Any treatment begins with a diagnosis. However, the more difficult the case and the heavier the disease, the more difficult it is to make a diagnosis. This applies, for example, to oncology, when the results of a histological examination can be inaccurately or incorrectly interpreted, which can significantly change the course of the proposed treatment and its effectiveness. To prevent this from happening, there is a “Second Opinion” service. To understand what it is and who can turn to an expert for a “second opinion” when it is vital, the head of the department of pathomorphology of the LabQuest Clinical Diagnostic Laboratory, MD, doctor of the highest category, Dmitry Bulanov, helped.
The “Second Opinion” service is a kind of telemedicine service when a physician at a histological laboratory calls on his or her experienced colleague to consult and comment on a complex diagnostic case. Most often, a second opinion is turned to an expert who specializes in a specific pathology. For example, if a patient is diagnosed with lung cancer, it is advisable to get an opinion of someone who is narrowly focused on pathomorphological diagnosis of this cancer.
The second opinion allows us to put the right histological (pathomorphological) diagnosis, on which further treatment of the patient depends. Dmitry Vladimirovich told a case from practice. The two-year-old child had a congenital giant melanocytic nevus, which was partially surgically removed. However, histological examination of nevus cells revealed their malignancy, which happens extremely rarely and tumor metastases are detected. Specialists of the French laboratory confirmed the diagnosis, after which the child was promptly appointed competent treatment of malignant melanoma of the skin, which developed in a congenital nevus.
“It happens that the doctor initially puts oncologic diagnosis, and when a second study, it is not confirmed. That is, it turns out that the diagnosis was incorrect, there was an incorrect interpretation of the analyzes. And here the second opinion saves the person from unnecessary, sometimes very serious surgical or chemotherapeutic treatment, “the expert adds.
In order for the expert to give his opinion, he needs to send scanned images of the glasses. There are situations when the doctor requests additional materials, for example: paraffin blocks, clinical information, laboratory test results, CT and MRI diagnostics. “In order to get a second opinion, we usually immediately provide our colleagues with all the materials that may be required. This saves time in case the expert still requests this information. This practice is widespread in the world, and we try to match it, “says Dmitry Bulanov.
Contact the histological laboratory or clinic where the service “The second opinion” is presented, can the attending physician, the specialist who conducted the study, the patient himself. “Patients, in particular oncological, are interested in setting the right diagnosis, on which the results of the effectiveness of their treatment depend. Therefore, often they themselves turn to the second opinion, “- adds the expert. Score of scanned images of glasses by an expert doctor lasts an average of 10 working days. “This period does not depend on whether we send materials to colleagues in foreign clinics and laboratories or ask for a second opinion from domestic specialists. The length of the expert evaluation is affected by the complexity of the case, the quality of the materials provided, the need for additional research and other factors directly influencing the quality of the doctor’s work, “adds Dmitry Bulanov.
The “Second Opinion” service is not yet so widespread in Russia. For comparison, it is a compulsory practice abroad. There, in difficult cases, the protocol of research should always be signed by at least two expert physicians. “In the United States, there is a whole program to study rare and oncological diseases. Biomaterial in paraffin blocks and histological glass preparations from a clinic or laboratory for a specific patient are sent to a reference laboratory that deals only with this pathology. That is, after the conclusions of two medical experts, the study is also conducted by a third person specializing in this disease, “- divides Dmitry Bulanov as a doctor who annually participates in educational programs for professional development in the US and is a full member of the North American and Canadian Pathology Academy . There is not enough modern professional literature in our country, there is a shortage of highly qualified specialists. But technically, according to a number of modern Russian pathomorphological laboratories, we have approached the level of equipment that is available in foreign clinics and laboratories.
Nevertheless, now and in our country the service “The Second Opinion” is gradually gaining popularity. In addition, many clinics and laboratories that provide this service, try to offer patients and other assistance in treatment. So, according to Dmitry Bulanov, the LabQuest laboratory plans not only to seek a second opinion from foreign specialists, which is already actively practicing, but also to help patients go abroad for treatment, that is, after receiving a second opinion, it will be possible to contact a foreign clinic and help the patient with highly qualified medical care.
Commented Daria Pikalyuk, founder and CEO of the medical company LabQuest:
“The second opinion allows unimpeded implementation of a targeted approach to diagnosis. Telemedicine component in this matter is that to get a second opinion of the required specialist does not necessarily full-time reception. All materials are transferred to the expert through electronic services, while he himself can be anywhere in the world. This makes it possible to obtain this service not only from doctors in Russia, but also from foreign specialists. And if earlier it was necessary to spend own means and personally go abroad to consult with a foreign specialist, now this service requires considerably less expenses. “