Managing Diagnostic Discrepancies in Anatomic Pathology in Viet Nam: Structured Case Review, Second Opinions and Patient Safety

Managing Diagnostic Discrepancies in Anatomic Pathology in Viet Nam: Structured Case Review, Second Opinions and Patient Safety

An anatomic pathology report can change the course of a patient's care. A diagnosis of malignancy may lead to surgery, additional investigations or systemic treatment. A finding of invasive disease rather than a precancerous lesion may alter the treatment plan, while tumor classification can influence specialist referral and therapeutic options. When two pathologists reach different conclusions about the same case, the implications may extend well beyond the laboratory.

Yet a difference of opinion does not necessarily mean that a diagnostic error has occurred. Anatomic pathology involves interpreting biological findings that are not always clear-cut. Some lesions have overlapping morphological characteristics, certain grading systems require professional judgment, and a small or poorly preserved specimen may not contain enough information for a definitive diagnosis. Even experienced pathologists can reasonably disagree in challenging cases.

For healthcare organizations, the question is not how to eliminate every disagreement. It is how to recognize differences that may affect patient management, determine when further review is appropriate, and ensure that important diagnostic uncertainty is addressed before it leads to inappropriate treatment or avoidable delays.

The College of American Pathologists (CAP), in collaboration with the Association of Directors of Anatomic and Subspecialty Pathology (ADASP), addressed these issues in its updated 2026 Interpretive Diagnostic Error Reduction guideline. The guidance emphasizes structured case review, timely identification of potential interpretive errors, monitoring of diagnostic agreement and improvement in areas where consistency is inadequate.

For pathology services in Viet Nam, these principles offer a practical foundation for strengthening diagnostic reliability. Their value lies not in requiring additional opinions for every case, but in establishing a dependable process for identifying clinically significant discrepancies, obtaining appropriate expertise and communicating the results when they can still influence patient care.

Understanding the Difference Between Diagnostic Discrepancy, Variation and Error

The terminology used to describe differences between pathology interpretations matters. When every disagreement is labeled an error, laboratories risk confusing reasonable professional variation with incorrect diagnosis. When disagreements are dismissed too readily, opportunities to identify and correct potentially important problems may be missed.

A diagnostic discrepancy is a difference between diagnostic interpretations or conclusions concerning the same case. Two pathologists may disagree about whether a lesion is benign or malignant, whether invasion is present, how a tumor should be classified, or which histological grade is most appropriate. The term identifies a difference without establishing which interpretation is correct.

Interpretive variation describes differences that arise when the available findings permit more than one reasonable professional interpretation. This may occur in borderline lesions, diseases with overlapping microscopic features, or grading systems in which distinctions between adjacent categories are difficult to reproduce consistently. Whether such variation is acceptable depends on the applicable diagnostic criteria, the available evidence and the limitations of the specimen.

A potential interpretive error is a suspected problem with an earlier interpretation that warrants further examination. It may be identified through peer review, specialist consultation, additional investigations or comparison with clinical findings. At this stage, an error remains a possibility rather than an established conclusion.

A confirmed diagnostic error, for the purposes of internal clinical quality review, requires a sufficiently supported determination that an earlier diagnosis was incorrect or materially inadequate when assessed against the relevant evidence, accepted diagnostic criteria and circumstances of the original examination. This determination should follow an appropriate professional review process rather than being inferred solely from the existence of a different opinion.

These distinctions are useful for quality management. They should not, however, be treated as formal legal classifications. A diagnostic error identified through clinical review does not automatically establish negligence, professional misconduct or legal liability.

The information available at the time of the original interpretation is particularly important. Additional immunohistochemical studies, molecular findings, deeper tissue sections or previously unavailable clinical information may allow a diagnosis to be refined. A later conclusion may be more complete without proving that the initial interpretation was unreasonable on the evidence originally available.

Changes in disease classification can also explain differences between reports issued at different times. A diagnosis based on an earlier classification system should not automatically be regarded as erroneous because diagnostic terminology or criteria have subsequently evolved.

