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.