Impacts des avis diagnostiques de cancérologie en Aquitaine. Étude quantitative, qualitative et médicoéconomique rétrospective sur une année Impact of pathological review by an expert on the diagnosis and management of patients with cancer in Aquitania

SummaryAims.„ The goal of this work was to evaluate the impact of expert pathological second opinionon the diagnosis and management of patients with cancer, in a French region (Aquitaine) andwith an economic point of view.Material and methods.„ The study was “rst quantitative, performed retrospectively on allcases of cancer, voluntary sent for a second opinion to an expert pathologist of two centers.Secondly, we restricted the study to lymphoid, melanocytic and soft tissue tumors sent forsecond opinion. We considered that the expert review had an important diagnosic impact eitherwhen the initial pathologist sent the specimen toidentify or classify malignant tumoror hesi-tated between benign and malignant tumoror hadno hypothesis, or if there were discordantdiagnoses(malignant/benign) between the two pathologists. We considered that the expertreview had a high therapeutic impact if the disagreement between initial and expert diagnosesinduced a complete modi“cation in therapy. We evaluated the cost of second opinion for theexpert centers and the cost of care management.Results.„ Over the year 2006, the expert centers received 5077 lesions for consultation: 3769specimens were sent by a pathologist for a second review, 1324 by pathologists of Aquitaniaand of these, 751 samples were submitted for lymphoid (55%), soft tissues (30%) or melanocytictumors (15%). There was an important diagnostic impact for 75% of the samples; the impactof the expert review on patient management was considered high for 46% of specimens andthe expert pathological diagnosis modi“ed the clinical prognosis for 40% of the specimens.We estimated that for 53 discordant diagnoses (malignant/benign), second opinion allowed aneconomy of 500000D.Conclusion.„ Expert second opinion is very important not only for diagnosis and managementfor patient with cancer but also for economic reasons.© 2008 Elsevier Masson SAS. Tous droits reserves.