These distinctions encourage a more balanced approach to professional review. Rather than beginning with an assumption of error, the laboratory examines what differs, why the difference arose, whether it is clinically meaningful and what additional evidence may be needed.

Why Some Pathology Discrepancies Matter More Than Others

Not every difference between pathology reports has the same clinical significance. A variation in terminology may have little effect on management, while disagreement about the presence of invasive malignancy can fundamentally change a patient's treatment pathway.

In oncology, the distinction between carcinoma in situ and invasive carcinoma may influence the need for additional surgery or other treatment, depending on the organ involved and the patient's circumstances. Differences in tumor subtype, grade or resection margins may affect risk assessment, specialist referral and multidisciplinary treatment planning.

Some conditions are particularly challenging because the distinction between diagnostic categories depends on subtle morphological features or specialized expertise. Selected hematolymphoid malignancies, soft-tissue tumors and melanocytic lesions are examples in which additional review may be valuable. A pathologist who regularly examines a particular group of uncommon tumors may bring experience that is not readily available within a general pathology service.

Predictive biomarkers introduce another consideration. Where biomarker findings influence the selection of targeted therapies or other treatments, the laboratory must consider both analytical reliability and the interpretation of results. Disagreement over immunohistochemical scoring, for example, may require examination of technical performance, scoring criteria and specimen quality rather than another assessment of routine morphology alone.

It is also important to distinguish disagreement between pathological interpretations from a lack of agreement between pathology and the broader clinical picture.

Consider a biopsy reported as negative for malignancy when imaging remains highly suspicious. This situation does not necessarily indicate that the pathologist overlooked cancer. The tissue submitted may not adequately represent the lesion, the abnormality may be heterogeneous, or the available material may be insufficient for a definitive conclusion.

Asking another pathologist to examine the same slides may help, but it may not resolve the underlying problem. The pathology service and treating team may need to reassess specimen adequacy, examine additional sections, consider ancillary testing, review imaging findings or determine whether further tissue sampling is appropriate.

A diagnosis made from a subsequently collected specimen should also be distinguished from an alternative interpretation of the original material. Differences between sampling sites, disease progression and newly available information can explain a change in diagnosis without necessarily establishing that the earlier interpretation was incorrect.

The practical priority is therefore to identify discrepancies that could lead to substantially different decisions about treatment, investigation, referral or follow-up. These are the cases in which timely review may have the greatest value for patient safety.

Selecting Cases for Structured Review

The CAP's 2026 guideline establishes two strong recommendations supported by moderate-certainty evidence. The first recommends that anatomic pathologists develop procedures for reviewing cases to identify disagreements and potential interpretive errors. The second emphasizes completing these reviews in time to positively influence patient management.

The guideline also includes four good practice statements addressing documented review procedures, periodic monitoring and documentation of findings, improvement in areas of poor diagnostic agreement, and the use of established grading criteria when grading agreement is inadequate.

These recommendations support structured review as a mechanism for improving diagnostic quality. They do not establish a universal requirement that every pathology case receive a separate second opinion.

For individual laboratories, case selection should reflect diagnostic complexity, clinical consequences, available expertise and the findings of previous reviews.

Cases involving rare tumors, uncertain morphological findings or potentially management-changing conclusions may warrant additional attention. Selected initial cancer diagnoses, important differences in tumor classification, unusual pathological features and findings that are difficult to reconcile with clinical or imaging information may also justify review.

Requests from treating clinicians should be accommodated through a defined process when they raise clinically relevant concerns. A surgeon or oncologist planning treatment may identify an unresolved question that is not apparent from the pathology report alone. The laboratory should be able to respond before the uncertainty becomes consequential.

Review should not focus exclusively on reports confirming malignancy. A benign or negative finding may also warrant reassessment when clinical suspicion remains high and the consequences of a potentially missed diagnosis are substantial.

Targeted review can be complemented by sampling of routine cases. The two approaches serve different purposes. Targeted review directs attention toward cases with greater diagnostic complexity or clinical risk, while routine sampling may reveal patterns of interpretation that would otherwise remain unnoticed.

