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Ziad Peerwani and Scott Kilpatrick

Apr 27, 2025, 06:25

Ziad Peerwani and Scott Kilpatrick emphasize the importance of accurate pathology diagnosis

Ziad Peerwani, Medical Director at Cleveland Clinic Reference Lab, shared Scott Kilpatrick‘s post on LinkedIn, adding:

“Agree with my colleague.

Getting the diagnosis right is critical to treatment. Wrong diagnoses results in incorrect therapy negatively impacting the patient’s health.

Additionally, we’ve found many hospitals and healthcare systems have access to advanced therapies and treatments. Often the rate limiting step is getting the right diagnosis.

Within our consult service, approximately 20 to 30% of cases have clinically impactful findings.

We’ve a few reasons why we receive consults. Although complex rare diagnosis is one, there are many cases with more routine diagnoses but with atypical or borderline findings.

A critical consideration, the average pathologist we work with are excellent and competent diagnosticians. It’s only a very small subset of cases requiring referral. But, when needed, the potential patient impact can be substantial.

All pathologists will face rare diagnoses, atypical patterns of presentation, borderline cases, and the like. This occurs infrequently, but happens. Just like complex surgical procedures, Whipples as an example, volume based experience is needed in these difficult scenarios. Larger centers with high volume of complex subspeciality cases can help when infrequent support is required.”

Quoting Scott Kilpatrick‘s post:

“If you decide to seek a second opinion for a life altering diagnosis, I highly recommend that you have your original pathology diagnosis, when applicable, also reviewed. At many institutions this is (and should be) standard practice. This generally requires having the original (or recut) glass slides (or digital images if available) sent to that second institution, and their pathologist(s) will render a second opinion. Truthfully, most of the time there is agreement with the original pathologist’s diagnosis.

Nevertheless, rarely, especially among uncommon diseases, the original diagnosis is found to be incorrect, significantly impacting subsequent therapy. The treating clinician can only provide the best and most precise treatment if they know the “correct” diagnosis. Please do not underestimate the importance of this practice.

Dr. Clifton Fulmer, an outstanding pathologist colleague of mine at the Cleveland Clinic, uncovered a rare example of epithelioid hemangioendothelioma, originally diagnosed as cholangiocarcinoma. In other words, the correct diagnosis is a mesenchymal tumor (sarcoma) not a carcinoma, with treatment and prognostic implications. Our highly skilled pathology staff have the expertise to recognize the spectrum of human diseases, including those rarely seen, involving every organ and/or anatomic site.

The below link provides a nice example of the above, illustrating very clearly the importance of reviewing the original diagnosis.”