Issues with tissues: Interpreting biopsy reports (Proceedings)


Issues with tissues: Interpreting biopsy reports (Proceedings)

Aug 01, 2008

Because the language of pathology originated in numerous countries and has been handed down for many generations, pathology reports are often confusing and full of misnomers. Reporting suffers from lack of standardization, canned sentences, and buried information gives rise to misunderstandings and lack of communication over pathology reports. This paper will alert you to several misnomers and misunderstandings commonly encountered by clinicians when interpreting pathology reports to anxious pet owners.

To make things worse, evidence based medicine is confounding for older and geriatric pets, especially in the field of oncology, because most published data excludes them.

Therefore the clinical trials that most generalists are expected to or are led to base their treatment decisions upon are not applicable to elderly patients! This course will assist you in the decision making process with clients regarding option

The first part of my oncology consultations is a careful review and clarification of the patient's pathology report so that the pet owner understands the actual situation and the stated prognosis. Most of the initial reports describe the tissues submitted to the pathologist by the referring doctor. Some of the samples are excisional biopsies and others are actually incisional biopsies despite the original intention of the surgeon. Over the years, I have repeatedly tangled with the threads of certain complaints in the fabric of histology reporting. I frequently wanted to formalize these "tissue issues" and commit them to print. It is my wish to help clarify, instruct and suggest improvements. It is paramount that we understand and communicate with rather than provoke an adversarial relationship with our pathologists who truly are our good friends and allies in the battle against cancer.

The "mini-histo" Often Falls Short of What is Actually Needed

Due to the high total costs involved with patients undergoing surgical oncology procedures, many veterinarians offer the less costly option for a short cut or the "mini-histo" for tissue diagnosis. Unfortunately, this short cut is too often assigned when more information is needed. Abbreviated reports generated from the "mini-histo" are not sufficient for cancer patients with owners who intend to go through the referral process. It is best for the referring doctor to call the lab and upgrade the report to a full histology report and ask the lab to send the full report directly to the consulting oncologist for the initial consultation. In my opinion, the "mini-histo" is appropriate for true cut biopsies and wedge biopsies and any other sampling biopsies needed to gain information as to tumor type and histologic grade. It is not appropriate for patients that have owners that love them enough to request "removal" of the tumor. The practitioner is theoretically engaged by the pet owner to perform an excisional biopsy (complete removal as understood by the pet owner). After the fact, the surgery may in reality only have been an incisional biopsy whereby the pet is left with an incompletely removed tumor. Unfortunately many samples are submitted that are inappropriate for determining the full status of the postoperative situation for the patient. In addition to tumor type and grade, there is a "need to know" about and report on the margins around the tumor especially if the clinician proposes to his/her client that he/she is "removing" a specific mass from their pet's body. Informed consent and informed refusal regarding the option of paying for full pathology reports are good points to recruit and openly discuss with the client. They need to know that the full pathology report plays a key role in our ability to understand the outcome of surgery.

Margins Are Essential Issues with Tissues

When evaluating the post surgical cancer patient, the oncologist needs an accurate description of the surgery along with a measurement of all margins around and below the tumor. At the time of the procedure, the gross cut margins may have been two cm but they may be reported as only one third to half of the actual operative margin. This reported disparity is due to the fact that tissues undergo shrinkage in formalin.