2nd Opinion On Pathology Report??

Rockym

Has anyone had their path report sent out to be read by another doctor?  I ask because on my final path the SN was negative, but the report said a lymph node that was a direct extension of the tumor was positive. It also said that 1 of 3 lymph nodes were positive with a micromet so all and all this gives me a dx of 2/6 positive nodes.

In the description of the tissue, it called my nodes "possible lymph nodes."  I'm not real happy with this because how would they know the lymph node is positive if it's a "possible node."  How about a doctor who can look at the tissue and tell me that yes, it's a node or no it's not.  Again, the sentinel node was clear while I was on the operating table and upon further examination.  This is bugging me since positive nodes direct us toward chemo and clear nodes give us options.  I'm also awaiting my Oncotype score so this may help but I'm thinking of having my slides looked at again.  Any thoughts or opinions?

Thanks for listening.

peggy_j

FWIW, one book i read suggested getting a 2nd opinion on your final path report if you have any questions and/or if the case isn't cut and dry. So yes, if you're considering it, you should do it. My understanding is that most insurances cover a 2nd opinion for docs visits, so hopefully they cover this too. (and the fee is probably less than the first opinion since they can look at the slides that are already prepped). Good luck!

hope2011

I had mine sent for a second opinion.  I just called the pathology lab on the report and they shipped the slides to the other doctor the next day.  The results didn't change on mine, but I felt better knowing that another doctor had reviewed it. 

JanetM

I had the slides from my first biopsy 2 years ago (B9)  and my recent stereoactic core biospy (LCIS/ALH) sent for a second opinion.  It made me feel better to know that 2 pathologists looked at them and saw the same thing.

peggy_j

BTW, not sure if this is an option, but I think the book recommended getting a non-affiliated second opinion (if possible, not another doc at the same place, but someone at a completely different facility/hospital, whatever that means in your location)

Rockym

Thanks everyone for your thoughts and ideas.  My friend who is 9 years out told me to just call the pathologist's office directly and ask what the heck they meant.  I never would have thought of that.  She also mentioned that the MO would have said something to me if he thought it was a concern, but I'm not so sure about that.

Since my "possible chemo" seems to be resting on the Oncotype test, I've decided to not worry about the pathology as much and wait and see what the test says.  If the numbers are low then maybe it won't be a concern.  If the test is high then I'm chemo bound regardless.  Numbers in the grey area will get me thinking again and for sure those slides will be off to a new pathologist!

Thanks!

jacee

I had my slides sent to Johns Hopkins Breast Center. The cost was $250 and my insurance covered it all. The results were the same. Don't hesitate to ask the pathologist questions. I had some language in my report that seemed contradictory. I brought it to my BS's attention,  she called the Pathologist and asked. He said I was right, and re-wrote the whole report.

You are your best advocate!

Rockym

jacee, Thanks for your reply and hopefully people will read this thread and know they have a say in their care.  I did have my pathology sent to Johns Hopkins too after emailing their NP Lillie.  My insurance also paid for the 2nd opinion.  The new report was much clearer.  It showed the lymph nodes were indeed positive, the Grade was a 2 (not a Grade 1) and there was some language that will help my RO once chemo is done.  It was my last effort to keep from chemo, but now that I made my decision I am more at peace.  Here's to an easy TCx4 coming up!

Maya847

Hello all, I am knew to this site.  Was curious how you went about getting your second opinion at John Hopkins or anywhere else outside the local area you are being treated?  Do you call them or just tell your medical oncologist you would like a second opinion and they help walk you through the process...

Birds

I got a second opinion.  I told my surgeon I wanted the pathology to be sent to MD Anderson for a second opinion.  also, I already new I was going to get my treatment there, not at the hospital where I had my surgery.  My surgeon got the pathology slides for me and I took them myself, but then, I am a control freak.  They could have just had them sent instead of me taking them.  BTW, the first hospital said I was triple negative.  MD Anderson found me Her2+.  When I raised heck with the first hospital, they admitted the stain was too dark and they should have redone the stain on the slides.  So, the tech did a lousy job, the pathologist did a lousy job and the other 2 pathologist on the tumour board also sucked.  Thank God for second opinion.  My insurance paid for it, didn't cost me anything.  My onc at MD Anderson said they have never seen the hospital that messed up make a mistake like this before. 

Maya847

pscheer1, all I can say is WOW....  I am looking at my path report right now and not sure how to interpret something under the staging.  I was told I was staged at 1a, but when reading my report it says:  pT1b pNO(sn)(i-)  Can anyone interpret this for me?  What makes it a 1a vs 1b?

