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The Importance of Negatives


Mark A. Hurt MD

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Although it is true that a positive is more important than a negative, a negative is not unimportant.

A positive will tell you what a thing [i]is[/i], and it is true that a negative will not do this. What a negative [i]does[/i] do is provide context.

Here is an example I see commonly in my practice: I receive a shave biopsy with a clinical diagnosis of basal cell carcinoma. In the initial sections, I see no basal cell carcinoma, only solar elastosis with telangiectasia. Based on the clinical diagnosis, I have the block sectioned to deplete all the tissue, and, still, there is no basal cell carcinoma. My diagnosis is: elastotic telangiectatic changes.

Note here that the "negative" is [i]not[/i] really a negative; I actually reported something I observed. Yet, what I reported was not the basal cell carcinoma, and by the nature of the examination, it excluded the carcinoma definitively.

In this respect, a "negative" serves the same purpose as a positive, provided that the examination is carried all the way through.

Consider [i]this[/i] the next time you might feel frustrated in attempting to diagnose AFX, scars, and putative neoplasms that simply aren't there. All those "negative" special stains and "negative" recuts really [i]do[/i] have meaning.
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Dr. Phillip McKee

Posted

I have one caveat to add to this. One needs to have confidence that the clinical has adequately biopsied the lesion. On many occasions I have recommended a repeat biopsy and low and behold, there is the tumor!
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Robledo F. Rocha

Posted

A “negative” report is really important since clinicians submit in the request some clinical hypothesis they want to be microscopically judged, and frequently the biopsy is taken just to rule out a given disease.
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