Their results should be analyzed separately because a group of highly selected difficult cases is unlikely to represent the laboratory's overall workload.

A sound review program should also preserve professional discretion. Even when a case does not meet predetermined selection criteria, a pathologist should be able to request additional review when significant uncertainty arises. No selection policy can anticipate every situation in which another opinion may improve care.

Choosing the Right Form of Case Review

Structured pathology review can take several forms. The most appropriate approach depends on the diagnostic question, the expertise required and the point in the patient's care at which the review occurs.

Prospective peer review takes place before the initial pathology report is finalized. Another qualified pathologist examines a selected case, allowing significant differences to be discussed before the diagnosis is formally issued. This can be particularly useful when an uncertain interpretation may influence an imminent treatment decision.

A post-report review occurs after the initial report has been issued. It may still provide an opportunity to prevent inappropriate management if the review is completed and any necessary diagnostic modification is made before the corresponding patient management begins.

An internal consensus review brings together pathologists with appropriate expertise to consider a challenging case. Its value lies in examining the morphological findings, applying established diagnostic criteria and understanding the reasons for disagreement. Agreement reached through reasoned evaluation is more meaningful than simply counting how many reviewers favor a particular interpretation.

External specialist consultation may be appropriate when a laboratory does not have the necessary subspecialty expertise or when an uncommon tumor, complex differential diagnosis or unresolved disagreement has significant treatment implications. The specialist's interpretation can provide valuable additional information, but it must still be assessed against the available evidence and clinical context.

Multidisciplinary review allows pathology findings to be considered alongside clinical history, imaging and proposed treatment. In oncology, this may occur through a multidisciplinary tumor board. Such discussions can identify important inconsistencies and help determine whether additional pathological evaluation, ancillary testing or further sampling is appropriate.

Multidisciplinary discussion complements rather than replaces the pathologist's professional responsibility for interpreting the specimen.

Retrospective quality audits provide another means of learning. Reviewing completed cases, comparing frozen-section diagnoses with permanent-section findings, correlating cytology with subsequent histology, or examining pathology results against later clinical information can help identify recurring discrepancies and areas requiring improvement.

These review methods are complementary but not interchangeable. A retrospective audit may identify an error after treatment has already begun. A specialist consultation completed before treatment, by contrast, may help prevent an inappropriate decision for an individual patient.

Both contribute to diagnostic quality, but their purposes and potential effects on patient safety differ. Laboratories should therefore define when each form of review is used, who is responsible and how the findings will be documented and acted upon.

Timeliness: Completing Review Before It Can Affect Patient Management

One of the most consequential clarifications in the CAP's 2026 guidance concerns what constitutes a timely case review.

CAP explains that review may be prospective or retrospective relative to the original pathology report. For a review to meet the guideline's definition of timeliness, however, it must be completed, with the diagnosis modified if necessary, before the corresponding patient management is initiated.

This distinction matters because the date a pathology report is signed is not necessarily the date a consequential clinical decision is implemented.

In cancer care, a report may be available several days before a multidisciplinary meeting, definitive surgery or systemic treatment begins. An additional review performed during that interval may still identify and resolve an important discrepancy before it influences management.

Conversely, a disagreement discovered through a retrospective audit after treatment has started may remain important for reassessment, modification of ongoing care and organizational learning. It should not be regarded as equivalent to a review that could have prevented the original management decision.

CAP also recognizes that consultation with an external expert may introduce substantial delays. Its guidance allows a substantially delayed diagnosis to be considered timely when the treating physician has been informed of the anticipated delay resulting from the need for external consultation.

This qualification requires careful interpretation. Informing the treating physician does not automatically remove the clinical risks associated with delay. The treating team must understand why further consultation is needed, what uncertainty remains and how the expected delay affects the patient's immediate management.

Where urgent care is required, clinicians must assess the risks of proceeding, modifying or deferring treatment according to the patient's circumstances. Necessary emergency care should not be inappropriately postponed solely to complete a pathology review.

