Diagnostic pathology

Pathology revision: knowing the prior diagnosis can be misleading

Updated: 06 December , 13:08
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A medical second opinion is a common practice. But will it be really objective if the physician reviewing the case knows what diagnosis his or her colleague has already made? Researchers in the United States have dealt with the issue.

The study involved more than 5,300 cases of melocytic skin lesion biopsies. At first, participant pathologists re-evaluated the samples without knowing the initial conclusion. About a year later, they were given the same materials again without letting them know that they were re-examining them. At this stage, only a randomly selected group of specialists were told the original diagnosis.

Results are disturbing

The study outcome was conclusive: when pathologists knew that the initial report included a severe diagnosis, they were more likely to draw a similar conclusion than when the initial diagnosis had not been given. Accordingly, if the initial diagnosis was of a less severe disease, specialists who knew it tended to interpret the result in the same way.

Of particular concern may be the fact that knowing the initial conclusion prevented physicians from making the correct diagnoses. This was the case even with those who claimed that other people's opinions supposedly had no effect on them.

Prior diagnoses should better be disguised

According to the study authors, this reliance on other opinions can lead to treatment errors. Researchers at UCLA Health in Los Angeles believe, that when seeking a second opinion, it is better not to tell a pathologist the original diagnosis.

References:

Joann G. Elmore et al. «Effect of Prior Diagnoses on Dermatopathologists’ Interpretations of Melanocytic Lesions», in: «Jama Dermatology», August 2022

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