This is a re-examination of the biopsies or samples of malignant tumour tissue by our expert in this speciality (Histopathology.) It allows us to be certain about the exact type of cancer the patient has.

 

 

 

As the diagnosis of the type of cancer determines the prognosis and specific treatment, we at Cancer Consultants believe it is a good idea for patients to get an expert second opinion. It is important to be aware that the evaluation of a tumoural sample is the only way to obtain a definite diagnosis of cancer and its characteristics. Thus, the pathologist (i.e. the doctor who specialises in analysing cancer samples) plays a fundamental role in the results of the cancer treatments: receiving the correct treatment depends on having been given an exact and correct diagnosis of the type of cancer and its prognosis.
Despite the importance of a correct diagnosis, there is scientific research which demonstrates that mistakes are all too common in cancer treatments, derived from a mistaken interpretation of the biopsies or tumoural samples. As this is the first step upon which all the others are based, mistakes at this point can be of major significance, causing avoidable additional pain and suffering:

• Unnecessary and/or incorrect cancer treatment (surgery, chemotherapy, radiotherapy) with serious long or short term complications caused by such treatments.
• Loss of the opportunity to treat a cancer correctly when it is still curable or controllable, especially when a malign lesion in the initial stages is diagnosed incorrectly as benign, or is mistakenly diagnosed as a different kind of tumour and consequently treated incorrectly.

At Cancer Consultants, we believe that the majority of cancer diagnoses should be revised and verified by a pathologist with experience with these tumours. There are also some unusual benign or premalignant tumours which should be re-evaluated to ensure that it is not a low risk cancer. Finally, there are some biopsies which, due to the difficulty involved in interpretation, the low frequency of the tumour and/or the disagreement between the histopathological diagnosis and the rest of the diagnostic tests and/or the clinical evolution of the tumour, we also consider as being "high risk" for mistakes. These should always be sent for a second revision by a pathological expert.

In general, some of the biopsies that should be revised by a pathological expert would be:

- Benign tumours:

• Breast biopsies with diagnosis of atypical ductal hyperplasia or ductal carcinoma in situ.
• Large adipose tumours, or tumours that reappear over time.
• Cytologies or biopsies of the uterus diagnosed as hyperplasia, dysplasia or atypical or "border-line" hyperplasia, especially if it occurs in several samples.
• Prostate biopsies that show high grade atypia, especially in several samples.
• Urinary bladder biopsies, diagnosed as carcinoma in situ, especially if they are recurrent.
• Freckles or moles that were removed due to suspicion of melanoma.
• Lymph node biopsies diagnosed as atypical lymphoid hyperplasia
• Colon biopsies which show atypia or dysplasia in patients with ulcerative colitis or Crohn's disease.
• Oesophageal biopsies in patients with Barrett's oesophagus, in which a high degree of dysplasia can be seen

• Hodgkin's disease or non-Hodgkin's lymphoma.
• Sarcomas of tissues/soft parts or of bones.
• Cancers which are known to be metastatic, but of which it has not been possible to determine the place of origin (metastasis of an unknown primary tumour).
• Any unusual or rare cancer.
• Cancers that are not responding to treatments administered as expected, or those where the radiological images are not typical of the patient's type of tumour.
• Those biopsies which are described by the pathologist as suspicious or compatible with some type of cancer, but where a certain diagnosis has not been made.
• Malignant tumours in which meticulous analysis of the tumour, as well as indicating the exact type of cancer, gives additional determining information for selecting the type of treatment, as is the case with breast cancer, or in the majority of those malign tumours that are not metastatic at the time of diagnosis and where, after surgery, no disease remains visible in the radiological tests.

Errors in the histopathological diagnosis are more common than people, including doctors, believe. Without going any further, in an investigation in a cancer hospital of global renown, the John Hopkins Hospital (Baltimore, USA) (2) it was found that in almost 10% of the cases where the biopsies or samples with cancer were revised, the diagnosis was changed, causing significant modifications in the treatment and/or prognosis of the patient. At the same time, in another investigation at the University of Utah, as well as in a revision of the medical literature in this respect, a change in the oncological diagnosis was found after the re-evaluation of the tumour biopsies of about 1% to 6% of the cases examined. These investigations are described in the following medical articles:

• Kronz JD, Westra WH, Epstein JI. Mandatory Second Opinion Surgical Pathology at a Large Referral Hospital. Cancer 1999; 86: 2426-35.
• Gupta D, Layfield LJ. Prevalence of Inter-Institutional Anatomic Pathology Slide Review. Am J Surg Pathol 24: 280-284, 2000.
• Frable WJ. Surgical pathology--second reviews, institutional reviews, audits, and correlations: what's out there? Error or diagnostic variation?. Arch Pathol Lab Med. 2006 May;130(5):620-5

Second opinions in Histopathology are easily obtained via Cancer Consultants. The revising pathologist only needs the tumour samples or biopsies of the tumour (glass slides or paraffin block filed in the hospital where the cancer diagnosis was made). It is not necessary to see the patient.

• To carry out the re-evaluation service of your diagnosis, Cancer Consultants obtain and send the patient's tumoural tissue (biopsies) to a head of Pathology with prestige, who is a cancer expert, to establish in a precise way the patient's diagnosis, based upon which will be given the prognosis and treatment evaluation.
• In this way, you will have your diagnosis verified by an expert in Pathology, irrespective of how far away you may be. This would also be the basis of our recommendation for a second opinion regarding your oncological process.