Muscle, Breast and Other Biopsies Often Need a Second Opinion

04.10.2016

Biopsies may need to be reviewed by a second physician, particularly if the diagnosis is unclear or if the findings do not go along with the clinical picture. It always troubles me to know how people given a serious diagnosis generally take the diagnosis at face value and don't get a second opinion.

Of particular concern are patients who have a muscle, breast or other biopsy done in a small private hospital and assume the diagnosis is correct.

Good pathologists know their limitations and often send biopsies out for a second opinion. However, even so-called  experts make mistakes. Sometimes egos are involved and the doctors don't want to admit they could ever be wrong. I remember one well known neuromuscular specialist who would not let me see the slides for a child I was to see from out of town. Fortunately, the father was a lawyer and insisted I see the slides. When I received them and was able to spend time looking at the muscle biopsy, I realized why the doctor didn't want me to see the slides. They were so badly processed they were unreadable. I never understood why he didn't have the technician re-do the slides because usually extra tissue is kept frozen so slides can be re-done.

I frequently received muscle biopsies from even big university medical schools that were so badly processed  there was just no way a diagnosis could be made. I would try to get the frozen block, so the biopsy slides could be re-done, but if that was not possible we did a repeat muscle biopsy using a local anesthetic. That is the way a muscle biopsy should be done to avoid the risk of Malignant Hyperthermia.  With a general anesthetic, a serious problem and even death can occur when a muscle biopsy is done if certain anesthetics are used when a patient has a particular muscle problem such as Central Core disease. So a second opinion may be life saving.

Image copyright: bradhoc/flickr/CC BY

Article last time updated on 02.11.2016.

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