The Second Opinion
Elizabeth Wingard
It would seem pretty simple. 2nd Opinions matter.
"Getting the right eyes on the case, is critical. The expert 2nd opinion validates the treatment plan for patients, immediately".
Ira M Klein, MD, MBA, FACP
Aetna, Senior Medical Director for Strategy
Numerous studies demonstrate the value of getting the right specialist in the particular area in question to review each case. Just take a look at these findings:
- Pathologists from the University of Virginia re-analyzed specimens from patients initially diagnosed with transitional cell bladder cancer. 20% of specimens had a significant discrepancy between initial and follow-up pathology evaluation with regard to diagnosis, stage, cellular aggressiveness and cellular type.
- At Northwestern Medical School, 340 patients presenting for second opinions regarding 346 breast cancers. Eighty percent (80%) resulted in some change in the initial diagnosis. Major changes that altered surgical therapy occurred in 7.8% of cases, and pathology review provided additional prognostic information in 40%.
- In another study at the University of Miami, 178 consecutive liver biopsy tissue glass slides provided to hepatology consultants were selected for evaluation. Thirty-five (28%) had major discrepancies and 47 (37.6%) biopsies had minor discrepancies.
Pathology specialists understand the need, and feel the pull to reach more patients, to help in the way they know best. John Bishop, Chief of Anotomic Pathology at UC Davis told me: “The cases that keep me awake at night are the youngsters in a remote ER with blood tests that look a little off. The diagnosis can be mono, the flu or leukemia. The local pathologist is doing their best, but if you haven’t seen a good many of each – the opportunity to err is pretty high.”
For me, the importance of specialist 2nd opinions is particularly personal. I have a colleague, a good friend, who lives in remote New England. His wife went to her annual physical and small lumps were found in her breast. A needle biopsy was performed and the diagnosis was Cancer – Stage 1. Her physician recommended a lumpectomy.
Because of our work in this field, we were able to assist and a Pathology expert in breast tissue Massachusetts General Hospital (MGH) reviewed her slides. The review found highly invasive cells in the biopsy and recommended she delay the lumpectomy in order to have radiology scans to determine whether the cancer had spread to other organs.
The cancer had spread to her bones and the diagnosis was revised to Stage IV. Since that diagnosis in December 2011, her local physician and MGH have worked together to provide her treatment plan – a significantly different plan due to the revised diagnosis provided from the 2nd opinion. That revised plan allowed her to participate in a number of clinical trials and she is beating the odds. Today, she lives with her husband and young daughter, with family nearby, and continues with her life.
2nd Opinions in Pathology matter. They help avoid unnecessary procedures, uncover undetected illnesses, and reclassify types of conditions to improve recommended treatments. They improve the quality of care patients receive - in some cases saving lives, in others, helping to extend them in a meaningful way.
Our mission at Corista is to extend the reach and service that Pathology specialists can provide. The technology we develop has a purpose – to empower these specialists to reach more patients, validate treatment plans and search for new approaches in evaluating the disease process.
We are working with expert centers and with their remote, referring hospital networks to make pathologist collaboration easier, faster and more cost effective. We are developing new technologies to overcome traditional barriers and enable physicians to provide better care.
Because for us, it’s personal.