Equivocal or ambiguous terminologies in pathology: focus of continuous quality improvement?

Ambiguous terminologies introduce uncertainty into pathology reports and may be misinterpreted by clinicians. Although absolute diagnostic certainty in all cases is not attainable, nevertheless, unbridled use of equivocal or ambiguous terminologies may lead to additional, sometimes unnecessary, tests and/or procedures directly or indirectly leading to increase in health care costs, as well as patient and clinician dissatisfaction. We evaluated the degree of certainty attributed to the commonly used ambiguous terminologies ("consistent with," "compatible with," "indicative of," "favor," "suggestive of," "suspicious for," "not excluded," "cannot exclude," "not ruled out," " not definite for," "not specific for," "indeterminate," "not identified") used in pathology reports by groups of attending physicians and their respective trainees using an online survey. There is no statistical difference in the interpretation of each terminology between attending pathologists and pathology trainees. There is also no significant difference between pathology and other attending groups for majority of the terminologies. However, there are significant differences between at least 2 of the 4 attending physician categories in the following pathology terminologies: "consistent with" (overall P = 0.01), "compatible with" (P = 0.02), "not excluded" (P = 0.008), and "cannot exclude" (P = 0.01). The pairwise comparisons among the 4 specialties show that there is significant difference in the interpretation of the degree of certainty between pathology and medicine in terms of "not excluded" (P = 0.007) and "cannot exclude" (P = 0.03). Focused peer review or monitoring of pathology reports with ambiguous terminologies may reduce their use and represent a worthwhile and achievable goal.