Critical values

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Critical values is a concept which comes to anatomical pathology from clinical pathology.[1]

Hyperkalemia is a critical value as it is associated with cardiac arrhythmias.

In the context of surgical pathology, it is, perhaps more appropriately, called critical diagnosis.

The general consensus is that these findings (critical valves, critical diagnoses) require a phone call and/or discussion with the clinician to ensure the situation is managed appropriately in a timely manner.[2]

List of critical diagnoses


Critical diagnoses as per Pereira et al.:[2]

  • Unexpected malignancy - vast majority of cases.
  • Microorganisms in non-gynecologic specimens and FNA specimens.

Surgical pathology

The following is primarily constructed from a list in Pereira et al.[3]


  • Large vessel in core biopsy specimen.
  • Unexpected malignant diagnosis.
  • Malignant diagnosis in the context of a medical emergency:
    • Neoplasm causing paralysis.
    • Malignancy causing superior vena cava syndrome.


Diagnostic of infection

  • Fungal.
  • Microbacterial.
  • Bacterial.
  • Viral.

Suggestive of infection


  • Mesothelial cells in heart muscle biopsy.

Transplant related

  • Transplant rejection.

Medical diseases


List of diagnoses that should be reviewed

  • AKA review diagnoses.

Review diagnoses are diagnoses that have significant treatment implications, and often mandate the opinion of a second pathologist and/or a sub-specialist. There is no general consensus around which diagnoses require review.

Examples of diagnoses that are high impact and are frequently reviewed:

See also


  1. Allen TC (May 2007). "Critical values in anatomic pathology?". Arch. Pathol. Lab. Med. 131 (5): 684–7. PMID 17491125.
  2. 2.0 2.1 Pereira, TC.; Clayton, AC.; Tazelaar, HD.; Liu, Y.; Leon, M.; Silverman, JF. (Jun 2006). "Critical values in cytology.". Diagn Cytopathol 34 (6): 447-51. doi:10.1002/dc.20443. PMID 16680772.
  3. Pereira, TC.; Liu, Y.; Silverman, JF. (Aug 2004). "Critical values in surgical pathology.". Am J Clin Pathol 122 (2): 201-5. doi:10.1309/7NRW-7G68-4VEP-WPMR. PMID 15323136.
  4. Wright, TA. (Jun 1997). "High-grade dysplasia in Barrett's oesophagus.". Br J Surg 84 (6): 760-6. PMID 9189080.
  5. Coblentz, TR.; Mills, SE.; Theodorescu, D. (Apr 2001). "Impact of second opinion pathology in the definitive management of patients with bladder carcinoma.". Cancer 91 (7): 1284-90. PMID 11283928.