Table 2 Comparative summary of characteristics of clinical studies relating to second, expert opinion: excluded studies Study ID Study characteristics Population Prior test Intervention Comparator Outcomes Country Azam 2002 Prospective multi-institutional Surgical pathology (any Initial diagnosis. EEO, requested by the Initial Diagnostic accuracy study of cases sent for organ system) and Most participating pathologist, clinician or patient. diagnosis Characteristics of participating personal (expert) haematopathology institutions Additional special laboratories consultation in 1999. Study (lymph node and bone (59.9%) did not histopathologic studies Extra-departmental consultation concluded when 20 marrow) cases have an expert in conducted as required. rate cases were a branch of N=2746 cases Turnaround time documented or 4 months had surgical Satisfaction rate passed, whichever came first. pathology in their Reason for selecting the Participants included 180 pathology group consultant pathologist institutions enrolled in the Nature of the specimen College of American Type of specimen provided Pathologists (CAP) voluntary Communication characteristics Q-Probes quality improvement Institutional protocol program. Cases excluded if no characteristics diagnostic impression was Factors contributing to delays rendered in the primary laboratory. Cases resulting from a patient’s referral to a different institution were excluded. United States (95.6%), Canada and Australia Fajardo 2011 Prospective study of Prostatic needle core Initial diagnosis EEO provided by an expert Initial Diagnostic accuracy (correlation consecutive cases of prostatic biopsies pathologist at The John Hopkins diagnosis of initial and expert Gleason needle core biopsies in which Medical Institution. EEO was N=59 (138 biopsy score) the EEO was Gleason pattern sought by clinicians or patients parts) Morphologic pattern of Gleason 5. The final diagnosis was then and not because the initial pattern 5 and its relationship to compared to the Gleason score pathologist was seeking a its under-diagnosis assigned by the initiating second opinion. pathologist. United States
Table 2 Comparative summary of characteristics of clinical studies relating to second, expert opinion: excluded studies Study ID Study characteristics Country Population Prior test Intervention Comparator Outcomes Azam 2002 Prospective multi-institutional study of cases sent for personal (expert) consultation in 1999. Study concluded when 20 cases were documented or 4 months had passed, whichever came first. Participants included 180 institutions enrolled in the College of American Pathologists (CAP) voluntary Q-Probes quality improvement program. Cases excluded if no diagnostic impression was rendered in the primary laboratory. Cases resulting from a patient’s referral to a different institution were excluded. United States (95.6%), Canada and Australia Surgical pathology (any organ system) and haematopathology (lymph node and bone marrow) cases N=2746 cases Initial diagnosis. Most participating institutions (59.9%) did not have an expert in a branch of surgical pathology in their pathology group EEO, requested by the pathologist, clinician or patient. Additional special histopathologic studies conducted as required. Initial diagnosis Diagnostic accuracy Characteristics of participating laboratories Extra-departmental consultation rate Turnaround time Satisfaction rate Reason for selecting the consultant pathologist Nature of the specimen Type of specimen provided Communication characteristics Institutional protocol characteristics Factors contributing to delays Fajardo 2011 Prospective study of consecutive cases of prostatic needle core biopsies in which the EEO was Gleason pattern 5. The final diagnosis was then compared to the Gleason score assigned by the initiating pathologist. United States Prostatic needle core biopsies N=59 (138 biopsy parts) Initial diagnosis EEO provided by an expert pathologist at The John Hopkins Medical Institution. EEO was sought by clinicians or patients and not because the initial pathologist was seeking a second opinion. Initial diagnosis Diagnostic accuracy (correlation of initial and expert Gleason score) Morphologic pattern of Gleason pattern 5 and its relationship to its under-diagnosis
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