title: Pathology review of outside material: when does it help and when can it hurt?
abstract: OBJECTIVE
  Pathology review is performed for patients when care is transferred to a tertiary care center after diagnostic tissue has been obtained. While it has many benefits, this practice can lead to unforeseen difficulties in doctor-patient communication and patient well-being, especially if a diagnosis is overturned or modified years after treatment. The aim of this analysis is to identify clinical situations in which pathology review can result in challenging discussions between patients and oncologists.
  
  
  METHODS
  Representative case scenarios are presented in the subspecialty area of hematopathology. Analysis of the clinical benefits and possible harm to patients, pathologists, and treating oncologists that may ensue from pathology review is performed.
  
  
  RESULTS
  Pathology review may result in a valuable second opinion and expert subclassification. However, problematic situations may arise with pathology review, especially if the patient has already undergone definitive treatment and is referred to an academic institution in remission. Difficulties can also arise when patients do not understand the limitations of diagnosing disease on small biopsies. The patient may receive a different diagnosis or it may become apparent that the diagnosis could have been made more expeditiously. These discrepancies must be communicated to the patient and may cause confusion and distress.
  
  
  CONCLUSIONS
  Pathology review can be beneficial or potentially harmful depending on the clinical situation. Preliminary recommendations are provided for selecting patients for review. Limiting pathology review to certain clinical situations and encouraging patients to get second opinions before initial treatment at local referral centers may be helpful in minimizing reassignment of diagnoses after definitive treatment.
authors.affiliation: University of Michigan, Ann Arbor, MI 48109, USA lbsmith@umich.edu
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Smith
mesh_terms: D000328:Adult; D000077548:Anaplastic Lymphoma Kinase; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D017728:Lymphoma, Large-Cell, Anaplastic / Q000473:pathology; D016411:Lymphoma, T-Cell, Peripheral / Q000473:pathology; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D010336:Pathology / Q000379:methods*; D011369:Professional-Patient Relations; D020794:Receptor Protein-Tyrosine Kinases / Q000378:metabolism*; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases