Use of modifying phrases in surgical pathology reports: is there a different understanding between pathologists and treating physicians?

When not all the histopathologic and clinical features necessary for a pathology diagnosis are present in a particular specimen, pathologists may use modifying phrases to convey various degrees of certainty, e.g., consistent with horizontal ellipsis and suggestive of horizontal ellipsis . However, it is unclear whether pathologists use such phrases consistently or whether treating physicians fully understand their intended meaning. A questionnaire concerning six common modifying phrases (consistent with, suggestive of, suspicious for, highly consistent with, highly suggestive of, some features of) was sent to all physicians from a single institution who either issued or routinely received surgical pathology reports. Physicians were asked to rank their understanding of each phrase on a printed scale between 1 (no evidence of) and 10 (diagnostic of). One hundred sixty physicians (74.3%) responded. Despite wide variation, there was a hierarchy (from more to less diagnostic): highly consistent > highly suspicious > consistent > suspicious > suggestive > some features (p < 1 x 10(-7)). There were no significant differences between pathologists and treating physicians (p = 0.72) or attendings and residents (p = 0.9). Pathologists and treating physicians share an overall common understanding of their hierarchical relationship, albeit with wide ranges. Based upon our results, we propose to use only three qualifying phrases to convey the degree of certainty for a particular diagnosis: suggestive of (> 25 <= 50% certainty), suspicious for (> 50 <= 75%), and consistent with (> 75%). The phrase no evidence of should probably be used only when there is <= 5% confidence in a diagnosis, and conversely, diagnostic of should probably be used only when there is >= 95% confidence in a diagnosis.

Automated summary

When not all necessary features for a pathology diagnosis are present, pathologists use modifying phrases to convey different degrees of certainty. However, there is variation in the understanding of these phrases among physicians. The study proposes using three qualifying phrases to convey the certainty of a diagnosis.