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#155323 - 09/30/12 04:08 AM Accuracy of scalpal biopsies.
DB7 Offline
Member

Registered: 09/02/12
Posts: 13
Loc: Ohio
Just curious as to some stories out there of negative findings from a biopsy that later turned out to really be cancer. Does this happen alot, or are they pretty accurate? The reason I ask is because I just got my results back from a scalpal biopsy on my tongue, and thank goodness they were negative. The surgeon said that the white patch on my tongue, (that had been there for several months), was "reactive" tissue, or something of that sort. I had seen two oral surgeons prior to the biopsy, and they both seemed so sure that the white patch was cancerous. One of them even photographed the area on my left ventral tongue, and looked me in the eye and said that he was sure after a biopsy that it would come back as cancerous. My second opinion agreed, and did the biopsy. So I was rather shocked when I got the call that no follow up was needed and that it was not cancerous. I'm ecstatic, to say the least, but these two basically ruined a month and a half of my summer with their pre diagnoses. Anyway, thoughts?

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#155325 - 09/30/12 04:54 AM Re: Accuracy of scalpal biopsies. [Re: DB7]
ChristineB Offline
Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Registered: 06/23/07
Posts: 7928
Loc: PA
Only thru a biopsy can it be determined if something is cancerous. A well trained, experienced doctor can suspect something is cancerous or nothing to worry about but they wont know for certain unless its biopsied. I do not know the rate of wrong biopsies but just like anything it certainly would be possible. A biopsy is only as good as the person studying the tissue and posting the results. Human error can happen but it should be a relatively rare occurrence.
_________________________
Christine

SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 rad end 9/27/07, no caregiver
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
total of 185 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo hospital extended stay, ICU & burn unit
PICC line w/ IV antibiotics 8 mo
10/4/10, 2/14/11 reconst surg
OC 3 times in 3 years
very happy to be alive smile

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#155334 - 09/30/12 09:38 AM Re: Accuracy of scalpal biopsies. [Re: DB7]
Shauneen Offline
"OCF Canuck"
Supporting Member (50+ posts)

Registered: 10/03/11
Posts: 66
Loc: Calgary, Alberta
I would get a second biopsy/opinion or at the very least, watch the area very closely. If the area on your tongue changes in any way - have it looked at again.
I had two biopsies that were negative. I also did not act immediately as I was swayed by false information that oral cancer doesn't usually hurt and my tongue was VERY painful! It can hurt a great deal if the cancer is on your oral tongue.
I still remember the first appointment with my ENT who said "Well, we could just zip it off, but it would have the same risk as a tonsillectomy - let's wait for the biopsy."

I sure wish now that I'd had it 'zipped off' smile

I really don't mean to alarm you in any way, just know that even if a false reading of a biopsy is rare - it happened to me.

Do you have a copy of the pathology report? And did you have a tooth that was irritating the area?

It would be interesting to know what your tissue was reacting to.

My situation may be nothing like yours at all, but I'm a little sensitive about the whole thing I guess.
_________________________
Pain late 2009. Dx as change in altitude. Sore spot on tongue late 2010. Dx as irritation.
Leukoplakia Bx Feb 2011 - Lichen Planus.
Bx May 2011 - Hyperplasia. Same sample retested as SCC.
June 2011 Rt Hemigloss,ND,rff,33 Rads. Hosp for 15 days w/bi-lateral pneumonia.
T3N1M0 Stage IV.

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#155336 - 09/30/12 12:15 PM Re: Accuracy of scalpal biopsies. [Re: DB7]
AnneO Offline
Gold Member (200+ posts)

Registered: 12/30/10
Posts: 282
Loc: Kansas
Hmmmm . . . I think you should follow up with an ENT. My cancer was on my left ventral tongue, and it is a common spot for scc.

As far as I know biopsies like yours are accurate, but as you've seen in Shauneen's reply, perhaps not always? And, things can change. You obviously have had some kind of irritation there. You don't say if you have any risk factors for oral cancer--tobacco use of any sort for instance. That, combined with the white patch, would be reason to watch it. The fact that not one but two oral surgeons were highly suspicious of cancer would keep me on the alert. You're lucky to have apparently be cleared, though.

Best,
Anne
_________________________
SCC ventral tongue 9/2010, excisedw/clear margins:8 X 4 mm, 1 mm depth
Neck Met, Oct/2010, 1 cm lymph node; 12/21/'10: Neck Diss 30 nodes, 29 clear, micro ECE node, part tongue gloss, no residual scc
IMRT & 6 cisplatin 1/20/11-2/28/11
GIST tumor sarcoma, removed Sept,'11,no TX needed
Non smoker

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#155337 - 09/30/12 12:27 PM Re: Accuracy of scalpal biopsies. [Re: DB7]
PaulB Offline
Patient Advocate (old timer, 2000 posts)

