**Author details**

detected by focused review processes with statistical difference (*p* < 0.001). The authors concluded that the focused review detects a higher proportion of errors and may be more effec-

In some cases, the pathologists consult extradepartmental experts to achieve the better diagnostic accuracy, and it is known that the diagnostic criteria vary according to the pathologist's experience. For this reason, it is common to use the same expert for various pathologists. The principal limitation of this approach is the high selectivity of the cases because only extraordinary cases must be evaluated by other pathologists, and this does not exclude apparently routine cases that must be false-negative [7]. Besides that, the use of expert consultants does not exclude the legal responsibility for the first pathologist. In these situations, called "vicarious liability," the first pathologist assumes legal responsibility for having chosen a negligent consultant [30].

Errors in Pathology laboratory can result in serious adverse patient outcomes, with catastrophic results. False-negative outcomes in oncologic diagnosis result in a dangerous delay in adequate treatment. As opposed, to false-positive diagnosis, the patient can be submitted to several unnecessary procedures, such as extensive surgical resections, radiation therapy, or chemotherapy. It is difficult to imagine in which of the scenes the impact is greater: the delay of imperative treatment or an unwanted treatment for a healthy patient. In both situations, the consequences can be devastating—adverse effects or mutilations in treatment without clinical indications, with possibly fatal consequences, besides medical and legal consequences for the pathologist or laboratory involved in the biopsy process, with serious risks to the credibility

The aim of any pathology laboratory must be establishing procedures that optimize quality control, such as additional case reviews and review of their laboratory techniques, to reduce interpretive errors or discrepancies in pathology reports. The quality formation, knowledge, and experience of the pathologist is crucial for diagnostic accuracy and the greater investment of laboratories, greater than higher technologies, must be continuing medical education for

The taboo around the diagnostic error in pathology should be broken. It is not possible to discuss the quality controls of laboratories without admitting the possibility of error. Investing in continuing medical education, with emphasis on patient safety, as well as on the training of new pathologists, with a critical view aimed at reducing errors, is an obligatory path in

tive in strategies for errors screening.

and reputation of the pathologist and the laboratory.

The authors declare that they do not have any conflicts of interest.

**5. Conclusions**

104 Quality Control in Laboratory

these professionals.

improving the pathology practice.

**Conflict of interest**

Monique Freire Santana\* and Luiz Carlos de Lima Ferreira

\*Address all correspondence to: monique.freire20@gmail.com

University Hospital Getulio Vargas, Amazon, Brazil
