide, but these differences do not necessarily mean that the pathologist is unskilled or that a mistake has been made.
Rating differences are unfortunate, and we will work to minimize them as much as possible. Artificial intelligence and digital image analysis have shown promising results in reducing this difference [5, 6]Also, one should not forget the possibility of dual audit as a means of reducing variability within a single clinic.
Dr. V everyone Majors can ask themselves: If a colleague reviewed a few hundred or thousands of cases for which I was responsible, would the fellow evaluate differently in some cases? Who is right? The Medical Association has an important mission to reduce unreasonable expectations and support the profession.
So, dear colleagues, read medical evaluations with caution and be open that other explanations are often possible!
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