Investigating Discrepancies Between Original and Review Diagnoses in Cervical Cancer and Precancerous Lesions

OBJECTIVE: Pathologic diagnosis is essential for guiding the management of precancerous and cancerous cervical lesions. However, discrepancies between original and review pathology reports may significantly impact treatment decisions. This study aimed to evaluate the prevalence and associated factors of pathologic discrepancies in cervical lesions. METHODS: This retrospective observational study included patients referred with a diagnosis of precancerous or cancerous cervical lesions between 2013 and 2023. Eligible cases required availability of both original and review pathology reports. Pathologic data from the original and review reports were retrospectively collected and compared. Discrepancies were categorized as major (those influencing treatment decisions or involving missing/critical information) or minor (those not impacting treatment). Clinical and pathologic variables, including turnaround times for the review process, were also analyzed. RESULTS: A total of 376 cases were included. Specimens comprised biopsy/endocervical curettage (42.3%), conization (46.8%), and hysterectomy (10.9%). The mean patient age was 49.6 ± 12.9 years. Immunohistochemistry was used in 4% of original and 4.3% of review examinations. The median review turnaround time was 3 days (IQR, 1 to 6), extended to 6 days (IQR, 4.3 to 12) when additional immunohistochemistry was required. Overall, 58.2% of cases demonstrated discrepancies: 33.2% major and 25% minor. The 3 most common major discrepancies were changes in pathologic diagnosis, lymphovascular space invasion, and tumor size. Multivariable analysis showed no clinical factors associated with major discrepancies. CONCLUSION: Pathology review revealed a high rate of discrepancies in cervical lesions, with significant clinical implications. Mandatory review is warranted for preinvasive and invasive cervical lesions.