|
Facts To Know When You're Having A Biopsy
WHY IS MY DOCTOR DOING A BIOPSY?
Your doctor can correctly diagnose many medical problems by taking a careful history and performing a physical examination. If needed, the doctor may order common supplementary tests, such as lab tests or radiology studies. For the great majority of problems, these studies will provide enough information for a diagnosis.
In certain circumstances, however, a doctor may find the answer to your medical problem by taking a sample of tissue, a “biopsy”, from your body. This may be necessary after finding an abnormal lump or mass, having an abnormal lab test, or having an abnormal radiology study. A tissue biopsy is only done when an answer cannot be obtained in any other way. As it is a diagnostic procedure of last resort, it is critical that the interpretation of your biopsy be correct.
WHO LOOKS AT MY BIOPSY?
Interpretation of biopsies and other tissue specimens is performed by doctors in the Pathology Department. Pathology is a medical specialty that patients may have little awareness of. This is because hospital pathologists primarily serve the doctors of the medical center rather than serving patients directly. Pathologists are medical doctors who spend at least 5 years in a specialized training program after graduation from medical school. Through their interpretation of biopsies, pathologists play a vital role in helping physicians to diagnose serious illness in their patients. Pathologists also play an important role in treatment of serious illness by participating in monthly Tumor Boards, where the treatment course for patients with cancer is determined. Finally, pathologists serve as source of knowledge for all other physicians in the medical center, providing information about both common and unusual conditions which are diagnosed by biopsy.
The pathologists of the Oakland Medical Center are committed to providing both the patients and the doctors of the medical center with the highest quality service possible. The six pathologists of the department are experienced, knowledgeable, and highly regarded by other physicians at the medical center. Most members of the department have been in practice with Kaiser for at least 10 years. During this time, they have accumulated the wealth of knowledge and experience which comes with working in a busy medical center. All members of the department attend educational conferences on a regular basis, and are active in a local professional society of Bay Area pathologists from university and community hospitals where information on unusual diseases and latest technologies is shared. Because of the integrated nature of the Kaiser system, the physicians of the medical center have worked with the same group of pathologists over many years. This long association has resulted in a great deal of trust, confidence, and respect; Pathology is always listed by other doctors as one of the most outstanding departments in the Oakland Medical Center.
WHAT HAPPENS TO MY BIOPSY?
Before a tissue biopsy can be evaluated by a pathologist, it must go through multiple processing steps. The biopsy must first be preserved in a liquid fixative called formaldehyde; then, after further chemical processing, it is embedded in a block of paraffin wax. A thin slice of tissue is then cut from the paraffin block, placed on a glass slide, stained to make the tissue visible, and covered with a protective coating. Tissue processing takes place overnight, and glass slides are ready for pathologist review 1 or 2 working days after the biopsy is submitted.
HOW DOES THE PATHOLOGIST MAKE A DIAGNOSIS ON MY BIOPSY?
The pathologist then examines each glass slide using a microscope. Based on his/her extensive training and knowledge of patterns of normal tissue and disease, the pathologist arrives at a diagnosis for each biopsy. Sometimes, the appearance of a biopsy is very characteristic of a certain disease, and a diagnosis can be made immediately. Some diseases, such as breast and prostate cancer, are unfortunately so common that most busy pathologists are quite expert in the diagnosis of these conditions. Occasionally, a biopsy may not be large enough or show enough of the disease process to be diagnostic. In those cases, a pathologist will not be able to make a definite diagnosis, and another biopsy will have to be performed. Some biopsies may be large enough, but have less clear cut findings. In these cases, the pathologist may request that additional glass slides be prepared from the paraffin wax tissue block. These slides may give the pathologist a slightly different view of the tissue which may clarify the diagnosis. The pathologist may also request that a variety of special stains be done on additional tissue sections cut from the paraffin block. These special stains may positively identify the disease process which is present in the biopsy. Often, in such complicated cases, the pathologist may ask several other colleagues in the department to review the slides. If the additional slides and special stains yield more information and all pathologists feel satisfied that the correct diagnosis has been made, the initial pathologist will issue a final report on the biopsy.