Registered: 07/06/12
Posts: 2175
Loc: NYC
No biopsy, diagnostic test is 100 percent accurate, but some are very close, and a direct biosy is one, but rarely, due to contamination, human error, inadequate discription, and not enough tissue section where biopsy was taken from, failures can happen. White patches, leukoparia, has many causes, and does not usuualy mean cancer as much as the red patches, erthoplakia, does, and id usually a concern. Although not used often in oral biopsies, a fine needle biosy can also be used to check for deep cancer cells, but the oral scapel biopsy is the gold standard. Good luck with everything.
_________________________
10/09 T1N2bM0 Tonsil 48
11/09 Taxotere Cisplatin 5-FU
07/10 NED
09/10 Recurrence
02/11 35 IMRT 70Gy
06/11 30 HBO
07/11 NED
09/11 Recurrence
10/11 Radical Neck Dissection
02/12 NED
04/12 Recurrence
05/12 Recurrence
06/12 Selective Neck Dissection
07/12 Recurrence
08/12 Radical Neck Dissection +HD-IORT 12Gy Pec flap
10/12 25 IMRT 50Gy Taxo, Erbitux
02/13 NED
08/13 Recurrence
10/13 Selective Neck Dissection
10/13 RND Carotid, Vagus, assesory nerve removed +HD-IORT 10Gy
12/13 25 Proton Therapy 50Gy +6 Carbo






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#155338 - 09/30/12 12:57 PM Re: Accuracy of scalpal biopsies. [Re: DB7]
davidcpa Offline

Administrator, Senior Patient Advocate
Patient Advocate (old timer, 2000 posts)

Registered: 09/28/06
Posts: 8028
Loc: Gulfport, Florida
_________________________
David

Age 58 at Dx, HPV16+ SCC, Stage IV BOT w/ 2 nodes, non smoker, casual drinker and exercise nut, Cisplatin x 3 w/ concurrent IMRT x 35, (70 Gy), no surgery, no Peg, Tx at Moffitt over 8/28/06. June 2007, back to riding my bike 100 miles a week. Now doing 12 Spin classes and 60 outdoor miles per week. Nov 2013 completed Hilly Century ride for Cancer, 104 miles, and took 1st Place in my age group. April 2014, Spun for 9 straight hours to raise $$ for YMCA's Livestrong Program.

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#155346 - 09/30/12 01:52 PM Re: Accuracy of scalpal biopsies. [Re: DB7]
DB7 Offline
Member

Registered: 09/02/12
Posts: 13
Loc: Ohio
Well I will definitely be watching the area closely. He took a pretty good portion of the suspect area. Tongue was in pretty bad pain for a week afterwards. I have not received a copy of the report yet, just a phone call from an aid at the office telling me it was not cancerous. I do have two fillings that hit the area and I will be asking the dentist to correct them as I have no other risk factors that I know of. Rarely drink, dont smoke/dip, etc. The one other symptom I had with the white patch was that the left side of my tongue would become irritated by certain things, like mouth wash and tooth paste. Now it was very mild, but noticeable. I'm waiting for the tongue to heal completely to see if this continues. I appreciate all of your responses, and knew I'd get some good information here. I just know that this disease is nothing to mess around with after watching my aunt deal with it.


Edited by DB7 (09/30/12 01:53 PM)

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#155355 - 09/30/12 03:55 PM Re: Accuracy of scalpal biopsies. [Re: DB7]
Cheryld Offline
"OCF Canuck"
Patient Advocate (old timer, 2000 posts)

Registered: 12/22/10
Posts: 4590
Loc: Toronto canada
Hibthere - definitely watch it - I had a negative biopsy 2 years later a positive - same area - my tumor was deeper than the initial biopsy removed. So if there are any changes - high tail it back! smile glad its clear.
_________________________
Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan

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#155371 - 09/30/12 09:20 PM Re: Accuracy of scalpal biopsies. [Re: DB7]
AnneO Offline
Gold Member (200+ posts)

Registered: 12/30/10
Posts: 282
Loc: Kansas
I have to tell you that I noticed a slight burning irritation when consuming some foods, liquids, or chewed gum, etc . . . I never used mouthwash, just flossed & used toothpaste. I noticed that in the area of my tongue before the ulcer appeared. That was my only sign that anything was amiss before the ulcer. By itself I did not think it meant much, apparently it did.

If you indeed have a problem there the good thing is you should be able to catch it early. Find a good ENT though, one that sees oral cancer.

Best,
Anne
_________________________
SCC ventral tongue 9/2010, excisedw/clear margins:8 X 4 mm, 1 mm depth
Neck Met, Oct/2010, 1 cm lymph node; 12/21/'10: Neck Diss 30 nodes, 29 clear, micro ECE node, part tongue gloss, no residual scc
IMRT & 6 cisplatin 1/20/11-2/28/11
GIST tumor sarcoma, removed Sept,'11,no TX needed
Non smoker

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#155394 - 10/01/12 07:09 AM Re: Accuracy of scalpal biopsies. [Re: AnneO]
Penny_T Offline
Contributing Member (25+ posts)

Registered: 01/30/12
Posts: 27
Loc: CA
I have had a negative biopsy myself, but still have strong concerns, so I know where you are coming from there. If you still have concerns then I would suggest continuing to pursue the issue. In the meanwhile, though, try not to stress too much.

Perhaps you could request an imaging study of some sort (MRI, CT) if they haven't done one already. If there is an area of concern deeper than where they took tissue they may be able to see it that way, and it may put your mind more at ease. Another option I've heard of is having your biopsy sent to a second pathologist for review. If they took enough I believe that is possible. I don't know how to set that in motion, but I'd guess you can talk to whoever took your biopsy about it. I have mostly heard about this being done to confirm a malignant report, but I don't see why it couldn't be done to double check for cancerous cells. Maybe someone who knows more can weigh in there.

_________________________
33 yr old female, former smoker of too many years.
Currently awaiting results of a neck ultrasound.

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