What If The Pathologist Is Wrong?

And they won't review all the tests. This is a two part misadventure.

First I was horrified by this first story where two women were found to have been misdiagnosed by a pathologist at a hospital in Ireland. Their original breast cancer diagnoses were incorrect. One woman was diagnosed with DCIS in 2010 and had a mastectomy. Based on the original pathology she was not required to have any additional treatment. In 2012, to the surprise of her and her doctor, her cancer came back.

"Her original 2010 biopsy had shown invasive cancer but this had been missed.

The hospital said this was a mistake that any pathologist could have made and a review of 39 of the specialist's cases from 2010 was conducted.

The review found that of nine DCIS cases Alison and another woman were misdiagnosed."
It is nice to know what they did review some of the test results to find the ten cases. But wouldn't you think those ten cases were the proverbial smoking gun and want to review more cases, not just the ones from 2010? They only made errors during one year?

No, apparently not.

Although it was recommended to review all the pathologist's breast cancer cases, the hospital decided it was not needed.

"A review of the breast cancer test results for around 270 patients has been ruled out despite the doctor involved in their care misdiagnosing two other women with the disease.

St James's Hospital, in Dublin, which has the country's largest cancer centre, has refused to investigate the tests of the women, despite the call being made to Health Minister Simon Harris.

The decision follows revelations a former locum pathologist at the hospital misdiagnosed the type of cancer Dubliner Alison McCormack had in 2010, finding she had a form known as ductal carcinoma in situ (DCIS), which is not invasive."

[HSE = Health Service Executive in Ireland and provides all of Ireland's public health services in hospitals and communities across the country.]

The hospital released a statement:

"“The review highlighted that identification of subtle foci of invasive carcinoma within in situ carcinoma is a difficult diagnostic area that challenged both the individual pathologist and the wider pathologist group.

“The pathology conclusion is that this error could equally have been made by any other competent pathologist and does not represent incompetency on the part of the individual pathologist or a departmental systems failure.

“On the basis of the contents of the report it is the view of St. James’s Hospital that any further review of the remainder of the pathologist’s work is not warranted."

Um, if its an error that could be made by any pathologist, I am not sure I would want any of their pathologists, looking at my tests. And when the error was discovered, after the patient was rediagnosed, the hospital didn't even rush to tell her and waited until a meeting months later.

St James is a big teaching hospital associated with Trinity University and, I believe, the biggest hospital in Dublin. But if I knew this, I wouldn't go to that hospital unless absolutely necessary and want every test done, redone elsewhere. 

A picture paints 1000 words

We all hear 'we need to wait for the pathology report' and 'Tamoxifen prevents breast cancer recurrence'. But what exactly does this look like? I had no idea. Now I do, thanks to Cure Magazine (www.curetoday.com) - go get a subscription if you have or had cancer and don't receive it.

On the left we have: Estrogen binds to the estrogen receptor, initiating a cascade of events that activate certain genes leading to tumor cell growth.

On the right we have:Tamoxifen blocks estrogen binding to the estrogen receptor, stopping tumor growth.

Starting from the left:

Immunohistochemitry (IHC) for the estrogen receptor in the cell nucleus. Left to right: Low, mildly positive, and highly positive.

Next image: Flourescence in situ hybridization (FISH) tests for Her2 expression by staining a control chromosome green and the Her2 receptor pink.
Final image: Immunohistochemistry (IHC) tests show the Her2 receptor at the cell surface.

On keeping doctors in business

I believe it is my personal goal to keep the local medical profession in business. I spend entirely too much time seeing different medical professionals. Then I got hold of the pathology report from my ankle MRI. I think its written in secret doctor language that requires a doctor to decipher it. To be fair, most pathology reports require some level of decoder ring but this one really takes the whole case.

I will not bore you with the entire thing but here is the finally impression at the bottom:

1. Chronic full-thickness tear of the anterior talofibular ligament.
2. Evidence of avulsive changes of the tip of the lateral malleolus, better characterized on the radiographs.
3. Osteochondral lesion in the posterior lateral aspect the talar dome, with overlying chondromalacia and at least partial-thickness chondral defect. Associated small focal vertically oriented osteochondral fracture.
4. 0.7 x 1.3 x 1.8 cm ganglion or synovial cyst arising from teh posterior aspect the tibiotalar joint and intimately associated with the flexor allucis longus muscle.

My thoughts (because the doctor already told me what's wrong):
1. I have a ligament tear
2. I have a bone chip
3. I have a cartilage chip
4. I have an old cyst

I tried to struggle through the first parts of the description of the report and it was like reading a text book in a foreign language. So I clearly think that its a plot by doctors to keep them in business. If you haven't gone to medical school you can't translate this to real English. What if you could go for a medical test and get a report that told you what was wrong and magically knew how to fix it? Nah, not going to work.

Anyway, this week Walter went to the doctor twice and I only went once, but might have to go back today. (Next week I will hit my weekly average of two appointments.) Walter's procedure went fine yesterday. He seems less whiney (big sign of improved health) and ate his favorite foods without regretting it later. I am off to work today and have made a very healthy salad for lunch with hummus on top to be healthier. And I talked to the vet and the cat has nothing discernible wrong with him but to reverse some of the weight loss issues he is now allowed to have kitty treats again. So his life is now complete.

Surgery went fine

I am home. The surgery went fine. Darvocet is a wonderful thing. I am tired, sore, achy, and otherwise okay. Nothing like a good night's sleep at the hospital. I slept from 830-930 and the pain meds wore off so I woke up. Vitals check around midnight and then I slept from 1230-3 when the night nurse came in to check on me. Then at 430 they came to check my vitals again. Then at 6 am about 10 residents showed up to check on me. I need a nap.

We will have results of the pathology reports on the 16th so no news until then. I also have this stupid drain which has to be emptied twice a day, by a visiting nurse at first, for the entire time! No driving, etc while I have it in as well. Just lots of naps with the cat.