FAQ
Why do we offer second opinion consultation services?
Why is it important to obtain a second opinion for your pathology diagnosis?
What to expect from a second opinion consultation?
How does the process of ordering a second opinion consultation work?
Can I still use your service if I don’t have a PAYPAL account?
Does ConfirmPath offer its service to patients in the US only?
How do Pathology labs operate? And how do errors occur in Pathology labs?
What are the types of pathology diagnoses could you help me with?
Why do we offer second opinion consultation services?
We believe that every patient deserves the ultimate care possible. Our pathologists have encountered, during their training as well as in practice, many examples of errors that would have been simply corrected and eliminated had the slides been reviewed by a second pathologist. Most errors are as simple as a typing error that usually goes unnoticed and has no impact on the treatment management. In the same token, simple errors such as a paperwork/slides swap could have a catastrophic effect on the treatment plan by giving a wrong diagnosis of cancer to a patient who does not have the disease. Such errors are easily discovered and corrected when you obtain a second opinion. We are proud to be the leader of online-based consultation Pathology Company that has been offering and helping patients since 2006. Return to Top
Why is it Important to Obtain a Second Opinion for your Pathology Diagnosis?
Second opinion is important because errors in pathology labs do occur, and no patient could afford any mistake in their pathology report. Since diagnostic errors without second opinion consultation could reach up to 6% of the total cases examined by any average lab, this means that 6 out of every 100 cases examined by every lab may carry significant diagnostic errors. The second opinion review would discover those errors and eliminates that 6% chance of error. A simple error such as paperwork/slides swap would have a catastrophic effect and usually results in giving a cancer diagnosis to the wrong patient, and at the same time someone else would get a negative study and walk away without treatment while having cancer.
Your treating physician and surgeon base their treatment procedure protocol on the pathology diagnosis (surgical procedure, radiation therapy, chemotherapy…etc.) The treatment would, in most cases, have physical or at least psychological negative effect on the patient. Therefore, knowing that you have the correct diagnosis and staging is worth more than gold when it comes to the treatment of cancer. No one would like to be over-treated or under-treated for a wrong assessment that is based on a wrong diagnosis. For all the reasons mentioned above, our pathologists advises patients who had any type of pathology diagnosis including malignant diagnosis, a vague diagnosis, or even a benign diagnosis, to obtain a second opinion consult to rule out errors, because errors are costly. Return to Top
What to expect from a second opinion consultation?
Our second opinion service is designed to reach the correct diagnosis on your benign or malignant pathology case. Our service is not designed just to alter your diagnosis in any way or for any reasons, including legal reasons, other than to reach the correct diagnosis. In fact we try to avoid creating conflicts with the original diagnosis, unless the patient care would be compromised by not alerting to the discrepancy. Therefore most of the second opinion consult cases will result in an unchanged diagnosis. An average of only 6% of cases will result in significant alteration of the diagnosis. Six percent may look like a small percentage; however, percentages are of no value if your case belongs to this 6 % error group. Return to Top
How does the process of ordering a second opinion consultation work?
The following are the general ordering procedure steps:
- You submit your payment through our PAYPAL charge system.
- You will then receive a “Release Form” by email to allow us to examine your case, as well as a “Material Request Form” that you will use to request your pathology material from your pathology department.
- Your pathology department should supply you with the requested material packaged for shipping.
- Sign the “Release Form” and mail it along with your pathology material that you obtained from your pathology department to our address at ConfirmPath, PLLC 7422 EAGLE LEDGE, SAN ANTONIO, TEXAS 78249. (please note that ConfirmPath will not be responsible for any material that has not been received in our office; We advise sending the material using one of the traceable mailing systems, USPS, UPS, or FEDEX)
- After we receive your case, it will be examined within 24 hours, and you will be contacted by one of our pathologists to discuss the case with you and to give you the results (a 10 min free phone consultation is included with every case)
After this, you will receive a formal signed report by mail along with the original case material. Return To Top
Can I still use your service if I don’t have a PAYPAL account?
Establishing a PayPal account is very easy and simple; however, you may elect to send a personal check or a money order to our address to start the consultation process. (Please note that there would be a $40.00 charge for any returned check for insufficient fund, and most importantly there would be a delay in processing your case. To avoid the delay contact us by email at cservice@confirmpath.com to request the “Release Form” as well as the “Material request Form” so that you could ship the material with the payment in a one package.) Return to Top
I have medical insurance. Would ConfirmPath accept my insurance as a form of payment for the consultation service?
