Second opinions on biopsy results could save lives

A Second Opinion post on 5/30/2014.   Topics: 

While biopsies provide important information that helps diagnose cancer and other diseases, several studies have found that there can be errors in the interpretation of the results. Seeking a second opinion can make a difference in both your diagnosis and your treatment options.

A study published in the journal Radiology pointed out that the number of biopsies performed every year in the U.S. increased from 1,380 procedures for every 100,000 Medicare patients in 1997 to 1,945 in 2008. That calculates to a compound annual growth rate of 3 percent a year during that time period, and suggests that both patients and doctors will depend on these diagnostic procedures for years to come.

This may be problematic considering the error rate. Researchers at Johns Hopkins Hospital once discovered that, out of more than 6,000 cancer patients across the U.S. who sought a second opinion, 1.4 percent had a change in diagnosis. Within this group, 23 percent went from being classified as malignant to benign.

Know what to expect during your biopsy
Biopsies, which collect tissue samples for laboratory tests, are usually used to diagnose cancer, but they can also help health care providers identify infections, autoimmune disorders and other conditions.

A biopsy can take place on virtually any organ of the body, including the abdominal organs, bones, bone marrow, breasts, lungs and prostate. Many biopsy procedures are minimally invasive and use long or fine needles to collect the tissue and cell samples. Radiology equipment – such as X-ray machines, ultrasound, magnetic resonance imaging scanners or computed tomography – may be needed to guide the placement of the needle.

These needle-biopsies are usually outpatient procedures, but if the target area is inaccessible to needles, surgery may be necessary. Doctors may suggest remov​ing whole lumps or larger sections of tissue, depending on the specifics of your case.

Once the samples are collected, a pathologist will examine cells to find out whether they are abnormal. The pathologist may or may not order specialized tests to further confirm the diagnosis or to help identify markers that can be used to personalize the treatment approach.

Getting a second opinion can alter your diagnosis and treatment
Based on the pathologist’s examination of your tissue samples, your doctor can diagnose your disease, recommend treatment options and form a long-term prognosis. When you face a serious diagnosis like cancer or one that requires surgery, it’s a good idea to get a second opinion on the interpretation of your biopsy. That second opinion can confirm the original diagnosis and treatment plan or, in some cases, change the diagnosis. A pathologist is only human, so sometimes a second set of eyes and brain power can be invaluable.

Why are second opinions important when you are diagnosed with a serious medical condition? Consider this case. We recently had the husband of a 54-year-old woman reach out when his wife was diagnosed with breast cancer and it was suggested that she quickly undergo a bilateral mastectomy followed by chemotherapy.

We arranged a second opinion with a top breast cancer specialist who had her pathology team carefully review the suspicious slides. The team came back with a diagnosis of atypical ductal hyperplasia, an abnormal cell growth that puts women at higher risk for breast cancer but is not cancerous itself. The bilateral mastectomy was canceled and instead the patient had an outpatient lumpectomy to remove all suspicious tissue and make a final and determinative pathology diagnosis. Not only did she avoid unnecessary surgery and chemotherapy, but she also avoided the cost and anxiety of cancer surveillance for a lifetime.

Working with private health advisors for a second opinion and personalized treatment plan
When you need a second opinion, a health advisory team can direct you to top specialists who can review the findings from the initial biopsies and medical exams and provide additional insight into your prognosis and recommend treatment options. Health advisors can help to leverage these insights to help you design a personalized treatment plan that may be more effective and evidence-based than what was initially recommended.

Additionally, private health advisors can connect you with specialists who are more knowledgeable about innovative testing modalities. For example, research published in the New England Journal of Medicine demonstrated how “liquid biopsies” may be able to monitor the progression of cancer more effectively than radiology tests by detecting abnormal DNA fragments from ordinary blood samples. While the accuracy of these tests has yet to be firmly established, private health advisors can provide additional medical research to help you assess the appropriateness of innovative therapies and treatments and connect you with physicians who have the most experience with these new approaches.


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