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reading the size of lesion from path report

K

Korbc

Expert
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414
Location
Uncasville , CT
hey guys

I have this on our path report and i just want to confirm the 2nd and 3rd numbers of each lesions are the margins right? Thanks so much!

two irregular portions of white-pink-red, fibrous and soft tissue measuring
1.0 x 0.9 x 0.1 cm and 2.2 x 1.5 x 1.1 cm
 
Korbc said:
hey guys

I have this on our path report and i just want to confirm the 2nd and 3rd numbers of each lesions are the margins right? Thanks so much!

two irregular portions of white-pink-red, fibrous and soft tissue measuring
1.0 x 0.9 x 0.1 cm and 2.2 x 1.5 x 1.1 cm
Click to expand...
It is inappropriate to assign size of lesions from pathology because they are usually trimmed before submit for pathology. Check the operative report if the sizes of lesions are documented, if not, a query is needed.
 
I do agree with @such78 that the op note should include the size of the excision, or the measurements of the lesion and margins that you would add to get the size of the excision.
Coding by pathology will often result in incorrect measurements, as specimens typically shrink after removal.
For education purposes to help you understand those numbers on the pathology report, those are not the margins. The 3 numbers for each specimen are the size of the specimen when received in pathology. Length x width x depth. So first specimen was 1.0cm long by 0.9cm wide (almost round) and 0.1cm deep. The details of the pathology report MIGHT state the margins, but it's not those numbers listed.

The excision size = lesion largest diameter size plus margin. Remember the margin exists on both sides of the lesion.
Example: lesion is 1.2cm x 0.8cm taking a 0.2cm margin all around. For coding, the size is 1.2 + 0.2 + 0.2 = 1.6cm.

I don't have a paper CPT book anymore, but I'm 99% certain there are some very good diagrams to help explain. It's one of those things that can be confusing until it clicks in your head, and then it's really pretty straightforward.
 
csperoni said:
I do agree with @such78 that the op note should include the size of the excision, or the measurements of the lesion and margins that you would add to get the size of the excision.
Coding by pathology will often result in incorrect measurements, as specimens typically shrink after removal.
For education purposes to help you understand those numbers on the pathology report, those are not the margins. The 3 numbers for each specimen are the size of the specimen when received in pathology. Length x width x depth. So first specimen was 1.0cm long by 0.9cm wide (almost round) and 0.1cm deep. The details of the pathology report MIGHT state the margins, but it's not those numbers listed.

The excision size = lesion largest diameter size plus margin. Remember the margin exists on both sides of the lesion.
Example: lesion is 1.2cm x 0.8cm taking a 0.2cm margin all around. For coding, the size is 1.2 + 0.2 + 0.2 = 1.6cm.

I don't have a paper CPT book anymore, but I'm 99% certain there are some very good diagrams to help explain. It's one of those things that can be confusing until it clicks in your head, and then it's really pretty straightforward.
Click to expand...
thank you so so much!!! exactly what i needed! and so do you know if specimens are immediately placed in formalin do they still shrink?
 
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