Institutional Second Opinion

Institutional second opinion involves the review of anatomic pathology materials from an outside institution when a patient is referred to a second institution for consideration of treatment or management recommendations. This patient care activity is most prevalent at larger health care centers, but is not a universal practice despite recommendations from the Association of Directors of Anatomic and Surgical Pathology. Existing literature generally supports institutional second opinion as a valuable patient care activity, but there is little in the way of a consensus on the “best practices” regarding the manner and scope of such activity. Issues such as potential cost savings, professional reimbursement, professional conduct, and defining the nature of interpretative disagreements are important to consider in the setting of institutional second opinion.