How to Get Pathology Slides for a Second Opinion

This page is for people who want another pathologist to look at their biopsy or surgery tissue. It explains what to request, who to call, and how long things take.

A second-opinion oncologist can read a report. A second-opinion pathologist has to look through a microscope. That means physical material has to travel.

The National Cancer Institute says people who want a second opinion should talk with their doctor. They will need to get the slides and/or paraffin block from the pathologist.

So this is a shipping problem as much as a paperwork problem.

NCI describes the process. Your tissue is first stabilized with a chemical. Water is then removed and replaced with molten paraffin wax. The tissue is embedded in a paraffin wax block and cut into sections.

That leaves three separate things, and they are not interchangeable:

• The report. The pathologist's written diagnosis, with identifying information, the body site, a gross description (what the tissue looks like to the naked eye), microscopic findings, the final diagnosis, and often a comment section.
• The slides. Thin sections on glass. A second pathologist usually looks at these.
• The block. The wax-embedded tissue itself. Ask the lab whether the reviewing center needs the block, slides, or both.

If you had a frozen section during surgery, know that it is a different preparation. NCI notes it takes about 15 to 20 minutes, so surgeons can get a quick answer during the operation.

Federal lab rules under CLIA (the Clinical Laboratory Improvement Amendments), at 42 CFR 493.1105, set minimum retention periods. These are floors, not ceilings, and many labs keep material longer.

• Histopathology slides: at least 10 years from the date of examination.
• Cytology slide preparations: at least 5 years from the date of examination.
• Pathology specimen blocks: at least 2 years from the date of examination.
• Pathology test reports: at least 10 years after the date of reporting.
• Remnant tissue: preserved until a diagnosis is made on the specimen.

Look at the block again. Two years is the federal floor.

That matters because later testing may need the original tissue. After the minimum period, the tissue may or may not still exist. Call the lab and ask what its own policy is, and ask how long it keeps your block.

The records office may not be able to release slides. You want the pathology department of the hospital or lab whose name appears at the top of your report, and specifically the person who handles slide release or "outside consults."

Have these ready before you dial:

• The accession number from the report, which looks like S24-12345 or similar.
• The date of the procedure and the body site.
• The exact name and address of the receiving pathology department, plus a contact name and phone number there.
• Your date of birth and the medical record number on the report.

Then ask four questions. What do you need in writing from me? Do you release the slides, recuts, or the block? Do you ship directly to the other lab, and how long does it take? Do the materials need to come back to you?

Ask whether fresh slides cut from your block can be sent instead of the originals.

Getting the written report is governed by HIPAA. Under 45 CFR 164.524 you have the right to inspect and obtain a copy of your protected health information in a designated record set. The provider must act on your request within 30 days, with one possible extension of up to 30 more days, and they must tell you in writing if they take it.

You can also require that the copy be sent straight to another person, if your request is in writing and signed by you. That is the efficient way to route your report to the second-opinion center.

Fees are capped by that same rule. A provider may charge only for labor for copying, supplies for the paper copy or electronic media, postage, and preparing an explanation or summary if you agreed to it in advance.

Slides and blocks are physical specimens, so ask the pathology department what release process and rules apply to them. A signed release from you is likely to be needed.

NCI says most doctors welcome a second opinion. It also notes that many health insurance companies pay for a second opinion, and some require one, particularly when a doctor recommends surgery.

Call your insurer and ask two things. Is a second opinion covered, and does a pathology review need separate approval from the plan?

To find a doctor or center, NCI points to its Find a Cancer Center tool and to 1-800-4-CANCER (1-800-422-6237).

• First: Request the written report through the records office. Note the 30-day deadline.
• First: Call pathology and ask what release form they need.
• Next: Send the signed release, with the accession number and the receiving address.
• Then: Material ships. Ask for a tracking number and confirm the other lab received it.
• Then allow the reviewing pathologist time to read and issue a consultation report.

Build in more time than seems necessary. Ask the lab how long it expects. A common delay is a release form sitting in the wrong place. Confirm the receiving address and ask for a tracking number.

https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-493/subpart-J/section-493.1105

https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.524

https://www.cancer.gov/about-cancer/managing-care/finding-cancer-care