Timeliness should therefore be understood in relation to clinical decision-making rather than laboratory turnaround time alone.

A laboratory may complete a second reading quickly but fail to communicate an important finding before treatment begins. Conversely, a more complex consultation may require additional time while remaining clinically appropriate if the treating team understands the situation and manages the patient's care safely.

The essential question is whether the review provides relevant diagnostic information when it can still improve patient management.

Making Second Opinions Clinically Useful

A second opinion is most valuable when it addresses a clearly defined diagnostic question.

The request may originate from the original pathologist, a treating clinician, a multidisciplinary team or a patient seeking further assessment. Regardless of its origin, the consultation should follow appropriate professional and organizational procedures.

The requesting team should explain why additional review is needed, whether an important treatment decision is pending and which aspects of the original diagnosis require clarification.

A request to confirm whether invasion is present, for example, is different from a request for comprehensive reassessment of tumor classification, grade, margins and relevant ancillary findings.

The reviewing pathologist should receive sufficient material and clinical information to address the question reliably. Depending on the case, this may include the original pathology report, relevant medical history, imaging findings, previous pathology results, stained slides, tissue blocks and results of immunohistochemical or molecular investigations.

The completeness of the material matters. A consultation based on a limited selection of slides may not provide the same assurance as a review of all relevant material. The scope and limitations of the consultation should therefore be clear to both the requesting and reviewing professionals.

When glass slides or tissue blocks are transferred, their identification, movement, preservation and return should be properly documented. These safeguards are particularly important when tissue is limited or may be needed for additional investigations.

Where feasible, the reviewing pathologist should develop an independent professional interpretation before comparing it with the earlier conclusion. This may reduce the influence of the original opinion without restricting access to clinically essential information.

The resulting report should clearly identify the conclusion reached, material differences from the original interpretation where relevant, and any limitations affecting diagnostic confidence.

Importantly, a second opinion is not automatically the correct or definitive diagnosis simply because it was issued later.

A subsequent report may benefit from additional expertise, better material or further investigations. It may also reflect another reasonable interpretation of borderline findings or be limited by the information available to the reviewer.

When the two opinions differ substantially, the next step should be an appropriate investigation of the disagreement rather than an automatic preference for either conclusion.

The pathologists may need to discuss particular findings, reassess the slides, examine additional sections or consider further testing. An additional subspecialist consultation or multidisciplinary discussion may be appropriate when the difference could materially affect treatment.

A third opinion should not be treated as a deciding vote. Its value depends on the expertise of the reviewer, the completeness of the evidence and the strength of the diagnostic reasoning.

Some cases remain uncertain despite careful review. When the specimen does not permit a reliable distinction between diagnostic possibilities, acknowledging that limitation may be more clinically responsible than presenting an unsupported conclusion as definitive.

In such circumstances, the consultation should explain the unresolved uncertainty and identify clinically appropriate options for further evaluation.

A useful second opinion does more than offer an alternative label. It helps the treating team understand the evidence supporting the diagnosis, the significance of any disagreement and whether further action is necessary before treatment proceeds.

Resolving Discrepancies and Maintaining a Reliable Diagnostic Record

Identifying a significant discrepancy is only the beginning. The laboratory also needs a clear process for determining what happens next.

Responsibility for reviewing the disagreement should be defined, including when escalation to a senior pathologist, subspecialist or multidisciplinary team is appropriate. Urgent cases should have a mechanism for prompt consideration when treatment decisions are pending.

The review record should preserve the original interpretation, the alternative opinion, the material examined, relevant investigations and the reasoning supporting the outcome.

A review may confirm the original diagnosis, clarify terminology without changing its clinical meaning, result in a significant diagnostic revision or identify an unresolved question requiring additional evaluation.

These outcomes should be classified consistently. A difference in descriptive terminology that does not affect patient management should not be grouped indiscriminately with a change from a benign diagnosis to invasive malignancy.

Where a clinically meaningful revision is necessary, the laboratory should use an appropriate amended, corrected or supplementary reporting procedure in accordance with its applicable requirements. The original report and subsequent changes should remain traceable, including the responsible professionals and relevant dates.