While ConfirmPath is always trying to work with patients to make the ordering process easier, our company does NOTaccept and will not be billing any medical insurance company, including Medicare, Medicaid, and Tricare. Patients are advised and encouraged to contact their insurance company for reimbursement of our service; however, ConfirmPath does not guarantee that your insurance company would cover part, or the entire service fee (sometimes getting a pre-authorization from your insurance company is required to pay for second opinions, this fact is particularly true for Government-run insurance programs such as Medicare.) ConfirmPath will be working in the near future to establish insurance company contracts, until that is in place we continue to offer our service as a private-pay provider. Return to Top
Does ConfirmPath offer its service to patients in the US only?
No, ConfirmPath offers its service to patients from all over the world. In fact a significant percentage of cases we have examined are from patients not living in the United States. You need to select the International option when submitting your payment through PayPal. The fee is slightly higher than patients residing in the US in order to cover the shipping charges of the report and the examined material back to an international address. Return to Top
Should I trust your service? Are you going to maintain the confidentiality & the privacy of my medical and personal information?
Confidentiality is fully maintained throughout our service process. Your information including name, e-mail, address, phone number, diagnosis, all reports, and payment process are confidential information; not to be shared with any other parties.
Our laboratory is in compliance with the Clinical Laboratory Improvement Amendments (CLIA) a section of the CDC (Centers for Disease Control and Prevention) which belongs to the Department of Health and Human Services; The federal licensing agency in the United States for medical laboratories.
ConfirmPath PLLC meets all the national standards to protect the privacy of personal health information by following the HIPAA regulations when dealing with patient’s medical and personal information. Return to Top
How do Pathology labs operate? And how do errors occur in Pathology labs?
To understand how errors occur in pathology laboratories, first you need to understand how pathology labs operate. Your specimen is delivered to the pathology lab with other cases from your surgeon or physician’s office and usually gets accessioned in the computer system that assigns it a case number. A patch of cases including your case are then examined by naked eye and reports called ‘Gross Examination Report’ are issued for each single case individually. After the grossing of the specimen, your tissue would be patched with other specimens tagged with your case number to the processing machines and then to be hand-embedded in Paraffin wax in patches. Thin sections are then made and placed on glass slides which are subsequently stained and submitted to one of the assigned pathologists with your paper work for microscopic review and reporting (the sign-out.) Up to six people could get involved in the processing of your case in the lab before a pathology report is issued. Many errors could occur in each of the steps of the processing procedure. For example:
Human errors could occur in each step of the extensive procedure from the time the specimen arrives at the lab until a report is issued.
High volume labs would translate into higher error cases while still showing error rates that are nationally accepted.
In most cases it is not the lack of experience of the pathologist that causes errors to occur; it is rather the extensive handling and processing of sometimes thousands of cases per day.
Diagnostic Errors in reading pathology slides could be grouped into one of the following categories:
- Over Diagnosis: (over-calling) usually happens when an over-interpretation occurs because of a close resemblance of your case with a more aggressive one (e.g. a lesion that would show overgrowth of certain tissue elements that alerts the examiner to potential malignancy.) These types of errors could be costly, especially when a major surgical procedure with long term effect takes place, obviously for the wrong reasons.
- Under Diagnosis: (missing diagnosis) usually occurs when the examiner rushes in reviewing the slides and misses a small area on the slides that have clear evidence of malignancy (e.g. where most of the slides show a non-malignant lesion, except one slide, where clear evidence of malignancy is evident.) These types of errors could also be very costly. When a malignant lesion could be treated to a cure if attention was drawn to it early before it has advanced and became out of control.
- Human-type errors: (unavoidable lab errors) usually occurs when human perform repetitive tasks such as entering data manually (like patient names) or number (like case numbers) over hundreds of times a day. Multiply that by the number of personnel that the data has to pass through in the lab and you get a sense of how vast these types of errors could reach. People make mistakes, and only a second look would discover that an error has occurred and addresses it accordingly.
What are the types of pathology diagnoses could you help me with?
