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.
List of critical diagnoses
Critical diagnoses as per Pereira et al.:
- Unexpected malignancy - vast majority of cases.
- Microorganisms in non-gynecologic specimens and FNA specimens.
The following is primarily constructed from a list in Pereira et al.
- 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.
- D&C on pregnant individual (or specimen labelled "products of conception") without chorionic villi or trophoblasts.
- Fat on endometrial biopsy.
- Fat on endocervical canal sampling.
Diagnostic of infection
Suggestive of infection
- Necrotic granulomas.
- Mesothelial cells in heart muscle biopsy.
- Transplant rejection.
- Crescents in kidney biopsy.
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:
- High grade columnar esophageal dysplasia.
- Muscle invasive urothelial carcinoma of the bladder.
- Allen TC (May 2007). "Critical values in anatomic pathology?". Arch. Pathol. Lab. Med. 131 (5): 684–7. PMID 17491125. http://arpa.allenpress.com/arpaonline/?request=get-document&issn=0003-9985&volume=131&issue=5&page=684.
- 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.
- 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.
- Wright, TA. (Jun 1997). "High-grade dysplasia in Barrett's oesophagus.". Br J Surg 84 (6): 760-6. PMID 9189080.
- 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.