Communication deserves particular attention. When surgery or oncology treatment is being planned, placing a revised pathology report in the electronic record may not be sufficient to ensure that the treating clinician recognizes the change.

A reliable process should identify who communicates the revised finding, how the information is delivered and how its receipt is confirmed.

If a discrepancy is discovered after treatment has begun, the treating team may need to reassess previous decisions and consider whether changes to ongoing care are indicated. The opportunity to prevent the original decision may have passed, but the responsibility to evaluate the new information remains.

Communication with the patient should be coordinated through the responsible clinical team. Explanations should distinguish established findings from unresolved uncertainty and address the implications for further investigation or management.

A well-designed process should support accountability without discouraging professional discussion. Pathologists need to be able to acknowledge uncertainty, seek assistance and question interpretations when appropriate.

If every disagreement is treated as evidence of individual failure, laboratories may unintentionally discourage precisely the activities that help identify potential errors before they affect patients.

Measuring Diagnostic Agreement and Learning From Difficult Cases

Structured case review becomes more valuable when its findings are examined over time.

Laboratories may monitor the proportion of eligible cases reviewed, the time taken to complete reviews, agreement between interpretations, the frequency of clinically significant discrepancies and the proportion of relevant reviews completed before patient management begins.

Other useful indicators may include the frequency of diagnostic revisions, the time required for specialist consultation, completion of communication following important changes and improvement in diagnostic categories where agreement has been poor.

These measurements need clear definitions and appropriate denominators. Results from highly selected difficult cases should not be interpreted in the same way as findings from a representative sample of routine specimens.

A laboratory that frequently reviews rare or diagnostically complex tumors may identify more disagreements than a service dealing primarily with straightforward cases. This does not necessarily indicate poorer quality.

Similarly, an increase in recorded discrepancies may reflect improved identification and documentation rather than deterioration in diagnostic performance.

Agreement and diagnostic accuracy are also distinct concepts. Two pathologists may reach the same conclusion without that conclusion necessarily being correct. Conversely, two interpretations may differ while both remain professionally defensible in light of the available evidence.

For these reasons, discrepancy rates should not be used as simple rankings of individual pathologists or laboratories. Their interpretation depends on case complexity, review methods, diagnostic categories and the criteria used to define agreement.

The most useful information often emerges when findings are examined within specific groups of diagnoses.

A laboratory may have consistently high agreement in identifying common malignancies while encountering substantial variation in grading a particular type of lesion. Another may discover that disagreements are concentrated in cases with limited tissue, inadequate preservation or incomplete clinical information.

Understanding these patterns is more useful than relying solely on an overall agreement percentage.

The CAP's 2026 guidance specifically addresses poor agreement in pathological grading and encourages the use of established, published and clinically relevant morphological grading criteria.

This is not a recommendation to simplify grading systems arbitrarily. The aim is to apply appropriate criteria that support reproducible interpretation and distinguish findings that are meaningful for clinical management.

Where poor agreement is identified, improvement should address the likely causes. These may include inconsistent application of diagnostic criteria, unfamiliarity with uncommon conditions, variations in terminology, insufficient clinical information or limitations related to specimen handling and processing.

Consensus discussions, shared reference cases, diagnostic calibration exercises, focused professional education and clearer criteria for specialist consultation may be useful.

When technical factors contribute to disagreement, improvement may instead require changes to tissue preparation, staining, specimen handling or other relevant laboratory processes.

The results should be reassessed after an intervention. Holding a training session or consensus meeting does not, by itself, demonstrate improvement in diagnostic consistency.

The real value of monitoring lies in identifying where the system is less reliable, making an appropriate change and determining whether that change has produced a meaningful benefit.

Developing a Practical Approach for Pathology Services in Viet Nam

Structured case review in Viet Nam should reflect both the applicable legal framework and the actual capabilities of pathology services.

Larger hospitals with established pathology departments may be able to organize internal peer review, regular case discussions and subspecialty consultations. Smaller laboratories may need arrangements with other healthcare facilities or specialist centers to obtain additional expertise.

