An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan.

What can a second opinion tell me?

Types of questions that pathologists often address in our second opinions:

Cancer or Benign?   

In some cases, it may be very difficult to be sure if a breast lesion is a benign proliferation or a malignant cancer. Treatment and prognosis hinge upon this crucial distinction. Many breast lesions, particularly papillary lesions and in situ cancers, can be very complex, and therefore a second opinion is often advisable. Only a pathologist can make these diagnoses.

Type of Cancer   

Cancers that occur in the breast may be in situ (pre-invasive), micro-invasive, or invasive, and there are many different types of invasive cancers. The carcinomas arise from epithelial (ductal) cells, whereas the sarcomas arise from the stromal cells. Within the carcinoma group, most are ductal carcinoma; however, there are a variety of specific subtypes that have either better or worse prognoses. While the pathology can look similar between the different types of cancer, the treatment for these subtypes may be very different. We offer consultative diagnostic interpretation of pathologic materials from breast biopsies and excisions by specialists in this field, specifically Drs. Pedram Argani and Ashley Cimino-Mathews.

Hormone Receptor Status and HER-2 Expression   

Accurate assessment of ER, PR and HER-2 expression in a breast cancer is essential to determine whether the patient will benefit from endocrine therapy or anti-HER-2 therapy, as well as predict overall patient outcome.  Our full-service Clinical Immunohistochemistry Laboratory provides analysis of ER and PR expression, HER2 overexpression, and markers of proliferation such as Ki-67. Our full service Clinical Tumor Cytogenetics Laboratory provides analysis of HER-2 gene amplification by fluorescence in situ hybridization (FISH).

Understand the details of your pathology report

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features offered by the johns hopkins pathology consultation services

The following features have been incorporated into our consult service to better serve our consulting physicians and patients:

  • Broad expertise in virtually all specialties
  • Direct line to responsive central receptionist to handle inquiries
  • Prompt response
    • Automatic faxed notification that cases have been received
    • Two-to-three-day turnaround on cases not requiring additional studies, with written reports typically within 24 hours
    • Our pathologists are available for telephone consultations
    • Reports automatically faxed and hard copies sent when case is signed out
  • Automatic return of all slides and paraffin blocks, by Federal Express, unless permission granted by consulting physician
  • Direct billing of patients, if desired

Special instructions for submitting pathologists, physicians and patients:

  • For diagnostic interpretations, please send the pathology slides and your pathology report. To avoid unnecessary delays in performing receptor analyses or other immunohistochemical tests, we need a representative paraffin block (or unstained slides) as well as slides.
  • IMPORTANT NOTE - Unstained Slides Requirement: note that all unstained slides must be submitted on a plus charged slide. The Immunopathology Laboratory recommends a white plus charged slide that is available from Cardinal Health (the catalogue number for the white plus slide is M6159-6).