Birds

I tried to find a link for you but can't get it to copy.  I found info on the American Cancer Society web site under breast cancer early detection diagnosis and staging topics.  Then, under that, choose How is breast cancer staged. It looks like it has your answer, but I am not sure.  Also, the Breastcancer.org home page has a lot of info regarding this type of question.  More than likely, one of the other women or men with breast cancer on this discussion board will be able to answer you better than I can, but I will get my Dr. Susan Love Breast Cancer book out and keep looking for the answer.  Hang in there!

Birds

Maya, found the answer, sent you a private message.

jacee

maya, I called Johns Hopkins Breast Center and asked the cost of a 2nd opinion and how I needed to go about it. They sent me forms to fill out and my oncologist filled out his part and he sent them in to the Path lab that originally did my report. Then Johns Hopkins sent me their report.

Rockym

Maya847, I told my MO and BS I didn't like the wording on my final path and that made me question everything about the doctor who read my slides.  This is big shit and when she said she saw possible lymph nodes, but then said they were positive (after the SN was negative), none of it made sense and even the NP at Johns Hopkins agreed.  Even if you are comfortable with your final path, Johns Hopkins has a service where you fill out the papers on-line and then you have to give them to your MO or BS office so they can have them sent out.  NOTHING WRONG with doing that and no one would question your right to a 2nd.

Maybe the geeky pathologist at the hospital, but you'll never even meet them.  I tried to call the lady who did my pathology and she wouldn't talk to me.  I was told she will only talk to the doctor.  When I went to meet the secretary in the path department and make sure everything was being done properly in the forms/mailing sense... I saw the pathologist's office and she was in there.  It took everything for me NOT to walk in and say, "What the hell were you thinking?  Do you leave these reports wishy-washy so we don't come back and sue you?"  She caused me a lot of grief, but when Hopkins came back with a more detailed report, it made things clear for me.  I even found out that one of my lymph nodes that was positive (and we thought maybe it was positive because it was actually sitting on the tumor), the Hopkins guy said the cancer truly spread to that node and that my RO was going to have to zap the axillary region for sure.

Anyway, hope this helps... I can get a little wordy, but the memory of the first pathologist brings out the anger.  BTW, the NCCN site will tell you EVERYTHING you need to know about pathology, etc.  Hope this helps too.

http://www.nccn.com/files/cancer-guidelines/breast/index.html

Maya847

Thank you all!  This is a great help!

susanella

Hi,

 I was just diagnosed with invasive ductile carcinoma today.  I am very new to this.  Are you talking about getting a second path opinion before you have surgery based on a core biopsy or based on the post-surgery pathology?

 Thanks.

Rockym

This was something I ended up doing after my surgery and after the final pathology.  Core biopsies are pretty dead on (so I've heard).  My final was the same as the biopsy, but with much more detail since the thing is now out and they can really examine it in greater detail.  I was .7cm with core, but 1.2cm with final.  ER+PR+ on both, but different percentages.  Final path tells you lymph node involvement, etc.

I didn't like the language on my final path and didn't want to overtreat myself.  Sending it out for a 2nd opinion gave me the answers I needed to choose my treatment plan.  Good luck!

jacee

susanella- I sent mine off after my mastectomy & sentinel node biopsy.

I am so sorry to hear of your diagnosis today:(   I know the news is shocking to hear. Please know you are among friends here, and we will all travel this road with alot of support here. You are ahead of the game, just by asking questions. Much strength to you and a big hug....Joni

susanella

Hi Jacee,

Thanks for the information.  It looks like I jumped the gun with the core biopsy path and trying to get a second opinion.  I am now trying to find a good surgeon who takes my insurance.  How difficult is the chemo/radiation?  Are people able to work or do they go on disability?  I am terrified.

peggy_j

Just as an FYI, the pathology report from the core biopsy may not match the final path report in some respects. In my case, the grade and size of tumor were different in the final path report, but the type (IDC) and ER/PR/HER status were the same. I asked my MO how often that happens and she said it's not that uncommon.

Susanella, sorry to hear about your Dx but welcome. There are a lot of supportive women here and lots of information in different forums. (There's a a nice message in the "newly diagnosed" forum, where a patients looks back after 2+ yrs and give advice for newbies i.e. "what I wish I knew when I was first Dxd".) I was initially in shock at my Dx (in Feb) and I did surgery and rads and today I'm OK.  Hugs to you.