Revision of histological preparations

What are the criteria for the completeness of the performed morphological analysis? “Is the diagnosis reliable or not, is a second opinion needed?”

Such questions arise in the vast majority of patients who have been diagnosed with a tumor.

It is impossible to give a universal answer to this question, because Much depends on the particular diagnostic case. However, several starting points can be given for evaluating your morphological conclusion.

- there is no conclusion with an exact indication  diagnosis. This includes cases of the so-called. descriptive conclusion, when a rather extensive description is given without a definitive diagnosis. There may be several reasons for such a conclusion, ranging from a banal poor (insufficient) sampling of material to the complexity of the observed process for a pathologist.  In the latter case, it makes sense to request a second opinion, which will eliminate the subjectivity of the diagnosis.

- no tumor code  ICD-O.

The ICD-O code translates to the International Cancer Code for the Disease and is referred to as "ICD-O". It is set by a pathologist based on the result of a histological (immunohistochemical) examination in accordance with the current WHO Classification of Tumors (4th  edition) IARC.

For instance:  adenosquamous cell carcinoma of the small intestine;  ICD-O  Code  8560/3. This code is an important indicator. Each tumor has its own unique code, and the number indicated by the fraction sign (/) indicates the malignant potential of the tumor.  The absence of such a code often requires a revision of drugs and a qualified assignment to a particular nosology.  

In fact, this code may not be indicated in the diagnosis, but with the obligatory indication of those additional research methods that are required for the final diagnosis (immunohistochemical, cytogenetic (FISH) ...).

- the absence of a code in the pathomorphological diagnosis  pTNM.

The pTNM code may be absent only in cases of small biopsies (needle, endoscopic, cases of oncohematological diseases). In cases of extended operations to remove an organ or tissue, such a code in the conclusion of a morphologist is mandatory. The cipher itself means the following:

T is the size of the tumor and its relation to the surrounding tissues and organs

N - damage to the lymph nodes (and whether they exist at all)

M - the presence of metastases.

Sometimes the letter "R" is added - indicating the condition of the edges of the removed tumor.  An example would be the following entry:

Medullary carcinoma  ascending colon,  ICD-O  Code  8510/3,  pT2N2а  M-R1. From this pathologist's note, your attending physician will understand the following:

There is a malignant tumor of the ascending colon. The tumor invades the muscular layer (T2). There are metastases in 4-6 lymph nodes. There is no information about distant metastases. Tumor tissue was found at the resection margins.

From the presented example, the importance of the pTNMR code becomes clear.

On our website you can see  list  all existing oncological diseases according to the current classifications. If you have not been able to detect your oncological disease, then you can contact our specialists for a consultation.