Value of second opinion pathologic review in enhancing patient access to advanced therapeutic options

Abstract

Occasionally, pathologists in referral centers are privileged to see patients who come for second opinions, to access advanced treatments and the latest of clinical trials. The process of review, reporting and returning the slides can be logistically challenging. This study aimed to determine concordance between diagnosis made outside and within the department of pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA, and the value of second opinion in pathologic reviews. A review of 251 histopathology results referred for second opinion between 2013 and early 2014 was performed. Cases reviewed were mostly neoplastic from gynecology, genitourinary, breast and hepatobiliary subspecialties. This study found 89.2% of histopathology results reviewed concur with reports from outside laboratories while the remaining 10.8% did not. Major discrepancies (defined as diagnostic or staging differences resulting in altered treatment) were seen in 22.6% of the cases that did not concur. Most of the discrepancies occurred with gynaecologic and genitourinary cases which respectively constitute 29.6% and 22.2% of cases with discrepancies. Second reviews are thus important in ensuring patients receive optimal therapeutic intervention and efforts should be made to improve the logistics of this process.