Obtaining Pathology Slides and Imaging for Another Center

A second opinion is only as good as the material it rests on. A team reading a summary letter is not reviewing your case. It is reading someone else's conclusion.

People ask for "my pathology" and receive one PDF. That PDF is the report. It is the pathologist's written conclusion. It is not the tissue.

Here is how tissue becomes a diagnosis. After a biopsy or surgery, the sample is treated with chemicals to fix it. A machine removes the water and replaces it with melted paraffin wax. The tissue is set in a wax block. Thin slices are cut from that block, placed on glass slides, and stained with dyes. A pathologist reads the slides under a microscope.

So three things exist:

• The report. The written document.
• The glass slides. The stained slices a pathologist looks at.
• The paraffin block. The wax block holding the rest of the tissue. New slides and new tests can be cut from it.

A second-opinion pathologist usually wants the slides. The block matters when more testing is needed. It is the only remaining source of tissue.

The National Cancer Institute lists what a surgical pathology report holds:

• Identifying details: name, date of birth, and date of the biopsy.
• Where the specimen came from, and how it was taken.
• The gross description: color, weight, size, and shape, seen with the naked eye.
• The microscopic description, including tumor grade, which is how abnormal the cells look.
• Margin status. A negative or "clean" margin means no cancer cells at the cut edge. A positive or "involved" margin means cancer cells reach the edge.
• Lymph node status: positive if cancer cells were found in the nodes, negative if not.
• The final diagnosis, with the cancer type and stage.

Reports usually reach the ordering doctor within 10 days of the procedure.

A frozen section is a fast read done during surgery, in about 15 to 20 minutes. The permanent section, made from the wax block, keeps much more detail. It is the one normally used to make the diagnosis.

Molecular tests, sometimes called biomarker tests, may be reported separately. Ask whether any linked reports exist. They often carry the results that decide drug choice.

Under HIPAA, you have a right of access to your own health information held in the designated record set. That set includes medical records, billing records, clinical laboratory test reports, and x-rays.

A provider must act on your request no later than 30 calendar days after receiving it. One extension of up to 30 more days is allowed. To use it, the provider must give you a written statement within that first 30 days. The statement must explain the delay and give the date the work will be done.

You may ask for the format you want. If the provider can produce it readily, it should, including by email.

An unpaid bill is not a reason to refuse. A provider cannot withhold your records because you owe money.

Fees must be reasonable and cost-based. Only these may be included:

• Labor for making the copy, once the information is ready to copy.
• Supplies, such as paper, a CD, or a USB drive.
• Postage, if you ask for it to be mailed.
• Labor to prepare a summary, but only if you agreed to that in advance.

Searching and retrieving cannot be charged for. Neither can record system upkeep, review, or verification, even where state law appears to allow it.

For electronic copies of information already kept electronically, a provider may use a flat fee instead. That fee is capped at $6.50, including all labor, supplies, and postage.

Ask for the estimate before you agree.

This part sits outside the usual records office. The report comes from medical records. The glass slides and the wax block are held by the laboratory that examined the sample.

The National Cancer Institute is plain about it: you obtain the slides or the paraffin block from the pathologist who examined the sample, or from the hospital where the biopsy or surgery was done.

Practical steps:

1. Ask the receiving center first what it wants. Some want stained slides only. Some want unstained slides cut fresh. Some want the block. Ask how many, and ask for the answer in writing.
2. Call the pathology department directly, not the general records line. Ask for the slide release desk, sometimes called outside consultation.
3. Give the accession number. It is printed on the pathology report, and it identifies the specimen far better than your name does.
4. Ask who ships it, and how. Many laboratories send material straight to the other laboratory rather than to you.
5. Ask whether the material must come back, and by when. Slides and blocks are finite. Ask how it will be tracked.

The radiology report is a text document. The scan itself is a set of images. A new team usually needs both, because a radiologist wants to look at the images.

Ask the radiology or imaging department for a copy of the study on CD or DVD, or by secure electronic transfer if it is offered.

Name the studies you need, with dates and body regions. "All my scans" tends to produce delay.

Check the disc before you travel. It should hold the image files themselves, and many discs include a small viewer program that opens them. If the disc holds only a PDF report, it is the wrong thing, and you will learn that at the worst moment.

Records requests fail quietly. The deadlines exist so you can act.

Escalate if:

• 30 calendar days have passed with no records and no written extension notice.
• You were sent an extension notice, and the extra 30 days have now passed.
• You are told you cannot have records because of an unpaid bill.
• You are charged a fee for searching for or retrieving the records.

First, ask for the facility's privacy officer or patient advocate by name, and put the request in writing. That settles most cases.

If it does not, you can file a complaint with the HHS Office for Civil Rights through its complaint portal. File within 180 days of when you knew the problem happened. That limit can be extended for good cause.

Tell your oncology team if a delay is holding up treatment. A call from one clinician to another often moves material faster than any form.

• What is my accession number, and which laboratory holds the block?
• Which slides does the second center want, and how many?
• Were molecular or biomarker tests done, and are they in a separate report?
• Will the material be returned here, and who tracks it?

• Pathology Reports — National Cancer Institute
• Your Rights Under HIPAA: Get It. Check It. Use It. — HHS
• Health information you can access, HIPAA FAQ 2042 — HHS
• Timeliness of access requests, HIPAA FAQ 2050 — HHS
• Fees for copies, HIPAA FAQ 2024 — HHS
• Calculating the limited fee, HIPAA FAQ 2029 — HHS
• Your Medical Records — HHS
• Filing a HIPAA Complaint — HHS Office for Civil Rights
• Seeking a Second Opinion — American Cancer Society