Jahangir S, Mushtaq S, Loya A, Akhter N and Hayat A

Objective: To determine the frequency and types of discrepancies in the surgical pathological diagnosis of soft tissue lesion, bone and lymphoid tissue submitted for second opinion.

Study Design: Cross sectional, Observational.

Place and Duration: Dept. Of histopathology, Shaukat Khanum memorial cancer hospital and research center, Lahore, Pakistan. 1 year duration.

Material and Method: All cases of soft tissue, bone and lymphoid neoplasm, irrespective of age and gender, which were referred for second opinion after being reported elsewhere, were included in the study. The cases were divided into 3 categories

  1. Non discrepant,
  2. Discrepant: Where there was disagreement in the specific diagnostic entity and this is further divided into, a) major discrepancies, b) minor discrepancies and
  3. Undiagnosed, includes those cases where definitive diagnosis could not be made in primary report. Role of immunohistochemistry is also compared in discrepant and non-discrepant cases.

Results: During the study period, total 488 cases of soft tissue, bone and lymphoid tissue were received for review and 2nd opinion. 177 (36.2%) were soft tissue and bone cases and 311 (63.7%) were lymphoid malignancies. Total number of discrepant/undiagnosed cases in all three categories were 175 (35.8%).

In Lymphoma Cases: 120/311 (38.5%) cases were discrepant. Major discrepancies were 26/120 (21.6%). Minor discrepancies were 6/120 (5%). Undiagnosed cases were 88/120 (73.33%). Immunohistochemistry performed before submission in discrepant cases were 14/120 (11.6%).

In Soft Tissue/Bone Cases: Total number of discrepant cases was 55/177 (31%). Major discrepancies were 23/55 (41.75%). Minor discrepancies were 11/55 (20%). Undiagnosed cases were 21/55 (38.1%). Immunohistochemistry done before submission for review in discrepant cases were 5/55 (9.09%).

Conclusion: Unavailability of Immunohistochemistry in many centers was found to be the main reason for disagreement in the diagnosis in both categories but more pronounced in lymphoid disorder. However, morphological features were also misinterpreted in sarcoma cases.

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