The role of second opinion pathology in the management of lesions of the head and neck

Joseph D. Kronz, William H. Westra

Research output: Contribution to journalReview article


Purpose of review: Medical error is a common problem, and its human cost in terms of disability, suffering, and death is stunning. Steps toward reducing medical error will require the identification of mistake-prone practices within a complex health care system. Erroneous pathologic diagnosis has been identified as one source of error. This review was undertaken to assess the magnitude of diagnostic imprecision in lesions of the head and neck, and to address the validity of mandatory review of pathology material for patients who are referred from one institution to another for management of tumors involving the head and neck. Recent findings: Mandatory second opinion pathology consistently uncovers discrepancies across all major organ systems and has a profound impact on management and prognosis. Site-specific studies have implicated the head and neck as a high-risk area that is prone to diagnostic error. Diagnostic discrepancy rates have ranged from 1 to 53% for surgical pathology studies and from 17 to 60% for cytopathology studies. Major changes (affecting treatment or prognosis) occur in 5 to 7% of surgical pathology cases. The thyroid is consistently identified as a site that is particularly prone to diagnostic discrepancies; and no specific head and neck sites are immune to diagnostic error. Summary: Limited studies addressing the site-specific impact of second opinion pathology implicate the head and neck as a high-risk area that is prone to major changes in diagnoses. Accordingly, mandatory second opinion pathology makes good clinical and risk management sense for all patients referred to head and neck surgery or oncology services before a major therapeutic endeavor is undertaken.

Original languageEnglish (US)
Pages (from-to)81-84
Number of pages4
JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
Issue number2
StatePublished - Apr 1 2005



  • Cytopathology
  • Head and neck
  • Medical error
  • Second opinion
  • Surgical pathology

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this