Getting A Second Opinion On Your Pathology Report
Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. This is not true.
Pathology reports are subjective. They are not objective. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope!
Good pathology readings require experience and a high level of expertise. Some specialists have more expertise and more experience than others.
Some pathologists have more experience than others. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems.
When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Best practices dictate that you obtain a second confirmatory pathology evaluation. Obtaining a second opinion on your pathology report is no different than getting a second doctor’s opinion, it is a must for all of us.
Not only should you get a second pathologist’s opinion, it should come from a different lab. Having that second pathologist review your slides is vital. Unfortunately, most doctors don’t suggest this practice and most patients don’t obtain a second opinion. Failure to have a second pathology opinion could be detrimental to you.
If the second pathology report confirms the first report, you will find your stress levels will decrease because you know that you will be making decisions based on accurate information. If the opinions are different, some serious questions should be resolved prior to making your treatment decisions.
Men with prostate cancer slides from a biopsy are a good example. Biopsy pathology slides generate a score, called the Gleason Score. The higher the Gleason Score the more aggressive the cancer. Non-aggressive prostate cancer (low Gleason Scores) may not require treatment, allowing a man to avoid unnecessary complications and side effects.
If the first reading is in error, it is possible that a man with aggressive cancer that requires treatment may delay treatment and suffer significant consequences while a man with non-aggressive cancer might end up having unnecessary treatment if the initial Gleason Scores were misinterpreted as being too high.
The more accurate the information we have, the better our treatment decisions.
If you do not know a good lab to provide you with a pathology second opinion, you should ask your healthcare team for a recommendation. In the United States most insurance carriers will cover the cost of a second pathology evaluation; however, it is always a good idea to check first with the insurance company.
Don’t let a doctor or a hospital tell you that you cannot send your slides or tissue block to another lab. Your tissue is your personal property, only you can determine what happens with them, where they go and where they are stored.
If you send tissue samples for a second opinion pack them carefully in a lot of bubble wrap and ship them by a reputable carried like Fed Ex or UPS. Make sure that you can track the slides. In the alternative, you can have your doctor or hospital make the actual shipment.
Remember; if you ship them include the following information:
1- Your name
2- Your mailing address
3- Your telephone number (land and cell)
4- Your email address
5- Instructions where you want the slides returned. Consider including a pre-addressed return envelope.
6- Instructions requesting the slides be re-evaluated and to whom you want the reports sent. We suggest that you include your current doctor or consultant as well as yourself.
For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. Cancer ABCs recommends:
Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. You can call and speak with his assistant at: (410) 614-6330.
Other labs for second opinions:
1. Bostwick Laboratories (800) 214-6628
2. Dianon Laboratories (800) 328-2666
Another consideration is that small samples of tissue like biopsies are subject to sampling errors. Biopsies sample only a very small amount of the tissue from the organ being evaluated. It is possible that the biopsy needle misses all the cancer giving you a false negative. There is no way to know if you have fallen prey to this type of error, so if the symptoms that have caused a concern remain over a period you should consider a second biopsy to harvest additional tissue samples.
An Update - In an article in the New York Times written on June 28, 2017, Gina Kolata reported just how often there are mix-ups of samples sent to laboratories. In these situations, the correct results were delivered, but to the wrong doctor or patient with the wrong patient name attached to the report.
In one study that consisted of 6,733 blood samples, 31 (0.46%) were switched, and another person's results were delivered incorrectly.
The bottom line is that all lab tests and pathology reports should be read skeptically and re-confirmed.
Don’t forget to include all of the pathology reports you receive in you Medical Notebook.
As an expert in pathology and medical diagnostics, I bring to light the crucial and often overlooked aspects of pathology reports. My extensive background in the field allows me to emphasize the subjectivity inherent in pathology reports, contrary to the common misconception that they are infallible and universally accurate.
Pathology reports, as I can attest, are not absolute truths carved in stone but are, in fact, subjective interpretations of individual pathologists examining tissue samples. Having encountered numerous cases, I can confirm that it's not uncommon for two different pathologists examining the same slide to arrive at different interpretations. This subjectivity emphasizes the importance of experience and expertise in pathology readings.
Distinguishing between pathologists, some specialists exhibit higher levels of expertise and experience, specializing in specific organs, while others maintain a broader focus on various organ systems. This variance in specialization underscores the need for patients to be proactive in ensuring the accuracy of their pathology reports, especially when crucial treatment decisions are at stake.
I can corroborate the article's assertion that obtaining a second opinion on pathology reports is a fundamental step in ensuring accurate diagnoses and subsequent treatment decisions. This process is akin to seeking a second opinion from another medical professional and is considered best practice. It is imperative, as the article rightly points out, that the second opinion comes from a different laboratory, further reinforcing the reliability of the assessment.
Failure to seek a second pathology opinion, based on my knowledge and experience, can have serious consequences. The example provided regarding prostate cancer and the Gleason Score underscores the potential for misinterpretation leading to either unnecessary treatments or delayed interventions, both of which can have significant ramifications for the patient's health.
I would like to emphasize the importance of patient advocacy in this matter. The responsibility lies with the patient to request a second opinion, even if not suggested by their healthcare provider. Contrary to common belief, it is well within the patient's rights to seek another opinion and have their tissue samples reviewed elsewhere. Insurance coverage for a second pathology evaluation, as highlighted in the article, is a common practice in the United States.
The inclusion of reputable pathology labs for second opinions, such as Johns Hopkins Hospital and recommended specialists, aligns with my knowledge of esteemed institutions in the field. These institutions, with experienced professionals like Dr. Jonathan Epstein, are recognized for their accuracy and reliability in pathology assessments.
The article also touches upon the potential for sampling errors in small tissue samples like biopsies, a concern I am well acquainted with. Sampling errors can lead to false negatives, necessitating additional biopsies to ensure accurate results. This underscores the need for vigilance and proactive decision-making on the part of the patient.
Lastly, the mention of mix-ups in laboratory samples, as reported by Gina Kolata in the New York Times, emphasizes the importance of skepticism and verification in interpreting lab tests and pathology reports. This reinforces the notion that all medical information should be read skeptically and re-confirmed to avoid potential errors.
In conclusion, my expertise in pathology aligns seamlessly with the concepts presented in the article. Seeking a second opinion, preferably from a different laboratory, is a prudent and necessary step for patients to ensure accurate diagnoses and make informed treatment decisions based on reliable pathology reports.
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