Obtaining expert opinions in diagnostically difficult cases

Our plain-English summary of Obtaining expert opinions in diagnostically difficult cases, by C. Hemmings (Pathology, 2013).

The study

• Author: C. Hemmings
• Journal: Pathology
• Published: 2013;45(1):80
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This was a one-page letter to the editor, not a research study. The author reported no new data and did not discuss asbestos exposure. The letter responded to an earlier report by Klebe and colleagues on expert review of 'difficult' mesothelial proliferations, which the author described as finding only 57% complete agreement between expert and referring pathologists' diagnoses, with 9.5% of cases showing significant disagreement (benign versus malignant, or mesothelioma versus another tumour type). The author cited other studies of soft tissue tumours with similar discrepancy rates. The letter pointed out that sending cases to experts costs both laboratories money, and that some institutions charge fees of perhaps several hundred dollars that are often passed on to patients. As an example of savings, it noted that one incorrect diagnosis of high-risk GIST costs more than AU$45 000 per year in drug costs. The author concluded that timely expert referral of difficult cases is needed and should be funded equitably, and supported Royal College of Pathologists of Australasia applications for such funding.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor (opinion/commentary) responding to a published report; no original data
• Who was studied: No patients or cases were studied. The letter discusses pathologists in non-specialist centres who refer rare and difficult tumours (including mesothelial proliferations, sarcoma and GIST) for expert opinion, with a focus on Australia.
• Exposure: Not applicable: the letter does not discuss asbestos or any other exposure
• Main results:
  • Cited from Klebe et al. (not this letter's own finding): in expert review of difficult mesothelial proliferations, there was 57% complete concordance between the expert and referring pathologists' diagnoses
  • Cited from Klebe et al.: 9.5% of cases had significant disagreement (benign versus malignant, or mesothelioma versus another tumour type)
  • Cited from Thway and Fisher (soft tissue specimens, not mesothelioma): minor discrepancy in 15.7% and major discrepancy in 10.9%
  • The author stated that some institutions charge a fee of perhaps several hundred dollars for expert opinions, which most referring laboratories cannot meet
  • The author noted that one incorrect diagnosis of high-risk GIST costs more than AU$45 000 per year in drug costs for adjuvant imatinib (figure from the Australian Pharmaceutical Benefits Scheme)
• The authors' conclusion: The author concluded that timely and appropriate referral of difficult cases for expert review is needed and should be funded equitably, and that the RCPA's applications to the Medical Services Advisory Committee should be supported

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

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• Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps — R. Thomas, N.M. Rahman, et al. (2020)
• The usefulness of expert opinion in medicolegal referrals of malignant mesothelioma — D.L. Dixon, K.M. Griggs, et al. (2013)

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