La pathologie au Canada

Regarding diagnostic quality issues in Canadian pathology departments (1), and based on our experience in the Royal Jubilee Hospital, Victoria, BC, we believe that quality can be improved in anatomical pathology (AP) by introducing obligatory peer review and subspecialization. We have used both of these modalities for several years in Victoria BC to great success. An American expert group recommended peer review each time the first diagnosis of a crucial pathology such as cancer is made (2). The rationale is that peer review is the best method to determine diagnostic accuracy in surgical pathology (3). This policy increases patient safety and is easy to implement but has yet to be widely adopted in Canada. Few AP departments in North America have subspecialized(4); most retain the traditional approach where general anatomical pathologists handle tissues from almost every organ system. Although most pathologists have an area of special interest in which they are the “local expert”, only an occasional case is referred to the expert. There is considerable evidence that surgeons who handle a large volume of specific case-types improve their performance and patient outcomes(5, 6). Our experience is that subspecialization in pathology, just as in surgery, results in better performance in terms of specimen reporting for patients and clinicians. Subspecialization has been reported from a five-person laboratory(7) and one of us (CW) found that subspecialization could be satisfyingly practiced in a three-person AP laboratory. We find that subspecialization offers each patient the opinion of a focused expert, is more manpower- efficient, facilitates communication with clinicians, allows the specialist to focus continuing education in the subspecialty, and gives the specialist appropriate autonomy and responsibility. We believe that anatomical pathologists across the land will embrace subspecialization as they recognize these benefits.

James K. Kelly MB, FRCPC Cheryl L. Wright MD, FRCPC Pathologists, Dept of Laboratories, Royal Jubilee Hospital, 1952 Bay Street, Victoria BC V8R 1J8

1. Chorneyko K, Butany J, Hebert PC, Kale R, Stanbrook MB, Sibbald B, et al. Canada's pathology. Cmaj. 2008 Jun 3;178(12):1523-6. 2. Tomaszewski JE, Bear HD, Connally JA, Epstein JI, Feldman M, Foucar K, et al. Consensus conference on second opinions in diagnostic anatomic pathology. Who, What, and When. Am J ClinPathol. 2000;114(3):329-35. 3. Nakhleh RE. Patient safety and error reduction in surgical pathology. Archives of pathology & laboratory medicine. 2008 Feb;132(2):181-5. 4. Black-Schaffer WS, Young RH, Harris NL. Subspecialization of surgical pathology at the Massachusetts General Hospital. American journal of clinical pathology. 1996 Oct;106(4 Suppl 1):S33-42. 5. Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, et al. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg. 2002 Nov;236(5):583-92. 6. Pearce WH, Parker MA, Feinglass J, Ujiki M, Manheim LM. The importance of surgeon volume and training in outcomes for vascular surgical procedures. J Vasc Surg. 1999 May;29(5):768-76; discussion 77-8. 7. Sanders DS, Carr RA, Stores OP, Chachlani N, Simon J. Subspecialisation in cellular pathology in the DGH setting: the Warwick experience. Journal of clinical pathology. 2006 Aug;59(8):884-6.

Conflict of Interest:

None declared