I first discussed the merits of collaboration (or even merger) between the specialties of pathology and radiology in October, 2006 (see: Ten Reasons for Merging Pathology/Lab Medicine with Radiology). Since that time, I have commented on this same topic from time to time as well as how to improve pathology/radiology reports (see, for example: Radiologists and Pathologists as Information Specialists; Merger of the Specialties?; Making Surgical Pathology and Radiology Reports More Patient-Friendly; Pathology and Radiology Collaborate with a Concordance Conference). I recently came across a longish article encouraging pathologists to communicate verbally with radiologists when certain findings are encountered. Below is an excerpt from it:
Discordance between radiology and pathology studies compounds...[the problem or arriving at the correct diagnosis]. As good practice, frequent verbal communications between pathologists and radiologists ensure that we recognize and minimize potential diagnostic confusion prior to issuing the pathology report. The radiologist-pathologist conversation may provide valuable feedback to the radiologist (because the pathologic findings may add to their understanding of imaging findings and improve interpretive skills), and to the pathologist (who may develop a better appreciation of the clinical question asked with the biopsy and provide a more relevant pathologic answer).....Importantly, the radiologist...[is] able to convey the degree of suspicion for malignancy much more thoroughly to the pathologist in direct conversation than in the biopsy requisition, which has only limited ability for nuanced communication.....
When should a pathologist contact the radiologist? We propose the following situations: (1) negative/benign biopsy result, (2) surprising/unexpected finding on the biopsy, (3) clarification of specific requests for the biopsy, and (4) insufficient material on the biopsy. We define a negative biopsy as one that “is negative for any pathologic process or contains only nonspecific findings.” In this setting, sampling during the biopsy may have missed the intended lesion, or the findings may reflect a process that is not the radiographic lesion of concern (for instance, inflammation adjacent to a malignancy). Additionally, the biopsy may have been performed on an atypical or unusual radiographic presentation of a typically benign process with a lower level of suspicion for malignancy, such as an apical cap or rounded atelectasis. Without an assured radiologic-pathologic correlation comment, the patient may be subjected to an additional, unnecessary needle biopsy or even a more invasive surgical biopsy....
Suggested Reading
J Sorace et al., “Integrating pathology and radiology disciplines: an emerging opportunity?”, BMC Med, 10, 100 (2012). PMID: 22950414.
AS Oh et al., “Imaging-histologic discordance at percutaneous biopsy of the lung”, Acad Radiol, 22, 481–487 (2015). PMID: 25601302.
National Academies of Sciences, Engineering, and Medicine, Improving Diagnosis in Healthcare. The National Academies Press: 2015.
The suggested readings above may be of value but, unfortunately, there is not a large literature on this topic. The most important steps to take to improve pathology-radiology communications would be to develop specific guidelines when oral communication is required for a case, as discussed above, and the launching of a periodic hospital diagnostic concordance conference (see: Pathology and Radiology Collaborate with a Concordance Conference).
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