In this month’s research paper, we look at the vexed issue of clinical-pathological correlation.
The paper by Lai et al is well worth a careful read and careful consideration.
The research team looked at the effect of clinical information on reporting of histology by the pathologists. I think some of the key take aways are:
1) There is not much high quality evidence on this topic, so more research is needed,
2) More clinical information increases the confidence of the pathologist in their reporting (but, does that make the reporting more accurate?), and
3) Upgrading of the pathology diagnosis occurred in a small number of cases.
Often, clinicians send a tissue sample to the lab expecting “the final, definitive answer”. And, in skin cancer practice, this is at times not possible. We have good evidence for low levels of accuracy and reproducibility of pathology diagnosis. Levels of uncertainty vary according to the type of lesion being examined.
Perhaps the key message remains – provide the pathologist with as much relevant clinical information as possible (emphasis on 'relevant'), and then very carefully consider the pathology result that comes back, and line it up with your clinical findings, to then settle on a final diagnosis and treatment.
– Prof David Wilkinson
Read another research summary from Prof David Wilkinson: Research summary: Adherence to melanoma screening tailored to risk
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