These arrangements should define the scope of consultation, the professional responsibilities of participating pathologists, the procedures for transferring specimens and information, reporting arrangements and mechanisms for managing urgent cases.

Internal quality assurance activities should also be distinguished from formal clinical consultation and legal processes.

The Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides relevant provisions concerning professional consultation, medical records and the determination of professional and technical errors.

Article 64 addresses clinical consultation, including circumstances in which a condition exceeds the diagnostic or treatment capabilities of the practitioner or healthcare facility, or treatment has not produced satisfactory progress or the patient's condition has worsened. It recognizes consultation within and between healthcare facilities, including international and remote consultation, and requires consultation results to be documented in the medical record.

However, routine peer review within a pathology laboratory should not automatically be equated with formal clinical consultation under Article 64. The applicable procedures depend on the nature, purpose and circumstances of the activity.

Article 69 establishes requirements concerning medical records, including their preservation, confidentiality and conditions governing access and use. These provisions are particularly relevant when pathology reports and associated clinical information are shared between healthcare organizations.

A separate distinction is necessary between internal diagnostic quality review and the legal determination of professional and technical errors.

Articles 100 and 101 establish the relevant framework for such determinations and the role of professional councils in specified circumstances. Article 101 addresses the establishment of a professional council when a medical adverse event gives rise to a dispute requiring resolution under the conditions provided by law.

A discrepancy or suspected diagnostic error identified through internal pathology review does not, by itself, constitute a legal determination that a practitioner has committed a professional or technical error.

Maintaining this distinction supports both patient safety and procedural fairness. Internal review should facilitate the timely identification and correction of potential diagnostic problems, while formal determinations of professional responsibility must follow the applicable legal procedures.

International laboratory quality standards can also inform local practice. ISO 15189:2022 provides a framework for the quality and competence of medical laboratories, including relevant requirements concerning risk management, examination processes, quality assurance and continual improvement.

Viet Nam's corresponding national standard, TCVN ISO 15189:2025, is identical to ISO 15189:2022 and replaces TCVN ISO 15189:2014.

These standards can support documented case-review procedures, clearly assigned responsibilities, management of nonconformities and systematic evaluation of improvement activities. Their use should nevertheless be distinguished from specific legal, licensing or accreditation requirements applicable to an individual organization.

The CAP's 2026 Interpretive Diagnostic Error Reduction guideline is likewise an evidence-based professional resource rather than Vietnamese legislation.

CAP confirms that the updated recommendations have not automatically become mandatory requirements of the CAP Laboratory Accreditation Program. Laboratories should distinguish these recommendations from any separately applicable regulatory requirements or accreditation checklist provisions.

Digital pathology may offer further opportunities for consultation between geographically separated centers. Whole-slide imaging can facilitate specialist review without routinely transporting glass slides, particularly when relevant expertise is concentrated in a limited number of institutions.

However, using digital images for clinical diagnosis requires appropriate validation for the intended application, reliable image quality, competent professional users and adequate information security arrangements. The CAP's guideline on validating whole-slide imaging systems provides relevant international guidance.

Digital access does not resolve every source of diagnostic uncertainty. Inadequate tissue sampling, incomplete clinical information and limitations of the original specimen may remain important regardless of how the images are reviewed.

Protecting patient information is another essential consideration.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and its implementing Decree No. 356/2025/ND-CP took effect on January 1, 2026.

Healthcare organizations exchanging identifiable pathology images, reports or clinical records should assess the applicable requirements concerning lawful processing, confidentiality, information security, disclosure and domestic or international data transfer. Consent requirements, applicable exceptions and other relevant legal conditions must be considered according to the circumstances of the consultation and the nature of the data processing.

Informal sharing of identifiable pathology images or clinical information through unsecured communication channels should not replace appropriately authorized and documented professional consultation procedures.

For many pathology services in Viet Nam, the most practical starting point is a focused institutional procedure that identifies which cases should be reviewed, how second-opinion requests are received, who is responsible for resolving material disagreements and how important findings are communicated to the treating team.