Many biopsies, even those that are relatively straightforward, are reviewed by more than one pathologist in the department. One pathologist may ask another to review a biopsy in order to make sure that no small detail has been overlooked. Other biopsies may be reviewed by multiple pathologists out of professional interest. In the first six months of 2005, 19% of biopsies were reviewed by more than one pathologist before a final diagnosis was issued. Biopsies are also routinely reviewed after a diagnostic report has been issued, in settings such as monthly pathology conferences and tumor boards. In pathology conferences, physicians from different specialties, such as urology, dermatology, and gastroenterology, meet with pathologists for a hour to review clinical findings and biopsy slides on a number of patients. Tumor boards are another setting in which biopsies are routinely evaluated by multiple pathologists. These are meetings where doctors from several specialties gather to present information about patients with cancer and formulate the best possible treatment plan. If a Kaiser physician has any question concerning a biopsy result, she or he may ask for the case to be reviewed by all members of the Pathology Department, or by an outside consultant. If a patient has a biopsy at another Kaiser facility and then comes to the Oakland medical center for a procedure, the Oakland based surgeon will usually request the biopsy slides, and they will be reviewed in the Oakland Pathology Department. Through all these avenues, the work of the Pathology Department is regularly reviewed and scrutinized. The members of the department welcome this as an additional check on the continuing high quality of their work.
If a biopsy has very unusual findings and the pathologist is not sure of the diagnosis, s/he will usually send the glass slide to an expert consultant outside of Kaiser. Expert consultants in pathology are usually on the faculty of a university medical center. These pathologists specialize in the examination and diagnosis of diseases of a particular part of the body; thus, they have experience with more unusual and rare diseases within their area of expertise. In such unusual cases, Kaiser Oakland pathologists are encouraged to seek outside consultation, and there is complete freedom to choose the most appropriate pathology consultant. Quality of care, not cost containment, is the highest priority of the department in these situations. Unusual cases that receive outside consultation are also an important part of continuing professional development and education for the department members.
WHO SHOULD I TALK WITH TO UNDERSTAND THE RESULTS OF MY BIOPSY?
Usually, it is best for the patient to discuss their pathology report with the physician who performed the biopsy or who is treating the patient for the illness. These physicians are well equipped to explain the details of the report and to talk about the relevant treatment for the patient’s illness. In some circumstances, patients are interested in discussing their biopsy results with the pathologist as well. Members of the pathology department are happy to meet such requests if they are arranged through the patient’s treating physician.
SHOULD I GET A SECOND OPINION?
Many patients wonder whether they should seek a second opinion on their biopsy. This may be obtained free of charge within the Kaiser system. A second opinion would usually be arranged through the physician who performed the biopsy or who is providing treatment for the illness. That physician would contact pathology and ask for review by additional members of the department. Slides may also be sent free of charge to another Kaiser hospital, if a second opinion outside the original pathology department is desired by the patient or their doctor.
Some patients request that their biopsy slides be reviewed at an outside hospital, such as UCSF or Stanford Medical Center. If an outside review is requested by a patient rather than by the pathologist or the patient’s doctor, the patient is responsible for the cost of the outside review. At Stanford or UCSF, the basic price for a slide consultation is between $275 and $350. If the consulting pathologist orders additional special studies on the biopsy, there would be additional charges. Any Kaiser member requesting an outside opinion may pick up their biopsy slides from the Pathology Department. In order to avoid waiting, it is best to call ahead and request the Pathology office staff to package the slides (click here for contact info). Kaiser members must sign an authorization allowing the department to release the slides. If the slide consultation is to be performed at UCSF or Stanford, the Pathology department can send the slides directly with a courier which shuttles daily from Kaiser to these hospitals.
CONCLUSION
The doctors of the Oakland Pathology Department are committed to providing the highest quality service to both the medical staff and the patients of the Oakland Medical Center. They understand the crucial importance of their work in determining the right diagnosis and the proper course of treatment for serious illness. They endeavor to follow the direction of the Permanente Medical Group leader, Dr. Robbie Pearl, by treating every biopsy as if it belonged to a member of their own family.
|
