Accurate pathology diagnoses are fundamental to patient care, guiding treatment decisions that can have significant clinical consequences. To help reduce interpretive diagnostic errors, the College of American Pathologists (CAP), in collaboration with the Association of Directors of Anatomic and Subspecialty Pathology (ADASP), has released an updated evidence-based guideline recommending structured and timely case review practices in pathology laboratories.
The guideline, titled “Interpretive Diagnostic Error Reduction,” outlines two strong recommendations supported by moderate-certainty evidence. First, pathologists should establish formal procedures for reviewing cases to identify diagnostic disagreements and potential interpretive errors. Second, those reviews should be completed quickly enough to positively influence patient management and treatment decisions.
“Structured and timely case review helps ensure patients receive accurate diagnoses without delay,” said guideline chair Suzanne Dintzis, MD, PhD, FCAP, in a statement. “Formalizing these processes strengthens diagnostic consistency and improves patient outcomes.”
Guideline emphasizes systematic case review and quality improvement
For clinical laboratory professionals, the recommendations reinforce the growing emphasis on quality assurance activities that extend beyond traditional compliance requirements.
While many clinical laboratories already conduct peer reviews, consensus conferences, or secondary reviews for select cases, the updated guideline encourages organizations to adopt more systematic approaches for identifying and addressing diagnostic variability.
In addition to the two primary recommendations, the guideline includes four good practice statements. These encourage laboratories to document their review procedures, monitor review findings on a regular basis, investigate areas where diagnostic agreement is poor, and apply established grading criteria when interpretive variability is detected.
The recommendations arrive as pathology practices continue to face increasing case complexity, growing subspecialization, and expanding use of molecular and digital pathology technologies. In this environment, structured review programs may help laboratories identify patterns of diagnostic discordance, support continuous improvement efforts, and strengthen confidence in pathology interpretations.
CAP said it will reassess the guideline every five years, or sooner if new evidence or changes in practice warrant an update.
For laboratory professionals and pathology practice managers, the guidance provides a framework for strengthening diagnostic quality programs while supporting a broader goal of improving patient outcomes through more consistent and reliable pathology diagnoses.
