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This question was answered on Tue 24, Jun 2008 07:11am by Dr Paul S, MD

conflicting pathology reports and what to do about them?


    
Asked by as51 (Female; 51; Breast Cancer; Relevant drugs:none ) on Sun 22, Jun 2008 08:47pm

 2 yrs ago I was dx with IDC, as an incidental finding when surgeon went after some suspicious calcs on mammo. Path lab called him and told him "you cut right thru tumor". He said this never happened to him before and I believed it. margins were positive for idc but RE-lumpectomy said No cancer in margins. He blew it off to cautery! Anyways, I have always had fibrocystic breasts. I went on to have lumpectomy, radiation, prophylactic hyst/ooph, and finally femara. I wanted to know my er/pr PERCENTAGES, so I called the path lab in major cancer center that did my path. They told me they dont do percentages, that I am positive for er/pr and her2neu neg.. I wanted to know to see if I could avoid femara because of my liver problems. I then asked to send my tissue block and slides to Dr Page in TN. His office sent me a report that said "Addendum" however, it looks like a complete report, including original bx and re-lumpectomy. IT SAYS NOWHERE IN THERE THAT I HAVE CANCER. Only that I had ALH in the ducts and some fibrocystic changes. I was floored. I am calling to figure this all out, but is this possible? Does this really happen to people? My husband has cancer too, now I am going to send his path out, his dx was 2 yrs ago as well. WHY dont doctors in general recommend SECOND op PATHOLOGY?
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Answer by Dr Paul S, MD  on Tue 24, Jun 2008 07:11am:

Hi there. This is really rather an unusual situation, since breast cancer really has characteristic findings and is relatively simple to diagnose (compared to other complex cancers). Pathologists usually don't seek second opinion unless they are not sure about the diagnosis. A possibility that I can think of is that not all the samples were sent to Dr. Page and that the only slides sent were the ones containing the normal structures (this should be verified with the laboratory personnel). If this is really a difference in the reading, then a third opinion may be warranted to settle the issue. Make sure that all the slides are sent and examined by the pathologists. I hope this can be settled soon. Regards and God bless.

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Comment by as51 on Tue 24, Jun 2008 10:05pm: Thank you Dr. YOU WERE RIGHT! it was that not enough tissue was cut from paraffin block. My path re stained and re read slides and is sending back to Vanderbilt for confirmation, it was cancer, same as at original bx. I have been told by certain higher ups in medical community that we should always get second path opinions, some that really can change course of treatment. I guess Im lucky they were so vigilant and found the error. Thank you for your time

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