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Penny wise and pound-foolish: Study shows need for second pathologist's opinion

A study of more than 6,000 patients by Johns Hopkins researchers found that one or two out of every 100 people who come to larger medical centers for treatment following a biopsy arrive with a diagnosis that's "totally wrong." The results suggest that second opinion pathology exams not only prevent errors, but also save lives and money.

Patients who fail to receive a second pathologist's exam of their biopsied tissue at the incoming hospital or elsewhere "have a small but significant risk of getting the wrong treatment, including surgery or chemotherapy," says pathologist Jonathan L. Epstein, M.D., who led a Hopkins research team. "That's not to mention the psychological trauma of having the wrong prognosis for an illness," he adds, "or the financial burden of the wrong treatment."

The study appears in the December edition of the journal Cancer.

The team compared the original pathologists' reports that 6,171 patients brought to Hopkins prior to treatment, with additional Hopkins-required pathology reports on the incoming patients. Eighty-six of the patients or 1.4 percent were wrongly diagnosed, Epstein says. "That's not a huge number, percentage-wise," he adds, "but the fact that it's as high as it is remains significant, as does the actual number of patients affected across the country."

In reality, the number of patients misdiagnosed in their original pathology reports is probably closer to 2 percent, Epstein says, because the study didn't consider patients wrongly given a clean bill of health from cancer. Such patients don't typically come to a large medical center for treatment.

The researchers tallied only cases in which the difference in the second report would cause a real change in patients' therapy or in their prognosis. More subtle disparities, such as saying a particular type of cancer was somewhat more advanced, weren't part of the s
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Contact: Marjorie Centofanti
mcentofanti@jhmi.edu
410-955-8725
Johns Hopkins Medical Institutions
30-Nov-1999


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