It is common practice in

the pathology community to use phrases of uncertainty in the diagnostic line, most commonly when dealing with biopsy specimens. This may understandably be due to inadequate tissue, or extensive artifact that makes definite interpretation impossible. Other cited reasons for uncertainty include nonstandard histomorphology, ambiguous immunohistochemical stains, lack of clinical information, uncertain criteria in the literature, lack of experience with the diagnosis, and hope AZD5363 (however unsubstantiated) to avoid legal liability for misdiagnosis. As pathologists we take pride in our linguistic acumen. When it comes to expression of uncertainty, pathologists are both very particular and very inventive in the phrases that they use. A 2004 survey of sign-out practices of 96 veterinary pathologists found they were using at least 68 unique terms to describe uncertainty [1]. No comparable study has been published in the human pathology literature. Unsurprisingly, clinicians and others in the health professions interpret and act upon these phrases in different ways based on their understanding (or misunderstanding) of the intent of the pathologist. To the pathologist

“consistent with” and “worrisome for” may be intended to mean different things and direct C59 wnt mw different courses of action, perhaps expressing a graded continuum of diagnostic certainty corresponding to an internal scale on the behalf of the observer; however if this difference is not being clearly perceived by the clinicians, then we are doing a disservice, both to ourselves and to our patients. This study sought to clarify and quantify this potential gap between intent and perception and diagnostic language, and to begin to seek means to narrow this chasm. We determined the incidence of usage of phrases of diagnostic uncertainty

in our institution by reviewing 1500 sequential surgical pathology reports and tallying both the occurrence of phrases of uncertainty in the diagnostic line and the frequency of use of each term. These sequential reports were completed between August Aspartate and October of 2011 (1000 reports) and April and May of 2009 (500 reports.) For the latter series of 500 cases, specifics of case type (biopsy, resection, etc.) category of question (neoplastic, medical) as well as additional determination as to gravity of issue was determined. Cases where use of the uncertainty phrase centered around a peripheral or subclassification rather than the core (malignant/not-malignant) were also noted and quantitated. In order to investigate the trends of usage of uncertainty terms by practitioner, a separate series of 200 sequential reported cases for each of the 14 actively practicing surgical pathologists at our institution were evaluated.