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Pathology second opinion

What to Send With — a Slide Review Request

A pathology second opinion is only as useful as the materials the reviewing pathologist receives. Incomplete submissions — missing slides, no report, no clinical context — are the most common reason a review cannot give a clear answer.

Medically reviewed by Dr. Muralidhar Muddusetty, Surgical Oncologist, MBBS (AIIMS) · MS Surgery (AIIMS) · DNB Surg Onc · MRCS (Edinburgh) · Last reviewed September 2026

  • Slides are essential — Glass slides are the primary material. No photograph or photocopy substitutes for the tissue itself.
  • The report is not optional — Without the original report, the reviewer may repeat tests already done or miss the specific question your team needs answered.
  • Context changes the answer — A clinical summary — your diagnosis, stage, and the exact question being asked — makes the review far more useful.
  • Blocks are not always required — The tissue block is sometimes needed for additional staining. Confirm whether it is required before arranging its release.
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For a pathology second opinion, the reviewing pathologist needs your glass slides, the original pathology report, and a brief clinical summary. The tissue block may also be requested, but slides are usually enough to begin. Incomplete submissions are the most common reason a review cannot give a definitive answer.

What does a reviewing pathologist actually need from you?

Glass slides are the foundation of any pathology review. A slide is the thin section of your biopsy tissue, stained and fixed onto glass, that the pathologist examines directly under a microscope. No photograph, scan, or copy of a report is a substitute.

The original pathology report tells the reviewer what stains have already been run and what findings were recorded. Without it, the reviewer risks duplicating tests that were already done or missing the specific point your team wants checked.

A clinical summary gives the review its purpose. It tells the reviewer your diagnosis, stage, any treatment you have received, and — most importantly — the exact question your team wants answered. A review without a clear question returns a less useful answer.

Which materials are essential, and which can wait?

MaterialWhat the reviewer uses it forNeeded to start the review?
Glass slidesPrimary source — tissue examined directly under the microscopeYes
Original pathology reportShows which stains and markers have already been tested and what was foundYes
Clinical summaryExplains your diagnosis, stage, treatment history, and the specific question for the reviewerYes
Paraffin tissue blockAllows new sections to be cut if slides are insufficient or additional staining is neededSometimes — confirm with the reviewing pathologist first
Imaging reports (CT, MRI, PET-CT)Supports staging context; useful in uncertain cases but does not replace pathology materialsHelpful — send if you have them
Cytology slidesRelevant when the original diagnosis came from a fine-needle aspirate rather than a core biopsyIf applicable to your case

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What should I collect before sending anything?

  • Request all available glass slides from the laboratory that processed your biopsy — not just representative ones
  • Obtain a copy of the complete original pathology report, including any immunohistochemistry or molecular testing results
  • Ask your oncologist to write a brief clinical summary covering your diagnosis, stage, treatment to date, and the specific question for the reviewer
  • Confirm with the reviewing pathologist whether the paraffin tissue block is required before arranging its release
  • Gather imaging reports (CT, MRI, PET-CT) to include as supporting documents
  • Ask the reviewing institution whether original glass slides or digital whole-slide images are acceptable — requirements differ between centres

How do I actually arrange a pathology second opinion?

  1. Talk to your treating team

    Ask your oncologist or surgeon to support the request and prepare a clinical summary. They will know the specific question that needs answering and may already have a relationship with a reviewing institution.

  2. Contact the original laboratory

    The laboratory that processed your biopsy holds your slides and tissue block. They will release materials to another accredited institution on receipt of a written request that identifies the patient name, date of biopsy, and original report number.

  3. Confirm what the reviewer needs

    Different pathologists and institutions have different requirements. Some accept digital whole-slide images; most need original glass slides. Confirm before anything is packed or sent so nothing has to be retrieved and resent.

  4. Send materials securely

    Glass slides are fragile and irreplaceable. Use a rigid courier box with individual slide protection. Include the patient's name, date of birth, original report number, and the clinical question in a covering letter.

  5. Keep copies and track the return

    Retain a copy of the original report and any imaging reports before materials leave the laboratory. Ask the reviewing institution who to contact if materials are delayed or not returned within the expected period.

Explore 112 more Markers, Molecular Testing and Test Accuracy topics

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Common questions

Frequently asked questions

Can a reviewing pathologist work from photographs or a scanned copy of the slides?

Whole-slide digital imaging is used in some specialist centres and is acceptable in certain clinical contexts, but it is not universally treated as equivalent to original glass slides for all diagnoses. Most institutions will ask for original slides. Ask the reviewing pathologist directly whether digital submission is acceptable for your case before assuming it can be done remotely. A mobile phone photograph of a report is not a substitute for the slides or the tissue itself.

How do I get the laboratory to release my slides and block?

Your pathology materials belong to you. Write to the laboratory that processed your biopsy — or have your treating doctor write — identifying the patient name, date of biopsy, and the original report number. The laboratory will release materials to another accredited institution with that request in hand. Ask specifically whether they send directly to the reviewing institution or return materials to you first, and confirm the process before making assumptions about timing.

What happens if the original tissue block has been used up?

Tissue blocks can be exhausted by previous rounds of staining, particularly when multiple markers have already been tested. If the block is depleted, the reviewing pathologist works from whatever slides remain. In some cases, a repeat biopsy may be suggested if the existing material cannot support a definitive answer. This is a known challenge in second-opinion pathology, not a failure of care — your team will explain the options available if this applies to your case.

Should I also send my CT, MRI, or PET-CT scan reports?

Yes, if you have them. Imaging reports — the written summary produced by a radiologist — are useful supporting documents and worth including with your submission. Sending the scan images on a disc is also helpful where available. Imaging does not replace pathology materials, but it helps the reviewing pathologist understand your staging and clinical picture, which can affect how tissue findings are interpreted in uncertain cases.

Do I need my treating doctor's permission to request a second opinion?

No. Your pathology materials belong to you, and you are entitled to request their release without your treating doctor's permission. In practice, having your oncologist write the accompanying clinical summary makes the review significantly more useful, because the reviewer then knows precisely what question is being asked. Most oncologists support second opinions. If yours does not, you are entitled to ask for a clear reason — and to seek that opinion regardless.

Full index

Browse all 701 biopsy topics

Every page in this section, grouped by the part of the journey it belongs to. Pick a group to see what is in it.

What Is a Biopsy?

What Is a Biopsy? Everything You Need to Know →

Types of Biopsy Compared

Which Biopsy Will You Have? Techniques Compared →

Preparing for a Biopsy

What to Expect on the Day of Your Biopsy →

Recovery and Aftercare

After a Biopsy: Recovery, Aftercare and Warning Signs →

Biopsy by Body Part

Biopsy by Body Part: What to Expect at Each Site →

Understanding Your Report

How to Read a Biopsy Report: Terms Explained →

IHC and Molecular Markers

IHC and Molecular Markers on a Biopsy: What They Mean →

Grading and Scoring Systems

Cytology & Prostate Scoring Systems Explained →

How Accurate Is a Biopsy?

How Accurate Is a Biopsy? Errors and Second Opinions →

If Your Result Is Benign

Your Biopsy Is Benign: What It Means and What Comes Next →

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