Oncologists urged to establish ‘communication stream’ with pathologists

Oncologists should establish a consistent “communication stream” with pathologists to avoid problems with molecular testing, according to Dara Aisner, MD, PhD, a molecular pathologist at the University of Colorado Cancer Center.

At this year’s ASCO Annual Meeting, Aisner presented on the problems that arise with tissue samples, particularly if a patient has visited multiple institutions. In an interview after the meeting, Aisner spoke with HemOnc Today about these problems and discussed ways to improve communication between oncologists and pathologists to maximize efficiency.

A common problem with molecular imaging is that not enough tissue is left over for the additional molecular tests, she said.

“What we see is a patient examined at one institution where biopsy is used as part of the diagnostic program, then they go to a new institution and get a new biopsy, but the pathologist doesn’t know and repeats the testing. You end up in the same situation where there isn’t enough material left to do the molecular testing,” Aisner said.

A patient’s new pathologist may also want to see prior testing material in addition to prior results for comparative purposes.

“Pathologists are also consultants for their expertise, so if they don’t have the report or slide, just as an oncologist would never send someone to a radiologist without having test results, they may want to repeat the testing,” Aisner said.

Additional problems include tumor biopsies labeled as bone, which may automatically be decalcified when they arrive in the pathology lab because most labs have strict protocols in place and treat every sample in exactly the same way, she said.

“When you decalcify, the process often, if not always, makes the sample unsuitable for molecular testing. Most labs use methods that make it highly unsuitable,” Aisner said.

Having a system will save steps in addition to conserving material for molecular testing. “Doctors have the ability to get on the phone with their pathologist and manage their cases. Cherry-picking the ones that the oncologist wants special handling for becomes a more effective task if you take that communication to another level and establish a systematic communications stream,” she said.

By institutionalizing a system of communication, the process can be streamlined for unusual cases, and additional steps such as multiple emails and phone calls can be avoided, Aisner said. However, each oncologist and department will have to establish a communication structure unique to their needs and existing systems. – by Shirley Pulawski