Table 2 Comparative summary of characteristics of clinical studies relating to second, expert opinion: Scenario 2 studies Study ID Study characteristics Population Prior test Index test Comparator Outcomes Country ALL SURGICAL - - - - - - PATHOLOGY Ahmed 2004 Retrospective study of all Surgical Initial diagnosis EEO provided by Section of Initial Nature of initial pathology consecutive cases pathology; any Histopathology at the Aga diagnosis opinion (no diagnosis/ referred to a major referral Khan University Hospital. EEO organ system provisional diagnosis) centre for EEO in a requested by clinicians and in N=381 cases Diagnostic accuracy period 2001 to some cases the primary (agreement, disagreement) 2002. Cases excluded if pathologist, across Pakistan. Use of IHC no initial diagnosis Additional IHC conducted as Specimen anatomical site provided. required. Number of cases in which Pakistan expert could not provide diagnosis BRAIN AND - - - - - - SPINAL CORD Bruner 1997 Retrospective review of Brain and spinal Initial diagnosis or EEO provided by 3 faculty Initial Nature of initial pathology 500 consecutive brain and cord biopsies or no diagnosis neuropathologists after diagnosis opinion (no diagnosis/ spinal cord biopsies resections of rendered conference review at a provisional diagnosis) referred to a tumours or multihead microscope, from the Diagnostic accuracy (no neuropathology suspected Section of Neuropathology, discrepancy, minor discrepancy, consultation service for tumours Department of Pathology at the total discrepancy) review (referred patient University of Texas M.D. N=500 casesa Nature of major diagnostic cases) or EEO in 1995. Anderson Cancer Center. EEO discrepancies requested by “pathologists or United States Initiation of therapy before other attending physicians, expert opinion in cases that such as surgeons, internists, or turned out to be major radiotherapists” (70.1%) or as discrepancies part of protocol studies for second opinions with regard to therapy (29.9%). Additional special histopathologic studies conducted as required. PROSTATE - - - - - - Chan 2005 Retrospective review of all Prostate needle Initial diagnosis EEO provided by an expert Initial Type of referral (patient or prostate needle biopsies pathologist at John Hopkins urologist-initiated)
Table 2 Comparative summary of characteristics of clinical studies relating to second, expert opinion: Scenario 2 studies Study ID Study characteristics Country Population Prior test Index test Comparator Outcomes ALL SURGICAL PATHOLOGY - - - - - - Ahmed 2004 Retrospective study of all consecutive cases referred to a major referral centre for EEO in a period 2001 to 2002. Cases excluded if no initial diagnosis provided. Pakistan Surgical pathology; any organ system N=381 cases Initial diagnosis EEO provided by Section of Histopathology at the Aga Khan University Hospital. EEO requested by clinicians and in some cases the primary pathologist, across Pakistan. Additional IHC conducted as required. Initial diagnosis Nature of initial pathology opinion (no diagnosis/ provisional diagnosis) Diagnostic accuracy (agreement, disagreement) Use of IHC Specimen anatomical site Number of cases in which expert could not provide diagnosis BRAIN AND SPINAL CORD - - - - - - Bruner 1997 Retrospective review of 500 consecutive brain and spinal cord biopsies referred to a neuropathology consultation service for review (referred patient cases) or EEO in 1995. United States Brain and spinal cord biopsies or resections of tumours or suspected tumours N=500 casesa Initial diagnosis or no diagnosis rendered EEO provided by 3 faculty neuropathologists after conference review at a multihead microscope, from the Section of Neuropathology, Department of Pathology at the University of Texas M.D. Anderson Cancer Center. EEO requested by “pathologists or other attending physicians, such as surgeons, internists, or radiotherapists” (70.1%) or as part of protocol studies for second opinions with regard to therapy (29.9%). Additional special histopathologic studies conducted as required. Initial diagnosis Nature of initial pathology opinion (no diagnosis/ provisional diagnosis) Diagnostic accuracy (no discrepancy, minor discrepancy, total discrepancy) Nature of major diagnostic discrepancies Initiation of therapy before expert opinion in cases that turned out to be major discrepancies PROSTATE - - - - - - Chan 2005 Retrospective review of all prostate needle biopsies Prostate needle Initial diagnosis EEO provided by an expert pathologist at John Hopkins Initial Type of referral (patient or urologist-initiated)
1332%20-%20FinalAssessmentReport%20-accessible.docx