That procedure should also provide a mechanism for periodically examining review outcomes and identifying diagnostic categories where additional education, clearer criteria or specialist support may be needed.

The intention is not to create an unnecessarily complicated approval process. It is to make sure that diagnostically important uncertainty can be recognized, evaluated and addressed through a dependable professional mechanism.

From Diagnostic Disagreement to Safer Patient Care

Some degree of interpretive variation is an unavoidable feature of anatomic pathology. Differences may arise because of genuine diagnostic ambiguity, limitations of the available material, variation in applying established criteria or the need for additional expertise.

A reliable pathology service does not need to pretend that these differences never occur. It needs to recognize when they matter and respond appropriately.

When an interpretation is questioned, the laboratory should be able to determine whether the disagreement has clinical significance, whether the available specimen is adequate, whether additional expertise or testing is needed and how the outcome should be communicated.

In cancer care, these questions are especially important because a different pathological interpretation may lead to a substantially different treatment pathway. Both unnecessary intervention and delayed appropriate treatment can expose patients to avoidable harm.

The CAP's 2026 guidance reinforces the importance of structured review, timely action, documented monitoring and focused improvement where diagnostic agreement is inadequate. These principles can be adapted to different practice settings without assuming that every case requires a second opinion or that absolute agreement is always achievable.

For healthcare organizations in Viet Nam, the priority should be a review process that makes clinically meaningful discrepancies visible, supports appropriate professional judgment, preserves the integrity of diagnostic records and ensures that important findings reach the treating team in time to influence care.

Diagnostic excellence is not demonstrated by the absence of professional disagreement. It is demonstrated by the ability to recognize when those differences matter, investigate them appropriately and prevent avoidable harm to patients.

Selected References and Regulatory Sources

Dintzis SM, Evans JJ, Hernandez M, et al. Interpretive Diagnostic Error Reduction: Guideline Update from the College of American Pathologists in Collaboration With the Association of Directors of Anatomic and Subspecialty Pathology. Archives of Pathology & Laboratory Medicine. 2026;150(9):668–677. DOI: 10.5858/arpa.2026-0016-CP.

College of American Pathologists. Interpretive Diagnostic Error Reduction. Updated Evidence-Based Guideline, Summary of Recommendations and Frequently Asked Questions. May 2026.

College of American Pathologists. Validating Whole Slide Imaging for Diagnostic Purposes in Pathology. Evidence-Based Guideline Update, published online in 2021 and in print in 2022.

International Organization for Standardization. ISO 15189:2022 — Medical Laboratories: Requirements for Quality and Competence.

Viet Nam National Standard. TCVN ISO 15189:2025 — Medical Laboratories: Requirements for Quality and Competence. Identical to ISO 15189:2022 and replacing TCVN ISO 15189:2014.

National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, particularly Articles 64, 69, 100 and 101.

National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Effective January 1, 2026.

Government of Viet Nam. Decree No. 356/2025/ND-CP, detailing certain provisions and implementation measures of the Law on Personal Data Protection. Effective January 1, 2026.

Professional Scope and Disclaimer

This article is published by Diagnostic Excellence Vietnam (DxEx.vn), a professional initiative dedicated to advancing diagnostic quality, safety and reliability in Viet Nam through evidence-informed knowledge sharing, risk management, measurement and quality improvement.

The content is intended for general professional education and discussion. It does not constitute patient-specific medical advice, a clinical or pathology diagnosis, an independent second opinion, a determination of professional or technical error, or legal advice. References to international guidelines and standards should not be interpreted as establishing mandatory obligations under Vietnamese law unless such requirements are independently applicable.

Patient-specific diagnostic interpretation, specimen review, professional consultation, additional testing and treatment decisions remain the responsibility of appropriately qualified and authorized healthcare professionals acting within their professional scope and in accordance with applicable laws, professional standards and the patient's clinical circumstances.

Diagnostic Excellence Vietnam does not provide clinical diagnosis or treatment services.