SECOND
OPINIONS
A correct, accurate, detailed and adequately documented anatomic pathology diagnosis is a prerequisite for effective treatment.
In those cases where the anatomic pathology finding includes a diagnosis with serious repercussions, it’s not unusual for either the attendant doctor or the patient themselves to seek a second opinion.
Given the subjective nature of the anatomic pathology assessment and the extent of the diagnostic field of anatomic pathology, there is a likelihood that the initial diagnosis made on a sample is either erroneous or lacks the degree of accuracy required.
It has been found that serious errors or shortcomings in anatomic pathology diagnosis can be observed at a rate ranging internationally from 1.4 to 9.5% depending on the location of the sample and the organ studied (Cancer 1999 86:2426-35).
Moreover, with the ever-increasing release and application of so-called targeted or tailor-made treatments, FFPE tissues from the initial sample may be necessary to select the most suitable treatment (after applying specialised supplementary techniques).
Some of the most specialised oncology centres abroad have made it standard practice to have their own anatomic pathologists re-examine the material on which the initial diagnosis was made before making any therapeutic intervention.
In light of this, the objective in seeking a second opinion is to provide:
I. assurance about the correctness of the initial diagnosis
II. additional or more up-to-date information about treatment options.
Second opinions and specialised supplementary techniques should always be based on records.
It should therefore be clear that records remain critically important long after the initial pathological findings are issued.
Based on international guidelines, anatomic pathology laboratories are obliged to keep at least three types of records for all anatomic pathology tests they carry out.
- Paraffin Blocks Records
- Slides Records
- Anatomic Pathology Findings and Referral Notes Records
All or part of the Records on which the initial diagnosis was based constitutes the diagnostic material.
The Records containing (a) paraffin blocks and (b) slides are kept for at least 10 years. After that, they are disposed of and destroyed.
THE RECORDS BELONG TO THE PATIENT FROM WHOM THEY CAME
ISTODIEREVNITIKI, like any other anatomic pathology laboratory, simply acts as custodian of those records.
NB
Doctors or patients who want to use records to obtain a second opinion should bear the following points in mind:
A. There is not an inexhaustible quantity of tissue within the paraffin blocks. In particular, if only small biopsies have been taken, the tissue may be minimal or in some cases already exhausted when making the initial diagnosis.
B. The anatomic pathology diagnosis made is the intellectual property of the anatomic pathologist. In some cases records are the only evidence of the first diagnosis.
