Table 3

Categorisation of diagnostic discordances

Discordance groups (organs involved)Percentage
ANuclear features, dysplasia, malignancy18 23 25 27 31 32 42–47 49 57%
  1. Identification and grading of epithelial dysplasia (colon, stomach, larynx, cervix, lung, penile, bladder and skin)

  2. Identification and grading of nuclear atypia (thyroid, uterus, breast and skin)

  3. Grading of malignancy (prostate, breast and endocrine pancreas)

  4. Missed/over-diagnosis of malignancy (lymph node, thyroid, colon, salivary gland, breast, urethra, testis, lung, prostate, adrenal and kidney)

  5. Subtyping of malignancy

BIdentification of small objects23–27 31 40 43 48 49 16%
  1. Identification of microorganisms, eg, Mycobacteria, fungi, Helicobacter pylori, Gram-positive cocci (stomach, oral mucosa, small bowel and skin)

  2. Identification of mitotic figures (breast and skin)

  3. Identification of inflammatory lesions and cells (oesophagus, colon, duodenum, stomach, cervix, oral mucosa and brain)

  4. Identification of granulomata (colon)

  5. Detection of metastasis or micro-metastasis (skin, ovary and breast)

  6. Identification of Weddellite calcification (breast)

  7. Recognition of small area with diagnostic features (endometrium)

CChallenging diagnoses20 25 26 31 32 41 43–49 26%
  1. Melanocytic lesions (skin)

  2. Atypical breast lesions (eg, B3 lesions)

  3. Identification of amyloid and mucin (skin)

  4. Focally invasive/malignant lesion (stomach, colon, tongue, breast, thyroid and bladder)

  5. Transplant biopsies (kidney)

DMiscellaneous23 25 40 1%
  1. Identification of ischaemia, necrosis or granulation tissue (colon)

  2. Intestinal metaplasia (stomach)

  3. Identification of ganglions (eg, Hirschsprung)