Thyroid Diagnosis – Can Be Tricky Business
A recent Wall Street Journal article, titled “What if the Doctor is Wrong?,” reported the story of a woman who requested a second opinion after receiving a diagnosis of probable ovarian cancer. In the article, the patient presented with multiple tumors in her pelvis, abdomen and spine. When her initial biopsy came back with inconclusive results, clinicians felt that she had ovarian cancer and should be treated with a hysterectomy. The patient decided to postpone surgery and get a second opinion. During the course of the second opinion, a second biopsy was performed which determined that in fact she had a rare form of lymphoma, which can be difficult to diagnose.
Some malignancies including lymphomas as well as rare cancers of the thyroid and salivary glands can be very tricky to diagnose. Test results may return as inconclusive or in some cases provide false results. Recently, the president of Argentina had her thyroid removed after being diagnosed with cancer from a biopsy. It was revealed after the surgery that she had a benign condition.
There are other considerations that may lead to an inconclusive diagnosis. Testing for thyroid cancers requires a procedure called a fine needle aspiration (FNA). These cases provide their own unique set of challenges because the quality of the specimen is highly dependent on the skill of the clinician performing the procedure. The ability of that individual to create readable, well preserved smears containing sufficient numbers of diagnostic cellular material and lacks obscuring debris, excessive blood, air drying and other artifacts is critical to how well the pathologist can diagnose disease.
InCyte pathologists interpret over 1,700 thyroid specimens annually, approximately 70% of these are fine needle aspirations (FNA). InCyte Pathology recognizes the importance of a second opinion for difficult thyroid biopsy interpretations. All of our pathologists are board certified, with many having subspecialty training in cytopathology.
One of the benefits of having 24 board certified pathologists at InCyte Pathology, is that difficult cases can be reviewed by the group. InCyte pathologists follow the practice of having all cancer cases and unusual cases reviewed by at least one other pathologist. Sometimes, when appropriate, multiple pathologists are asked to review the same case.
Additional consults with recognized experts outside of InCyte Pathology may also occur in very difficult or unusual cases. When such a consultation is sought, the referring physician is notified because an outside consultation may delay the diagnosis for up to two weeks, which may cause undue stress for the patient and their family. Therefore, knowing when it is appropriate to use an outside consult demonstrates good practice, brings additional expertise to the diagnostic process, and provides clinicians enough information to create a treatment plan appropriate for each patient.
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