When Should You Consider a Pathology Second Opinion?

There are two basic types of the second opinion – pathology second opinion and treatment second opinion and you should get both kinds of the second opinion in order to ensure that your diagnosis and treatment is on the right track. A pathologist is a physician concerned with laboratory medicine. He interprets the body fluid and tissue samples and provides a report that helps the doctor to make a diagnosis about your health and medical problem. You should try to get a pathology second opinion before getting a treatment second opinion because the doctor will base his/her diagnosis and treatment depending on your pathology report. If your pathology report is wrong then you will receive the wrong diagnosis and wrong treatment.

Who Is A Pathologist And What Does A Pathology Report Contain?

A pathologist makes a diagnosis of a disease based on the analysis of the lab test results and specimens of tissue in the context of the clinical presentation. Just like doctors, surgical pathologists also have particular areas of expertise and varying degree of competence and experience. Surgical pathologists make a diagnosis based on examination of tissue sample removed from the patient’s body. They develop the biopsy report based on microscopic evaluation of the tissue. The report can contain details down to the level of single cells within the tissue specimen. The pathology report is written in technical medical language and it helps the doctors to diagnose the disease and measure its level of seriousness.
A pathology report contains a detailed analysis of the physical and chemical characteristics of the tissue. The report can:

Determine the area where cancer started
Distinguish between different types of cancer such as carcinoma, lymphoma, and melanoma
Diagnose and classify leukemia and lymphoma
Measure the properties of the cell, percentage of living cells and the presence of tumor markers on the cell surface
Presence or absence of malignant cells and genetic or molecular abnormalities in the specimen
Determine whether the cancer is invasive or non-invasive
Mitotic rate or the speed at which the tumor cells are dividing
Locate the presence of cancer cells at the margins of the biopsy sample
Determine whether cancer has spread to the nearby lymph nodes or other organs.

So, you see with so many pieces of important information about your disease at one place, even a single mistake in the pathology report can lead to misdiagnosis and wrong treatment.

Why Should You Consider Pathology Second Opinion?

It is highly recommended to opt for a pathology second opinion because it has been seen that pathology reports contain errors almost 44% of the times, with 10% of the reports containing serious errors that affect treatment.

A study at Johns Hopkins University’s School of Medicine in the year 1999 found that 86 out of 6,171 pathology reports (1.4%) contained serious errors that changed the diagnosis. Some of the common errors were mistakes in staging, misidentification of the type of cancer and misdiagnosis of a benign tumor as a malignant one or vice versa. Prostate cancer staging and grading involved errors 20% of the times, skin cancer 2.9%, breast cancer 1.4%, lung cancer 0.6% and biopsies of female reproductive tract 5.1%

A study at Dana Faber Cancer Institute comprising of 602 prostate cancer pathology reports found 44% error rate in the Gleason scores. 10% of the pathology reports contain errors serious enough to affect treatment.

A study at Northwestern University involving 340 breast cancer patients shows that errors in breast cancer pathology reports affect the decision to choose between lumpectomy and mastectomy 7.8% of the time. In another study of 231 breast cancer patients, it was found that the second opinion brought about a change in the management of 54 patients which comes to 23.3% of the total number.

A study at the Department of Urology at the University of Virginia Health Sciences Center involving 97 bladder cancer patients found that pathology second opinion leads to significant difference 18% of the time.
A study of 295 gynecologic oncology patients at Ohio State University found changes of major clinical significance in 14 (4.7%) cases.

A study at the University of Texas M.D. Anderson Cancer Center of 500 brain/spinal cord biopsy cases found that a second opinion leads to serious disagreement with the first opinion in 44 (8.8%) cases.

A study at the Institute for Pathology at Leeds involving 66 thyroid cancer patients found that 18% of patients had a different pathological diagnosis and 7.5% culminating in a change in the management of cancer.

[Also Read: Choosing Best Doctor For Thyroid Treatment]

When Should You Get A Pathology Second Opinion?

Some of the reasons why you may require a pathology second opinion are as follows

If there is a chance that an error in the pathology report can affect your choice of treatment then you should get a second opinion in order to confirm your diagnosis and treatment approach.
If you have rare cancer or your pathologist does not have much experience with the particular type of cancer that you have, or if the tissue samples are unusual in some ways. In such cases, you should ask for second opinion from a pathologist who has expertise and experience in the concerned field.
If your pathology report is confusing or you are uncertain about the results. A second opinion from another pathologist can clarify the report.
If your cancer is not responding to current treatment or you are not satisfied with the progress of the treatment. A second opinion on the original pathology report will help to ensure that you are not being treated for the wrong type of cancer.

Any diagnosis or treatment based on your pathology report that requires life-altering therapy such as surgery for cancer, chemotherapy, radiation therapy or combination of these procedures can be devastating for the patient and his or her family members. So, it is justified of the patient to cross-checks the pathology report with the help of pathology second opinion in order to confirm the diagnosis and treatment prescribed by the doctor.

[cl-review quote=”Medically Reviewed By” author=”Dr. Kaushal M. Bhavsar (MBBS, MD)” occupation=”Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad” avatar_image=”1325″ source=”url:https%3A%2F%2Fwww.linkedin.com%2Fin%2Fdr-kaushal-bhavsar-a8137355%2F|target:_blank”]