54 Ensuring Diagnostic Integrity: A 40-Year Quality Assurance Audit of Surgical Pathology Consultations

Introduction/Objective Interinstitutional pathology consultations serve as an essential quality assurance measure. This study benchmarks diagnostic discrepancies and clinical impact over 40 years at our institution. Methods/Case Report A retrospective review was conducted on 1,038 surgical pathology consultation cases referred to our department in 2023 (n = 447) and 2024 (n = 591), initiated post-final diagnosis by outside institutions. Diagnostic discrepancies and clinical impact were analyzed. Data were compared to literature-reported discrepancy rates and historical departmental data from 1984–2024. Results Discrepancies were identified in 1.6% of cases in both 2023 and 2024, well below the 6.3% rate in the literature. In 2023, 3 out of 6 cases (0.7%) were amended, none with clinical impact. In 2024, 4 out of 7 cases (0.7%) were amended, with 1 (0.002%) potentially impacting clinical management. The diagnoses of remaining 7 cases were not altered after internal reviews during the 2 years. The 40-year cumulative departmental discrepancy rate was 2.2%, major discrepancy 0.9%, and clinical impact 0.03%, all significantly below national benchmark rates. Conclusion Our data confirm high diagnostic accuracy and low clinical impact of discrepancies in interinstitutional consultations. These results validate the effectiveness of internal diagnostic processes and highlight the value of peer review in maintaining quality standards in surgical pathology.