Preanalytical errors in surgical pathology are not spread evenly across hospital workflows but follow distinct patterns tied to the clinical pathway that produced each specimen, according to a retrospective observational study published in Diagnostic Pathology. The finding suggests that laboratory-wide quality indicators may mask risks that are specific to how and where samples are obtained.
Researchers analysed prospectively recorded preanalytical non-conformities in a tertiary academic pathology department between 2019 and 2024.
Over five complete years, the study covered 68,274 pathology requests. Of these, 10,421 requests, or 15.3 percent, presented at least one preanalytical non-conformity, corresponding to a total of 14,205 events. The overall incidence of non-conforming requests fell markedly during the observation period, from 203.0 per 1,000 requests in 2019 to 79.0 per 1,000 requests in 2024.
Despite that overall improvement, marked differences persisted across clinical referral pathways. Compared with specialty outpatient clinics, the adjusted incidence rate ratios were highest for image-guided procedures at 5.40, followed by operating room specimens at 4.12, gynaecology and obstetrics at 3.95, and medical wards at 2.26. In other words, after adjustment, requests arriving through these routes carried substantially higher rates of preanalytical non-conformity than those from specialty outpatient clinics.
Hierarchical clustering identified distinct pathway-specific patterns of non-conformities involving documentation, specimen handling and identification. This means the types of problems that recur are not random but cluster together within particular workflows, so that each referral pathway shows its own characteristic risk profile rather than a generic share of the department’s overall error burden.
The study was conducted as a retrospective analysis of prospectively recorded data within a single tertiary academic pathology department, and its results describe the experience of that setting over the 2019 to 2024 period.
In surgical pathology, problems at this stage can include incomplete documentation, mishandling of specimens and failures of patient or specimen identification. The new analysis quantifies how these categories of events distribute across the different clinical routes by which specimens reach the laboratory.
According to the authors, incorporating pathway-specific analyses into routine quality assessment may complement conventional laboratory-wide indicators and support more targeted quality improvement strategies. Rather than treating the department’s aggregate non-conformity rate as the sole measure of performance, quality teams could direct interventions at the referral pathways where specific categories of non-conformity concentrate.
The reported decline in overall incidence from 203.0 to 79.0 non-conforming requests per 1,000 requests between 2019 and 2024 represents a measured observation from this single department’s records over the study period. The study’s conclusions are framed as evidence that preanalytical risk follows distinct clinical referral pathway-specific profiles, offering a framework that other pathology services may consider when designing their own quality assessment approaches.
Subject of Research: Preanalytical non-conformity risk profiles across clinical referral pathways in surgical pathology
Article Title: Beyond counting errors: clinical pathway-specific preanalytical risk profiles in surgical pathology
Article References: Vienne, O., Khettab, M., Bedoui, Y., Tran, P. L., & Ah-Pine, F. (2026). Beyond counting errors: clinical pathway-specific preanalytical risk profiles in surgical pathology. Diagnostic Pathology. https://doi.org/10.1186/s13000-026-01864-x
Image Credits: AI Generated
DOI: 10.1186/s13000-026-01864-x
Keywords: surgical pathology, preanalytical phase, non-conformities, clinical referral pathways, quality assessment, negative binomial regression, hierarchical clustering, specimen handling, documentation errors, patient identification, tertiary pathology department, incidence rate ratio
News Source: Ophelia Keating. (October 28, 2026). Preanalytical errors in surgical pathology cluster by clinical referral pathway, five-year study finds. Scienmag.
