July 21, 2008

Keep Your Eyes On The Slides

The discovery in Canada of an extremely large margin of error in reading breast cancer pathology slides and the subsequent preventable deaths that occurred have lead to public outrage and the demand for national standards. But don’t think that misreading of pathology slides is only a problem that can occur up north in the land of socialized medicine. The financial push behind our cost controlled medical system in the U.S. doesn’t exactly incentivize long, thoughtful, diligent behavior in any other part of our care, so why would the laboratory be an exception?

As the bad-ass, proactive, young adult cancer patient I hope you are, my guess is you grill your oncologists and radiologists, but how about raking your pathologist over the coals? If you look closely on your medical record you might see typed in the corner the name of the white lab coat clad pathologist who was huddling over a microscope determining the future of your life, but that is as close as we get to meeting “the man” behind the curtain. Well, I say screw that.

Demand a second opinion on your pathology when the results seem to not fit the pattern of your disease or leave your doctors scratching their heads. Perhaps your insurance or medical care coverage will balk at the expenses at first, but you just might win using the good argument that pathology is what determines how much treatment and surgery you need and you may save them bundles in the long run.

If you cannot get a second opinion from the pathologist, at least have your doctor talk to the pathologist, live on the phone. I asked a doctor to do this once for me and strangely enough when they took a second look they decided well, maybe he would actually classify the cell type differently.

Reporter Allison Gandey wrote an article on the Canadian crisis in which she interviewed Jared Schwartz, MD, president of the College of American Pathologists. He asked this question for oncologists: “Do you know who is examining and interpreting your pathology?” In Gandey’s article Dr. Schwartz suggests that doctors adopt a more collaborative approach and work more closely with one another. “You have to have a relationship with the person looking at that slide. And clinicians, like patients, should have the ability to request a second opinion.”

For a brief, cliff notes-like lowdown on pathology, visit the National Cancer Institute website and read Pathology Reports: Questions and Answers.

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Comment(s)

  1. Lisa Hirsch Says:
    August 10th, 2009 at 6:03 PM

    The NY Times had a series of articles on what goes into reading mammograms a few years ago: accuracy goes way up when doctors specialize in reading mammograms, and, I believe, when they see many of them. They also burn out. One doctor who was interviewed had reached the limit and gotten out of reading mammograms. He worked in a practice (maybe Kaiser in Colorado?) that monitored quality carefully.


  2. Samantha Says:
    December 24th, 2009 at 10:51 AM

    My problem may not have been human error. I will never know but I had almost a liter of fluid taken out of the cyst on my neck and it came back NOT CANCER. Well I had surgery anyway because I could not breath very well and to everyone’s suprise I hadeThyroid cancer. I even had a MRI and was told that my thyroid was fine and that this cyst was not related to it. Medical tests can be wrong and it happens all the time.

    My mom had a rash and the Derm. biopsied it and called to tell her that she had a rare cancer that was 100% terminal. Well, it turned out that the lab was wrong, thank goodness. Maybe my family is just has bad luck?


  3. Kairol Rosenthal Says:
    December 24th, 2009 at 1:11 PM

    Yikes Samantha, sorry your family has had such highs and lows around pathology and other tests. From the info in your comment, I still wonder if human err or lack of knowledge is the culprit.

    MRI’s are not as accurate for detecting thyroid cancer as ultra sounds. Is it possible if the doc prescribed an ultrasound maybe they would have seen the thyroid cancer?

    Also, with doing pathology on cystic fluid, it can be very challenging because often times you are just sucking up the fluid but no cancer cells. My understanding is it’s like the cyst is a huge egg: the cystic fluid is the white and the cancerous matter within the fluid is the yolk. With a really big cyst it can be hard to suck up the yolk – especially if the biopsy is not done under ultrasound guidance. I too had a big cyst that came back non-cancerous – meanwhile I had cancer throughout my thyroid and in 19 lymph nodes. As I went for second, third, fourth opinions I got more and more accurate news because those doctors looked for it in a different manner using more precise procedures than the first guy.

    I also think that when medical tests are wrong – it is still often the person interpreting the scans, slides, pathology who is to blame for the error. I have asked for second opinions from pathologists before.

    Sorry your mom had to go through that hellish scare and I hope you are doing well with your thyroid cancer!
    Best,
    Kairol

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