When to Get a Second Opinion on a Biopsy

by Melodie on May 14, 2010

© Bryan Jones

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Biopsies are on my mind as I recently had a nodule removed to check for the presence of cancer. Even though my doctor was sending the tissue to a pathologist at a cancer hospital, I asked for slides to forward on for review at a second institution.

If experienced pathologists are checking my tissue, why would I ask for another opinion? Unfortunately, I have had biopsy slides misinterpreted before. Mistakes do happen. In one study, researchers examined pathology errors over the course of one year at four hospitals. The diagnostic errors were dependent on the hospital and ranged from approximately 2 to 20 percent of gynecology cases and from approximately 5 to 12 percent of non-gynecologic cases. Errors due to misinterpretation alone accounted for 5 to 51 percent. Another study found that of all pathology errors, 25 percent were due to misinterpretation of the diagnosis.

I want to be one whose diagnosis is accurate. And I know you do too. So, when should you ask that your tissue slides be sent to another institution for review?

Get a second biopsy opinion if you fit one or more of these criteria:

1. The biopsy report does not correlate with your symptoms or the clinical picture.
2. The original pathologist or lab lacks experience in determining the type of diagnosis it is believed to be.
3. You are at high risk for recurrence or secondary cancers.
4. Your type of cancer is rare.
5. There is any ambiguity or question about the first biopsy report.
6. You intuitively believe the first report is not accurate.

Physicians will usually agree to send out your slides if you present your reasons for desiring this, and they may even do this without your request. If you do encounter resistance, remember: you are your best advocate and you don’t need to apologize for asking that this be done. Generally, there is no charge. I have witnessed numerous situations where a person did request a second opinion on a biopsy and learned as a result that the original diagnosis had been wrong. It’s worth asking for a second opinion (or even a third or fourth, depending on the situation) to avoid this kind of error.

Many doctors already will have a relationship with pathologists at larger teaching hospitals, and it can be a good move for them to send your tissue to a professional there. The process of coming to a correct diagnosis will be enhanced when physician and pathologist confer on the case, something that happens more readily when there is already a relationship. If this is not the case, you can ask that the slides be sent to a lab that is known to have experience in the type of cancer your doctor may be concerned about. A couple of respected institutions that offer second-opinion biopsy services are M.D. Anderson Cancer Center and the Armed Forces Institute of Pathology.

I also recommend you request that a copy of the biopsy report be mailed to you. That way you can review it and confirm that what is in the written report is in line with what your doctor has reported to you. The College of American Pathologists offers a helpful article on “How to Read Your Pathology Report.”

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{ 1 comment… read it below or add one }

1 Daniel December 17, 2010 at 10:29 am

great post, thanks for sharing

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