Lege Artis Medicinae

[DISCREPANCIES BETWEEN THE CLINICAL AND PATHOLOGICAL DIAGNOSES IN CASES OF MALIGNANT TUMOUR]

KOVÁCS Attila, ILLYÉS György, SCHÖNFELD Tibor, SCHAFF Zsuzsa

DECEMBER 16, 2006

Lege Artis Medicinae - 2006;16(12)

[INTRODUCTION - In Hungary, like in other countries, previously undiagnosed diseases are frequently discovered at autopsies despite the availability of modern diagnostic tools. The aim of this study was to determine the accuracy of clinical diagnosis in malignant tumour cases. METHODS - Between 1996 and 2006, 5005 autopsies were performed in our institute. Malignant tumour cases with differing clinical and pathological diagnoses were selected and revised with regard to the localization of the primary tumour and the type of diagnostic difference, i.e., false negative, false positive or difference in the tumour site. The proportion of tumours with clinically undetermined primary site that were subsequently recognized at autopsy was established. The causes of misdiagnoses and the appropriateness of therapy were also analysed with regard to whether diagnostic mistakes were made and whether these significantly affected disease outcome. RESULTS - Of 1495 autopsies 235 cases (16%) showed a difference between the clinical and the pathological tumour diagnosis and a further 74 cases (5%) had a clinically undetermined primary tumour. Of the misdiagnosed cases 57% were false negative, 23% were false positive and 20% differed in their localization. Autopsy clarified 75% of the clinically undetermined primary tumours. Overall, there was one misdiagnosis or undetermined primary localization for every 5 correct clinical diagnoses (309/1495, 21%). The most frequent misdiagnosed tumours were lung, liver and kidney cancers. Most (60%) misdiagnoses were due to factors independent from the clinician, so these in fact were not diagnostic errors. Out of the remaining 40%, the true diagnostic error had an adverse effect on disease outcome in 11%.. CONCLUSION - Despite of the use of modern diagnostic tools the rate of clinically misdiagnosed malignant tumours is high, therefore, autopsy will still play an outstanding role in the future in quality control of clinical activity and education.]

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