Modifying phrases in surgical pathology reports: introduction of Standardized Scheme of Reporting Certainty in Pathology Reports (SSRC-Path)

Modifying phrases in veterinary pathology diagnostic reports: The veterinary professionals' perception on the diagnostic confidence

Pathologists use modifying phrases (MPs) to express diagnostic confidence (DC) in the diagnosis when essential features of a lesion are lacking. Although commonly used, a standardized application and shared definitions of MPs are not recognized, resulting in a discretional use in veterinary pathology reports. Through an anonymous online survey, this study explored how different groups (veterinary pathologists, general practitioners, specialists of other specialties, residents, and students) perceive selected MPs used in veterinary pathology reports, evaluated their impact on the clinical decision, and provided a possible indication on their use. Participants (n = 753) responded from various continents. The highest DC was generally perceived for the term "diagnostic of," in all groups. "Compatible with," "indicative of," and "consistent with" were also generally perceived with high DC. The DC was lower for the other MPs ("suggestive of," "suspicious for," and "cannot rule out"). MPs perceived as having the highest DC were more often interpreted as definitive diagnoses, while those with lower DC were more likely perceived as suggestions to perform additional diagnostic tests. Pathology reports may benefit from using the comment section to further clarify the level of certainty of the diagnosis. Limitations in the data's representativeness arise from the non-probabilistic sampling and a predominance of a single nation's participants. Despite this, our study provides valuable insights into the perception and clinical impact of MPs, providing a foundation for discussions aimed in standardizing their use in veterinary pathology reports. Adopting consistent and uniform MPs could improve communication between pathologists and clinicians and patient care.

From classroom to clinic: evaluating a clinical pathology course to strengthen pathology report literacy of medical interns

BACKGROUND

Pathology reports serve as the primary communication tool between pathologists and clinicians, directly influencing clinical decision-making and treatment strategies. Despite their critical role, medical students may struggle with interpreting these reports, which can lead to miscommunication and potential diagnostic errors. This study investigated the impact of incorporating a clinical pathology course into the routine medical curriculum to enhance medical students' understanding of pathology reports and their satisfaction with the course.

METHODS

This cross-sectional study involved 92 medical students in their internship phase, who were divided into two groups: those who had completed the clinical pathology course and those who had not. The participants were provided with two pathology reports (covering malignant and benign gastrointestinal diseases) and a self-administered questionnaire consisting of 24 items. The data were analyzed via the chi-square test to assess significant differences between groups.

RESULTS

Medical interns who completed the course demonstrated significantly higher rates of moderate interpretation scores (80.43% vs. 63.04%) and lower rates of weak scores (6.53% vs. 32.61%) compared to those who did not participate (p = 0.001). Interns who passed the clinical pathology course had a significantly greater mean number of correct answers for interpreting malignant cases reports (p = 0.04), although no significant difference was found for benign cases reports (p = 0.93). Most interns who completed the course reported that it helped improve their interpretation skills, although some felt that the perceived benefits were limited. Additionally, the study identified key challenges students still faced when interpreting pathology reports including difficulties with pathology report terminology, understanding cancer staging abbreviations, and applying basic pathology concepts in clinical context.

CONCLUSIONS

Our findings suggest that clinical pathology courses can improve medical students' understanding of pathology reports, particularly in cases of cancer, but improvements in course content and teaching methods are needed. This research offers valuable insights into improving medical education.

Use of Artificial Intelligence Chatbots in Interpretation of Pathology Reports

Importance

Anatomic pathology reports are an essential part of health care, containing vital diagnostic and prognostic information. Currently, most patients have access to their test results online. However, the reports are complex and are generally incomprehensible to laypeople. Artificial intelligence chatbots could potentially simplify pathology reports.

Objective

To evaluate the ability of large language model chatbots to accurately explain pathology reports to patients.

Design, Setting, and Participants

This cross-sectional study used 1134 pathology reports from January 1, 2018, to May 31, 2023, from a multispecialty hospital in Brooklyn, New York. A new chat was started for each report, and both chatbots (Bard [Google Inc], hereinafter chatbot 1; GPT-4 [OpenAI], hereinafter chatbot 2) were asked in sequential prompts to explain the reports in simple terms and identify key information. Chatbot responses were generated between June 1 and August 31, 2023. The mean readability scores of the original and simplified reports were compared. Two reviewers independently screened and flagged reports with potential errors. Three pathologists reviewed the flagged reports and categorized them as medically correct, partially medically correct, or medically incorrect; they also recorded any instances of hallucinations.

Main Outcomes and Measures

Outcomes included improved mean readability scores and a medically accurate interpretation.

Results

For the 1134 reports included, the Flesch-Kincaid grade level decreased from a mean of 13.19 (95% CI, 12.98-13.41) to 8.17 (95% CI, 8.08-8.25; t = 45.29; P < .001) by chatbot 1 and 7.45 (95% CI, 7.35-7.54; t = 49.69; P < .001) by chatbot 2. The Flesch Reading Ease score was increased from a mean of 10.32 (95% CI, 8.69-11.96) to 61.32 (95% CI, 60.80-61.84; t = -63.19; P < .001) by chatbot 1 and 70.80 (95% CI, 70.32-71.28; t = -74.61; P < .001) by chatbot 2. Chatbot 1 interpreted 993 reports (87.57%) correctly, 102 (8.99%) partially correctly, and 39 (3.44%) incorrectly; chatbot 2 interpreted 1105 reports (97.44%) correctly, 24 (2.12%) partially correctly, and 5 (0.44%) incorrectly. Chatbot 1 had 32 instances of hallucinations (2.82%), while chatbot 2 had 3 (0.26%).

Conclusions and Relevance

The findings of this cross-sectional study suggest that artificial intelligence chatbots were able to simplify pathology reports. However, some inaccuracies and hallucinations occurred. Simplified reports should be reviewed by clinicians before distribution to patients.

Substantial improvement of histopathological diagnosis by whole-slide image-based remote consultation

Consultation by subspecialty experts is the most common mode of rendering diagnosis in challenging cases in pathological practice. Our study aimed to highlight the diagnostic benefits of whole-slide image (WSI)-based remote consultation. We obtained diagnostically challenging cases from two institutions from the years 2010 and 2013, with histological diagnoses that contained keywords “probable,” “suggestive,” “suspicious,” “inconclusive,” and “uncertain.” A total of 270 cases were selected for remote consultation using WSIs scanned at 40 × . The consultation process consisted of three rounds: the first and second rounds each with 12 subspecialty experts and the third round with six multi-expertise senior pathologists. The first consultation yielded 44% concordance, and a change in diagnosis occurred in 56% of cases. The most frequent change was from inconclusive to definite diagnosis (30%), followed by minor discordance (14%), and major discordance (12%). Out of the 70 cases which reached the second round, 31 cases showed discrepancy between the two consultants. For these 31 cases, a consensus diagnosis was provided by six multi-expertise senior pathologists. Combining all WSI-based consultation rounds, the original inconclusive diagnosis was changed in 140 (52%) out of 266 cases. Among these cases, 80 cases (30%) upgraded the inconclusive diagnosis to a definite diagnosis, and 60 cases (22%) changed the diagnosis with major or minor discordance, accounting for 28 cases (10%) and 32 cases (12%), respectively. We observed significant improvement in the pathological diagnosis of difficult cases by remote consultation using WSIs, which can further assist in patient healthcare. A post-study survey highlighted various benefits of WSI-based consults.