The role of IHC in complex clinical cases
In medical practice, ambiguous situations regularly arise where a standard initial assessment proves insufficient. If basic examinations fail to establish a definitive diagnosis with high accuracy, determine the stage of the pathological process, or assess its true extent, obtaining an expert "second opinion" becomes necessary.
In such cases, the initiative comes entirely from the attending physician. Specifically, the oncologist (or pediatric oncologist) arranges for diagnostic materials to be referred for additional expert review, objective evaluation, interpretation, and a detailed description of the results. A crucial part of such in-depth verification is repeating the immunohistochemical examination (IHC), which allows for a detailed study of tissue properties at the molecular level.
Routing of physical biopsy material
The procedure for referring diagnostic material is strictly regulated. Performing an immunohistochemical examination always requires a real physical substrate—biopsy or surgical material obtained during a surgical intervention.
The main goal of referring this material is to repeat and thoroughly conduct a complex of expert tests, which include:
- Pathomorphological examinations;
- Immunohistochemical examinations (IHC);
- Molecular genetic testing.
The patient's physical material is transported to specialized institutions equipped with the necessary facilities. The primary destination is a pathological anatomy bureau (or specialized department) belonging to the fourth group, which officially functions as a reference center. In situations where specific genetic tests are required, samples are sent to specialized molecular genetics laboratories.
Telemedicine and digital images
Unlike the physical tissue material required for IHC, the results of certain other diagnostic procedures can be transmitted remotely using modern information technology. Telemedicine technologies allow specialists to promptly receive consultations from experts at reference centers.
Remote routing includes two main workflows:
- Digital images of pathomorphological examinations. Digitized glass slides are sent via secure communication channels to the same fourth-group pathological anatomy bureau (reference center) for visual expert evaluation.
- Digital images of diagnostic imaging methods. Radiological test results (scans) are transmitted for independent analysis to a specialized remote diagnostic imaging consultation center.
A comprehensive approach combining the physical shipment of tissues for IHC and remote analysis of digital images ensures the most accurate diagnosis in complex cases.
PHOTOS to the web, TISSUE to the center. (Digital images from diagnostic imaging and pathomorphological examination are transmitted via telemedicine, while physical biopsy material for IHC is always sent to the reference center physically).
Class and exam questions
Who is responsible for referring material for reassessment and IHC?
The referral of materials is organized by the attending oncologist or pediatric oncologist.
Where is biopsy material sent for repeat IHC?
Tissue samples (biopsy or surgical material) are sent to a pathological anatomy bureau or department of the fourth group, which acts as an expert reference center.
In which cases is it necessary to send material to a reference center?
Referral is necessary in complex clinical cases when the primary stage fails to reliably establish the diagnosis, determine the stage of the disease, or assess the extent of the pathological process.
Where are digital diagnostic imaging scans sent?
They are transmitted via information interaction (telemedicine) to a remote diagnostic imaging consultation center.
What else to study on this topic
- Criteria for classifying a pathological anatomy bureau as a fourth-group facility (reference center).
- Organization of telemedicine consultations and information exchange in oncology.
- Differences between pathomorphological, immunohistochemical, and molecular genetic studies.
- Functions of the remote diagnostic imaging consultation center.
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