Article from Uro Alerts ---Today
"Second Opinion Pathology in Tertiary Care of Patients with Urologic Malignancies" - Abstract
Tuesday, 23 June 2009
Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, USA.
The purpose of this study is to evaluate the utility of second opinion pathology in patients who are seen in consultation for urologic malignancy.
We retrospectively reviewed the records of all patients who were seen at our institution in consultation for urologic malignancy from August 2002 to April 2008. All available pathologic slides were reviewed by the urologist and pathologist at the time of consultation and compared with the original diagnosis. Discrepant diagnoses were reviewed by at least 2 pathologists. Diagnostic disagreements were graded as minor or major according to the significance of their effect on treatment or prognosis. We report the proportion and types of diagnostic discrepancies and their impact on patient care.
A total of 264 patients were seen in consultation. Of these, 213 had pathologic material available for review: prostate cancer 117 (55%), bladder cancer 83 (39%), testis cancer 5 (2%), renal pelvis or ureteral cancer 5 (2%), retroperitoneal tumor 2 (1%), and kidney cancer 1 (0.5%). Disagreement with the original diagnosis was found in 22 cases (10%), of which 18 (8%) were classified as major, and 4 (2%) were classified as minor. Interventions avoided or delayed, as a direct result of second opinion pathology, were a prostate biopsy in 1 patient, management of metastatic prostate cancer in 1 patient, partial nephrectomy in 1 patient, management of urothelial carcinoma in situ (CIS) in 1 patient, and radical cystectomy in 5 patients. Interventions recommended or performed were radical prostatectomy in 1 patient, and radical cystectomy in another. Additional pathology from subsequent biopsy or surgery was available in 12 of the 22 patients, and the second opinion pathologic diagnosis was supported in all patients.
A second opinion review of surgical pathology for urologic malignancy can result in major therapeutic and prognostic changes, which can impact patient care. Our results support the review of all pathology by the urologist and pathologist as part of the consultation in patients with urologic malignancy.
Written by:
Wayment RO, Bourne A, Kay P, Tarter TH. Are you the author?
Reference:
Urol Oncol. 2009 Jun 11. Epub ahead of print.
doi:10.1016/j.urolonc.2009.03.025
PubMed Abstract
PMID:19523859
This article appeared today.. The idea and recomendation we stress of a second opinion is extremely important as the article states....
Arlene
Already a member? Sign in
Welcome to Inspire!
What - Inspire is a place where you can connect with people who share your health concerns and find information and advice in groups sponsored by organizations you know and trust.
Why - As a member you can use Inspire to let friends and family know how you're doing, contact others who share your health concerns, receive personalized updates and information about participating in surveys and clinical trials, and more.
How - Joining Inspire is completely free and usually takes less than a minute. Join now!
Second Opinion Pathology
- By Ciboney1
- Posted June 24, 2009 at 8:54 am · 3 replies
- Shared with the public
Explore topics in this journal entry and replies:
Cancer Surgery Prostate cancer Kidney cancer Ureteral cancer Carcinoma in situ Prostatectomy Stress Bladder cancer
3 replies
- Oldest first
- Newest first
- By jj803
- Posted June 24, 2009 at 1:35 pm
- Report post
Hi Arlene,
As you know I couldn't agree more with 2nd opinions from an institution independent of your original. That 2nd path opinion can be vitally important. As the above study noted about 90% concordance, but there can be important differences or additional findings that can result in a markedly different approach to treatment. If you decide that the original urologist is fine with you, then at least think about 2nd path opinion. Quote this study if you want or just let them know that you know of someone who this affected. Thanks for sharing.
JJ
- By Nea
- Posted September 20, 2009 at 11:49 pm
- Report post
Hi, I appreciate this article. I had my first turbt done and then went to UCD. The doc at UCD had their lab look over the first specimens. Because there was so much 'black" tissue and no muscle tissue identified, a second turbt was done. The biopsy of the second turbt revealed no invasion of the muscle tissue but it was important to do the second biopsy for accurate staging.
I have been looking at the information on getting second opinions, and found that I would have to go to SF Bay area to get another opinion if I needed to have more surgery. Mid October is my next cysto exam. This note is a "late" response to an old journal posting so I won't add anymore now. Look forward to now Ciboney is doing this month. Bye now.
- By lsh
- Posted September 21, 2009 at 6:50 am
- Report post
Nea,
BCan is having it's next Bladder Cancer Forum at Mission Bay Conference Center in SF. There are many good cancer urologists there.
Lynda
Add to the discussion