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Patterns and Sources of Error in Intraoperative Neuropathology Diagnosis

The objective of this study was to gain a better understanding of sources of error and diagnostic trends with increasing experience in intraoperative consultations for an individual neuropathologist. The first 100 (P1) and subsequent 100 (P2) intraoperative consultations performed by the study pathologist were reviewed. Using the final diagnosis as the gold standard, intraoperative diagnoses were scored as correct, or having minor or major misinterpretations on clinicopathological grounds. Misinterpreted cases were then reexamined by two independent reviewers to identify sources of error in each case. Twenty misinterpretations, were identified among the 200 cases: 11 in P1 and 9 in P2. Of these 20, 12 were classified as being of potentially major clinicopathological significance by one or both reviewers. Sampling, technical and diagnostic errors were all influential alone or in combination. There was a modest improvement in diagnostic accuracy over time and a trend towards fewer diagnoses deferred to permanent sections.