We examine all types of human tissue with all their pathology diseases. Below is a list of the most common pathology material and diagnoses that we examine:
Types of Specimen Samplings:
- Biopsy: Excisional biopsy, needle core biopsy, bone marrow biopsy.
- Excisions & Resections: Local excision, organ resections (breast mastectomy, breast lumpectomy, total colectomy, partial colectomy, lung lobectomy, total pneumonectomy, thyroid lobectomy, complete thyroidectomy, hysterectomy, LEEP excision, cone resection.
- Cytology Specimens: FNA (fine needle aspiration), cytopathology preparations, cervical PAP smears, peripheral blood smears.
- All printed lab test reports: Clinical pathology including: chemistry reports, protein analysis, lipid profile, tumor markers, blood bank charts and reports, coagulation study report, platelet aggregation study, mixing studies and endocrine hormone profile reports.
- Forensic pathology: Complete autopsy reports as well as partial autopsy reports.
Most Common Types of Malignant Diagnoses:
- Carcinoma: All types of carcinomas such as adenocarcinoma, squamous cell carcinoma, small cell carcinoma and transitional cell carcinoma.
- Breast Cancer: Such as ductal and lobular carcinoma, DCIS “ductal carcinoma in-situ”, malignant phyllodes tumor and sarcoma.
- Prostate Cancer: Prostatic adenocarcinoma, high grade intraepithelial neoplasia (high grade PIN.)
- Colon Cancer: Colonic adenocarcinoma, neuroendocrine carcinoma, malignant GIST (gastrointestinal stromal tumor), sarcoma, carcinoid tumor.
- Lung Cancer: Adenocarcinoma, squamous cell, small cell, and bronchoalveolar carcinoma, metastatic tumors, large cell neuroendocrine carcinoma, undifferentiated carcinoma and sarcoma.
- Skin Cancer: Squamous cell carcinoma, basal cell carcinoma, malignant melanoma, mycosis fungoides (T-cell lymphoma), Merkel cell (neuroendocrine) carcinoma of the skin, and Mohs surgery procedures.
- Ovarian Tumors: Serous, mucinous and endometroid adenocarcinoma, papillary serous carcinoma.
- Cervical Cancer: Squamous cell carcinoma of the cervix, endocervical adenocarcinoma, CIS.
- Endometrial and Uterine Tumors: Endometroid adenocarcinoma, malignant mixed mullerian tumor (carcinosarcoma), sarcoma.
- Esophageal Cancer: Esophageal adenocarcinoma, squamous carcinoma of the esophagus.
- Kidney Tumors: Renal cell, clear cell and chromophobe cell carcinoma of the kidney.
- Lymphoma: Hodgkin’s lymphoma, all non-Hodgkin’s disease including B-cell lymphoma, T-cell lymphoma, small lymphocytic lymphoma (SLL), follicular cell lymphoma, mantle cell lymphoma.
- Liver Tumors: Hepatocellular carcinoma, angiosarcoma, cholangiocarcinoma, metastatic tumors to the liver.
- Thyroid Cancer: Papillary, follicular, medullary and anaplastic carcinoma of the thyroid.
- Bladder Cancer: Transitional cell and squamous cell carcinoma of the bladder.
- Bone Tumors: Osteosarcoma, Ewing’s tumor, metastatic carcinoma, chondrosarcoma.
- Sarcomas: Fibrosarcoma, undifferentiated pleomorphic sarcoma (previously malignant fibroushistiocytoma, sarcoma not otherwise specified.
- Stomach Cancer: Gastric adenocarcinoma, signet cell carcinoma of the stomach, malignant GIST tumor.
- Testicular Tumors: Seminoma, choriocarcinoma, yolk sac tumor, embryonal carcinoma.
- Adrenal Tumors: Adrenocortical carcinoma, metastatic tumors to the adrenal glands, pheochromocytoma.
- Brain Tumors: GBM glioblastoma multiforme, astrocytoma, medulloblastoma.
- Head and Neck Cancer: Squamous cell carcinoma of the tongue, laryngeal carcinoma.
- Leukemia: Acute lymphoid leukemia, acute myelogenous leukemia, chronic lymphoid leukemia, acute myelogenous leukemia…etc.
We also offer second opinion consultation on all benign pathological diseases in order to rule out a missed malignancy.