Pathology consultation services

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Joaquín García, M.D.

Professor of Laboratory Medicine and Pathology
Vice Chair of Anatomic Pathology Laboratories
Medical Director, Histology Laboratory
Medical Director, Histology Technician Program
Department of Laboratory Medicine and Pathology 
Mayo Clinic, Rochester, Minnesota



Good afternoon. Today we're going to talk about pathology consultation services at Mayo Clinic Laboratories. My name is Joaquin Garcia. I'm a professor of Laboratory Medicine and Pathology and the Vice Chair of Anatomic Pathology Laboratories. 


I have no disclosures. 

Learning objectives

Today's learning objectives are to introduce Mayo’s pathology consultation practice; understand how Mayo Clinic Laboratories manages pathology consultation cases; provide guidance for optimizing the pathology consultation experience; and recognize the value of pathology consultations. 

Pathology consultation practice

Our consultation practice has over 100 pathologists, providing subspecialty expertise spanning from autopsy all the way to urologic pathology. 

Results that matter

Each year we evaluate over 45,000 consultation cases that fall into these 19 subspecialties. Our over 100 pathologists are academically inclined. In fact, in 2019 alone, we published over 1,300 peer-reviewed manuscripts. Over 300 were first- and last-authored by our consultants. 

Mayo Clinic Laboratories

You can learn more about Mayo Clinic Laboratories at, such as the test catalog, our pathology and subspecialty pages. You can learn about onboarding, manual and electronic orders, as well as our breadth of ongoing technical and business support. 

What is a pathology consult?

A pathology consultation, also known as a second opinion, is typically ordered when a client pathologist has doubts about the diagnosis; the client department has disagreement about the diagnosis; or a clinician or a patient requests a diagnosis confirmation. Pathology consultation is very different from most orderable tests. This is a complex service that may vary greatly on a case-by-case basis. And that's because it requires depth and breadth of subspecialty expertise. 

Pathology consult overview

This schematic shows the roadmap of a case that comes in for pathology consultation. Starting at the upper left, a client can collect a specimen, prepare slides, review the case internally, and order the secondary consult. [They then] send the case to Mayo Clinic Laboratories, where we accession, deliver the case to one of our experts who reviews the case, may or may not elect to perform ancillary testing, and ultimately sign out and report the results. 

MCL case receipt: Guiding client requests

Let's dig a little deeper. In accessioning, a courier delivers to Mayo Clinic Laboratories, Monday through Saturday. It's here that we verify that the order is complete and consistent with the received shipment. Mayo Lab Inquiry, also known as MLI, will contact the client if there are order issues. At the level of case assignment and delivery, if a case is directed to a pathologist or a section, we naturally put the case in that pathologist’s hands. If a case is not directed, we will accession that case and assign it to a subspecialist expert. 

Mayo case review: Internal review process

At the level of case review, a pathologist — and potentially a trainee, if they're on a rotation — will conduct the initial review and may elect to perform additional analysis, such as immunohistochemistry, molecular, cytogenetics, unsubmitted, unstained slides or blocks. If genetic or cytogenetic testing is required, that material will go through tissue slide review, where we make sure that the specimen meets validation requirements for downstream testing. Lastly, we will sign out the case after reviewing the test results and creating the final pathology report, and we return the materials to the client.

Case review: Wide range of case complexity

As I mentioned previously, there's a wide range of case complexity in the pathology consultation practice. This ranging complexity is a function of the number of specimen types that are submitted; imaging that may or not be interpreted on our end; ancillary testing that's required, such as immunohistochemistry, molecular, cytogenetics; and of course, if we have to share this with our expert colleagues as well. This leads to increasing complexity, duration, and of course, cost. 

Optimize pathology consults with MCL

It is important to optimize your experience with the pathology consult patient practice at Mayo Clinic Laboratories. We require both the pathology report and Mayo Clinic Laboratories account number for our consultations. The client pathology report allows us to positively identify the patient, and appropriately match the specimen with the order. The required information includes patient name, date of birth, the date of service, gross description, slides and block IDs, the client pathology accessioning number, and specific questions the client would like answered. The Mayo Clinic Laboratories account number, or MCL account number, is essential for reporting results and billing. Most of our consultation delays are caused by missing information. Please contact us if a new MCL account number is needed. Of course, select cases require radiographic imaging studies to correlate histopathologic findings, for example, in bone tumors, central nervous system tumors, and medical lung disease. Pertinent laboratory work is also valuable for evaluating medical renal and medical liver biopsies. 

MCL path consult differentiators: Best of breed path consults

Our practice has over 100 pathologists across our campuses, with broad subspecialty expertise falling into 19 categories. Our depth of experience and esoteric testing includes over 3,000 Department of Laboratory Medicine and Pathology tests. Naturally, we are integrated with our clinical practice and consistently collaborate with subspecialty experts within our department. Our processes have extensive quality controls to drive the best of breed pathology consult service, and of course, we couple that with superior lab and administrative staff. 

Getting started

To get started, you can contact us, or for additional information and instructions, contact a Customer Service Representative at 800-533-1710. Or, you can visit our test catalog at 

Thank you


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MCL Education

This post was developed by our Education and Technical Publications Team.