Discrepancies between clinical and pathological diagnosis in gastroenterology

Introduction Clinical autopsies still represent a reasonable tool for quality control in hospitals and continue to reveal diagnostic problems at different departments, also primary place of malignancies is always detected despite modern methods od investigation (D.Wittschieber et al, 2012; S.Scwanga-Burger et al, 2012; H. Mashall et al, 2017; A.Lai et al, 2019). Study Aims Study aim was to analyse the mismatch of clinical and pathological diagnoses in gastrointestinal, biliary tract, liver and pancreas cases and its possible causes. Methods Sixty-three pathology records from RECUH, Pathology Center, clinical epicrisis and information from Doctors bureau were used to compare clinical and post-mortem diagnoses. We have evaluated time of hospitalization, laboratory tests and morphological specimens stained with H/E and some immunohistochemical markers. Results were analysed by Excel programme. Results In gastrointestinal tract diagnostic discrepancies were about gastric and duodenal ulcer (n= 10), intestinal gangrene (n=2) and gastric and colon carcinomas (n=8). As differential diagnoses in these cases were constituents of para-neoplastic syndrome. Missed diagnoses in pancreas were: 7 cancers, 9 pancreatitis. Instead of pancreatic pathologies clinicians mainly diagnosed liver and cardiac diseases. Mismatch in diagnostics of liver diseases were in 16 cases: 6 primary tumors, 7 cirrhosis, 3 steatosis. Pre-mortem diagnoses were mainly secondary tumors of liver. During hospitalization in biliary tract was not diagnosed: cholecystitis with and without stones (n=8) and adenocarcinoma of gall bladder (n=3). Causes of mismatch of diagnoses in clinics and pathology were mainly: too late hospitalization (33 %)-average hospitalization time was 1,5 days; objective difficulties (34,2 %) in cases with multiple concomitant diseases, also alcoholism; misinterpretation of laboratory tests (24,3 %) etc. Diagnostic errors in 27% to[...].