Uncertainty in Pathology Reports – The Reality and How to Deal

It is a reality that in the pathologist community (pathologists both here and abroad) use phrases of uncertainty in the diagnostic line.  Such situation is usually seen in biopsy or sampling specimens.   Some of the phrases of uncertainty include the following: “consistent with”, “highly suggestive of”, “suggestive of”, “highly suspicious of”, “suspicious of”, etc.

[Of 1500 surgical pathology reports, we found expressions of uncertainty in 529 (35%). The most commonly used phrase at our institution was “consistent with” (50%), while the other oft-used phrases included “suggestive of”, “worrisome for”, “cannot rule out”, “highly suspicious for”, “favor”, and “indefinite for.”  http://www.sciencedirect.com/science/article/pii/S0344033814001162]

Uncertainty is inherent in medicine.  Absolute diagnostic certainty in all cases is not attainable.  Phrases of uncertainty in the diagnostic line of the pathology reports exist and are here to stay.

The phrases of uncertainty in the diagnostic line should be managed and controlled.  If not, it can lead to a lot of negative consequences.  It could lead to inappropriate treatment. It could lead to delayed treatment.  It could lead to repeat biopsy and other interventions which increase medical expenditures.   It could lead to patient dissatisfaction, not to say physician’s dissatisfaction as well.

How to deal with phrases of uncertainty in the diagnostic line:

  • There must be communication between the pathologist and surgeon on the phrases of uncertainty, particularly on the meaning of the phrases used, specifically on degree of certainty or uncertainty.  For example, “consistent with” will carry at least 95% degree of certainty; “highly suspicious  of” will carry at least 90% degree of certainty; “suspicious or suggestive of” will carry at least 80% degree of certainty; etc.
  • The physician or surgeon should correlate the pathology report with the clinical data. If it jibes with the primary clinical diagnosis, accept it as the diagnosis.  If it does not jibe with the primary but it jibe with the secondary clinical diagnosis, accept it as the diagnosis.  If it does not jibe with the primary and secondary clinical diagnosis, make a decision – to repeat, to go for another type of diagnostic procedure, to put aside, etc.
  • The physician or surgeon should explain to the patient and relatives.  One, on the phrases of uncertainty of the pathologist and what they mean.  Two, on the processes that the physician or surgeon will use to arrive to a pre-treatment diagnosis, whether to accept, to repeat, to do another diagnostic procedure or to put aside.

ROJ-TPOR@16aug20

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