Six Points of Miscommunication Between Oncologists and Pathologists
Regardless of where you practice, good communication between you and your pathologist is the best way to ensure that correct testing is done. Here are six common points of miscommunication to watch out for.
References:
1. Janne PA. What Are We Talking About: Next-Generation Sequencing, Sanger Sequencing, etc. Presented at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting.
2. Aisner D. Tissue is the Issue: The Pathologist’s Role in Facilitating Molecular Analysis. Presented at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting.
3. Nowak JA. The Practitioner's Guide to Using Molecular Testing. Presented at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting.
Regardless of where you practice, good communication between you and your pathologist is the best way to ensure that correct testing is done. Engage your pathologist in the care. Your patients are the pathologist’s patients too.
“The biopsy happened on Friday! Where are my results?”
Most institutions do not process samples over the weekend, so Friday biopsies sit in formalin until Monday morning. Extended formalin time may be detrimental to molecular pathology testing. Avoid Friday biopsies if you can.
“My patient only has bony lesions that will be rejected due to decalcification.”
If the sample is exclusively for molecular testing, some lytic lesions are able to undergo molecular testing directly. This usually requires revision of institutional routine to prevent the reflex response of the gross room to automatically decalcify. Another solution is to consider an FNA of the bone, since spicules may not need to be decalcified and therefore may be suitable for molecular testing.
“My patient is having a liver biopsy via IR and they tell me they can only do FNA. I was hoping to have molecular testing done!”
Numerous studies have demonstrated that cytology is suitable for molecular testing. Some labs can test directly from smeared slides but have to sacrifice the slide. This may have medico-legal implications, so you will need to talk to your pathology department/legal advisors. Also consider that post-treatment biopsies are becoming more common: Often in these cases there are treatment-related tissue changes that make a sample unsuitable for testing.
“I put in the request 2 days ago for path to request tissue!”
Pathology materials are kept in vast off-site archives and can take 1 to 4 days to be released.
“My patient has a malignant pleural effusion and my surgical pathologist tells me there is ‘lots of tumor,’ but my molecular pathology lab says it is insufficient for testing.”
Remember, the tumor cells may be present but represent a low proportion of pleural fluid cells. If the percentage of tumor to other cells is too low it might preclude successful molecular testing.
“My patient has nonâsmall-cell lung cancer, which was diagnosed by FNA-now I’m told that the pathologist has insufficient material for molecular testing.”
Not infrequently, the pathology report issued from an FNA offers a histologic diagnosis, but tissue is exhausted and there is none left for molecular testing: In these cases, the pathologist may have been unaware that the secondary purpose of the biopsy was for molecular testing. The clearer/more specific you and your pathologist can be in your communication, the more time and money you’ll save yourselves and your patients.