Pathologists With Gynaecological Subspecialties Show Improved Diagnostic Success: Presented at ASCP

By Nancy A. Melville

LAS VEGAS -- October 22, 2011 -- General pathologists accurately diagnose most ovarian lesions in intraoperative frozen-section evaluations; however, pathologists with subspecialties in gynaecology show higher levels of diagnostic success and have fewer understaged primary ovarian malignancies, according to research presented here at the 2011 Annual Meeting of the American Society for Clinical Pathology (ASCP).

While complete subspecialisation in surgical pathology still faces obstacles, partial subspecialisation has gained more interest, reported lead author Travis Parker, MD, Stony Brook University Medical Center, Stony Brook, New York, presenting here on October 20.

“The issue of subspecialisation in surgical pathology is an ongoing discussion in many institutions,” noted Dr. Parker’s team. “Complete subspecialisation is only feasible in large centres. However, partial subspecialisation is more common and is implemented for areas recognised by the American Board of Pathology, such as neuropathology and dermatopathology.”

The researchers identified 831 ovarian frozen-specimen cases at their medical centre between 2000 and 2010, in an effort to investigate levels of accuracy among gynaecological pathologists compared with general surgical pathologists at Stony Brook.

In all, 456 cases (54.8%) were identified as having been read by gynaecological pathologists, and 375 (45%) were read by general pathologists.

The cases included a broad mix of diagnoses: 448 serous tumours; 105 mucinous tumours; 71 nonneoplastic lesions; 48 sex-cord stromal tumours; 43 germ-cell tumours; 34 clear-cell tumours; 30 endometrioid tumours; 31 metastases; 15 carcinosarcomas; 5 Brenner tumours; and 1 case of mesothelioma.

Among 31 diagnoses that were deferred, 24 were by general pathologists compared with 7 by gynaecological pathologists. In 12 cases, metastasis could not be excluded, as determined by 7 general pathologists and 5 gynaecological pathologists.

Of the cases that could not be classified, 15 were read by general pathologists, compared with just 4 by gynaecological pathologists.

Among 11 primary malignancies that were not staged due to a deferred or benign diagnosis, 10 were read by general pathologists, including 4 serous carcinomas, 1 clear-cell tumour, 4 mucinous tumours, and 1 malignant germ-cell tumour compared with 1 mucinous tumour staged by a gynaecological pathologist.

Three other discrepancies, all involving readings by general pathologists, included 1 metastatic colon cancer called primary ovarian, 1 granulosa cell tumour determined to be benign, and 1 mesothelioma that was called leiomyosarcoma.

The results demonstrate a greater level of diagnostic efficacy among subspecialists, and suggest that gynaecologic pathologists should interpret intraoperative consults of difficult ovarian tumours when possible, the researchers said.

“Most ovarian lesions are easily diagnosed by general surgical pathologists,” the researchers concluded. “With difficult tumours, gynaecologic pathologists have fewer deferred and discrepant diagnoses and undercalled or understaged primary ovarian malignancies.”

[Presentation title: Impact of Subspecialization on the Intraoperative Diagnosis of Ovarian Lesions: A Review of 831 Cases. Abstract 349]

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