Surgical pathological second opinion in thyroid malignancy: impact on patientsʹ management and prognosis

Objectives To evaluate the effect of inter-institutional surgical pathology review of thyroid cancer on patientsʹ treatment and prognosis. Methods All cases referred to the Institute of Pathology at Leeds for thyroid pathology review between January 2001 and March 2003 were included. The referring pathologists reports were compared to those produced in the MDT meeting by the expert pathologist. Whenever there was disagreement a third expert opinion was sought who was blinded for both diagnoses. Effects on management and prognosis were evaluated if there was disagreement. Results Of the 66 patients reviewed, 12 (18%) had a different pathological diagnosis (κ=0.33). Two had their diagnosis changed from malignant to benign and a further two from benign to malignant. Eight patients had their prognosis downgraded and four upgraded after histopathological review. Five patients had their management affected by the new pathological diagnosis. Conclusion A second opinion of surgical pathology for thyroid tumours can result in major therapeutic and prognostic modifications. All cases of suspected thyroid cancers should be reviewed in a multidisciplinary meeting supported by pathologist with experience in thyroid pathology.