This data was then used to assess the effect of age and gender. To assess how various phrases were interpreted by clinicians, we administered an anonymous survey of attendees at check details multi-disciplinary tumor boards. The survey asked respondents to estimate the degree of

certainty associated with eight diagnostic scenarios (Fig. 1). One diagnosis contained no expression of uncertainty while the other seven contained the following phrases: “cannot rule out”, “consistent with”, “highly suspicious”, “favor”, “indefinite for”, “suggestive of”, and “worrisome for”. The order of presentation of each phrase and the specific content or specimen type associated therewith was randomized between surveys. The clinical context of the diagnoses was also customized according to the specialty of the tumor board where the evaluation was performed. A total of 76 responses were received. Statistical analysis was by Student’s t-test and ANOVA. Subgroup analyses were performed based on level of training and clinical specialty (medical students, residents, fellows, attendings, medicine/medical subspecialists, pathologists/radiologists, and surgeons). Looking for viable solutions to reporting of uncertainty, we conducted a focus group by sending a more detailed

survey to seven senior physicians in various departments (surgery, oncology, radiation oncology, gynecologic oncology, and otolaryngology). In this survey, respondents rank ordered eight

phrases from least to most certain. We also asked respondents what their opinion for moving forward Alectinib order to resolve this communication problem would be and assessed their response to examples of certain proposed solutions. Finally, to gain further input into possible solutions to this problem, we held an open discussion with attendees at a short course at a national pathology meeting in fall 2012. Of 1500 surgical pathology reports, we found expressions of uncertainty in 529 (35%). The most commonly used phrase at our institution was “consistent with” (50%), while the other oft-used phrases included “suggestive of”, “worrisome for”, “cannot rule out”, “highly suspicious for”, “favor”, and “indefinite for” (Fig. 2). We found no statistically significant difference in incidence of uncertainty phrase usage by either age or gender (Fig. 3). Uncertainty BCKDHB phrases were used more often in biopsy cases (96 of 149 incidences, 64%) than in resection cases. Most often these involved a question of neoplasic or pre-neoplastic (83 of 149, 56%) rather than medical (66 of 149, 44%) disease. About one-fifth (22%) of incident usage dealt with a “trivial” matter (e.g. “consistent with lipoma”, “favor ganglion cyst”) and a similar number (29 of 149, 19%) dealt with a sub-classification issue (e.g. “serrated polyp, favor serrated adenoma” or “spindle cell sarcoma, consistent with undifferentiated pleomorphic sarcoma.