Inconsistent biopsy and pathology reports

Sorry this has happened and raised more questions than it has answered.  I would speak to the docs who did the biopsy and see if they can corroborate the number of samples taken.  For the pathology report, is there description of each sample received in formalin, etc., or just one path result and a statement that they received seven samples?  There should be an accounting on both the collection and reception ends of how many samples there were - either in the reports, or in backing documentation in your record - so ask the question at both ends.  As far as the difference in size of the core samples, this is common.  They are sampling from different areas, so some samples are taken at differing angles, or from different areas of the mass, which is not a uniform size.  You can ask for a second opinion on a core sample from another institution, they will tell you over the phone how to go about that and what they need.  Usually larger teaching hospitals or NCI centers routinely do this type of thing.  I had a friend who had secondary pathology done at another hospital and it is usually just a matter of getting the sample to the facility.  The physician who requested the biopsy can also request that this be done and set up the second pathology/imaging opinion - but if you want both to be considered know that you are asking for a second opinion from a pathologist and a radiologist, so two different areas of specialty..  Also, I believe that often facilities have more than one pathologist look at biopsy samples before generating a report - so frequently reports already have a built in consensus second opinion, but this may not be universal.  Good luck!

jewels9 IMO you should get a second opinion. This is not the way to start a process. Too many inconsistencies. I would get copies of all your test results and go to another facility. It sounds like you are already at a teaching hospital but I would not feel confident with this set of docs. The new docscan tell you if they need to redo the biopsy. Good luck. Keep us posted....

Jewel, I'm so sorry you're having to deal with all of this.

Have you spoken with "your doc" about your new symptoms? The skin/texture changes + size changes? These are potentially alarming and might call for asap evaluation, even if you weren't already in the midst of a diagnostic process. Note that I don't know enough to really be helpful on that. But you want to add that to your list of "things" to discuss.

Given the renowned specialist who's been involved in reading your imaging and doing your biopsy, am I safe assuming that you're at a large university or hospital with a breast center? The reason I'm asking is that most institutions like that will have "navigators" to help patients navigate the process. Or ombudsmen to help with problems.

There is clearly a paper discrepancy. But it is possible that there is no actual discrepancy. That's what you need to find out. For example, it could be that one of the samples managed to be separated into two so that what the pathology lab received as seven might have been "taken" from you as six. (I have no idea, but that's an idea of what might have happened.)

So. To your questions.

1. Start with a "navigator." Tell them you saw a discrepancy, and how can that have happened? That person will need to follow up with the various people who write reports/saw your samples.

2. Even if they use the same core needle, there are at least two things that could cause different sizes that come immediately to mind. How compressed were your breasts? Might they have taken samples in different areas where the compression was slightly different? Did the needle go to different depths in some of the core samples. Again, I don't know the answers--or even the possibilities. But it's certainly possible that there isn't anything wrong. Go in with a curious mind--you want to understand. No accusations...that just makes people defensive. And you want to enlist these people onto your "team" (if they aren't there already).

3. I haven't had those experiences. But given modern bar-coding/labeling procedures (where they slap a bar-coded label on the sample as it is packaged for the lab), it has become increasingly unlikely that there is a mislabeling error. That's something that the navigator may be able to help with. Where your biopsy was done, what is the procedure? Do they package/label specimens before they're taken away from the patient or the procedure room? Do they compare your bar-coded wrist band with the biopsy labels?All those things are intended to make mechanical errors less likely--although unfortunately, where humans are involved, nothing is impossible.

4. Do you still trust the "expert"? If so, ask him/her for suggestions on second opinion docs and on what portions of the process second opinions are required. (Given the bafflement among docs, the renowned expert might be as interested as you in having a second pathologist group take a look at your samples.) If you don't trust the "expert" is there another doc you do trust? Talk to that person about accessing another breast center group for second opinions. (BTW, consider checking in with your health insurer. They may well have some procedures you need to use to make sure second opinions are covered by your insurer.)

5. Finally, ask the navigator who you should ask to review the skin/texture changes. You are trying to avoid full-panic mode (they should appreciate that), but want to make sure that a new and potentially alarming symptom gets included in the diagnostic process.

HTH (and best wishes--hope you hear that all is in order and nothing to worry about),

LisaAlissa

Jewels9, my initial biopsy came back benign, as a fibroadenoma. (I had a vacuum-assisted ultrasound-guided core needle biopsy, she took 5 samples.) The doctor who did the biopsy (my breast surgeon, actually), said that while it most likely was a fibroadenoma she thought one side looked a little odd and suggested I have the lump excised, just in case. I did and there was 2.2cm of IDC in the fibroadenoma. This is not common but it does happen. Luckily my doctor had many years of experience and went with her intuition.

I would think that experienced doctors would take your concerns more seriously!