Not all errors are created equal: assessment of amended diagnoses at a major academic center.

Abstract

We sought to characterize amendment rates, patterns, and turnaround times in surgical pathology and to identify subspecialty and error-specific opportunities for quality improvement. All amended surgical pathology and fine-needle aspiration reports from quarter 3 of 2021 to quarter 2 2025 were retrieved through our in-house Epic Beaker system. Amendments were allocated to 1 of 7 predefined error categories and analyzed by year and subspecialty. Amendment rates, odds ratios, and 95% CIs were calculated, and time-to-amend metrics were compared using nonparametric tests with false-discovery-rate correction. Over 5 years, 0.33% of finalized surgical pathology reports were amended (95% CI, 0.31-0.35), within national College of American Pathologists Q-Probes and Q-Tracks program benchmarks, and stable over time (P = .64). Typographical errors predominated (20%-30%), followed by minor diagnostic changes and additional diagnostic information (12%-20%). Major diagnostic amendments declined from 30% (95% CI, 21.5%-40.6%) in 2021 to 15% (95% CI, 9.9%-22.8%) in 2025. Breast pathology showed enrichment of laterality errors (16.1%; odds ratio, 4.68 [95% CI, 2.65-8.27]; q = 8.26 ×10-6), gastrointestinal cases were enriched for anatomic-site errors (15.4%; odds ratio, 2.80 [95% CI, 1.71-4.56]; q = 9.28 ×10-4). Median amendment turnaround time was 1 to 3 days overall, with the longest for laterality and major diagnostic changes. Among major diagnostic changes, benign to malignant reclassification and vice versa made up roughly half. Cytology fine-needle aspiration amendments were rare (0.19%), with similar times to amend across all error categories. Amendments in surgical pathology are uncommon, timely, and stable. Subspecialty-specific amendment patterns highlight discrete areas for targeted quality improvement and focused secondary review.