"Lab Quality"

Errors in Surgical Pathology Surface in the United Kingdom

Starting 10 years ago, physicians in Bristol, England alerted NHS officials about problems in lab test accuracy

ERRORS IN SURGICAL PATHOLOGY DIAGNOSES made the newspapers in the United Kingdom earlier this month. The accuracy of histopathology results at the Bristol Royal Infirmary (BRI) in Bristol, England was the subject of a news story in The Sunday Telegraph on April 10.

Under the headline “Doctors fear that cases of cancer have been regularly missed in a scandal over botched diagnoses which goes back a decade,” The Sunday Telegraph reported that physicians in the University Hospitals Bristol NHS Foundation Trust (UHB), which operates the Bristol Royal Infirmary, have raised concerns about “repeated and critical blunders” occurring in BRI’s anatomic pathology laboratory. According to the newspaper, these con- cerns date back as far as 2000.

The Telegraph wrote that “submissions by specialist doctors said other serious errors [in pathology diagnoses] had caused the death of a child, while other patients were treated for the wrong disease, received a late diagnosis, or were given needless toxic treatment.”

NHS Launches Audit

Evidently these allegations had enough merit to cause officials at the National Health Service (NHS) to launch an inquiry last summer. An audit of a random sample of 3,500 tissue specimens that were originally evaluated by BRI’s pathol- ogy department is being conducted.

The public has learned that one patient who was misdiagnosed was an employee of the UHB trust. Jane Hopes was a 55-year-old senior manager in Bristol. She died in 2004, three years after an NHS biopsy failed to detect her breast cancer.

Hopes’ family has said neither Hopes— while she was alive—nor anyone in her family had ever been told that physicians at the hospital where she worked believed that the lump in her breast had been wrongly diagnosed as benign, at a time when her disease was in its earliest stages.

What caught the attention of the The Sunday Telegraph is the fact that NHS officials do not appear to have taken effective action in response to concerns raised by physicians about the failures in the accuracy of pathology services at BRI, dating back as far as 10 years.

It is not yet known what specific problems in the diagnostic accuracy of pathologists and/or laboratory testing problems may have occurred at the BRI histopathology service since 2000. What The Sunday Telegraph published on April 10 were multiple examples over the past decade of physicians stepping forward to notify NHS administrators of their belief that inaccurate pathology test results had been reported on their patients.

By itself, this fact is notable. Physicians are well-positioned to gauge the reliability and consistent accuracy of the lab test results produced by a specific laboratory. What remains to be seen is whether NHS officials at the UHB health trust will be forthcoming once the findings of their audit of the 3,500 BRI pathology cases is finished.

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