Spotting the Diagnostic Disconnect: How Medical Record Review Catches Conflicting Lab Results

A diagnostic disconnect is what happens when two pieces of the same patient’s diagnostic record point in different directions and the record does not show that anyone reconciled them. Have you ever opened a pathology file and found two reports on the same specimen that do not agree? That single mismatch, buried across two providers’ records, can carry an entire case.

A Philadelphia jury made that point in November 2025. Isis Spencer, then 45, was reported to have grade 2 to 3 endometrial cancer on a February 2021 biopsy read at a Main Line Health facility. A repeat biopsy at Penn Medicine came back negative. She underwent a total hysterectomy in March 2021, and the post-surgical pathology found no cancer in the removed tissue. Main Line Health later determined the original biopsy slides had been contaminated with another patient’s tissue material. The jury returned a $35 million verdict, apportioning 35 percent, roughly $12.25 million, against the University of Pennsylvania Health System and the treating gynecologic oncologist. Main Line Health had settled separately in 2022 for an undisclosed amount.

Source Credit: Spencer v. Trustees of the University of Pennsylvania et al., Philadelphia Court of Common Pleas, case No. 230100053; jury verdict reported November 25, 2025, as covered by The Philadelphia Inquirer, The Daily Pennsylvanian, Expert Institute, and Tissuepathology.com. Verdict details, including apportionment, are as reported; some outlets cite differing post-trial dates. The verdict may be subject to post-trial motions or appeal, and the allegations described are the plaintiff’s claims as reported rather than findings by LezDo TechMed. Confirm the docket before relying on any detail.

This post is for the personal injury attorneys and medical malpractice litigators who work these files. Let’s look at where diagnostic conflicts hide in a record set, what a reconciliation trail looks like on paper, and how a cross-referenced chronology surfaces both without stepping into the expert’s role.

Why conflicting results are so easy to miss in a record set

Conflicting results are easy to miss because the two reports almost never sit next to each other. One is an outside lab report that arrived by fax and was scanned into a referral packet. The other is an in-house pathology report filed under a different encounter, on a different date, in a different section of the chart. Read page by page, each looks unremarkable on its own.

A few structural realities make it worse. Records arrive from multiple custodians in different formats, so the same specimen can appear under different accession numbers and different descriptions. Pathology language is comparative rather than binary, so a report may say a finding is suspicious for or consistent with something rather than stating it outright, and two such reports can differ in degree without visibly contradicting each other. And clinical notes often carry the diagnosis forward as settled once it has been stated once, which means the later negative result can appear in the file without ever changing the narrative around it.

That is the pattern the Spencer case put in front of a jury. The conflict existed in the documents. The question the litigation turned on was what the record showed about reconciling it, and that is a records question before it is a clinical one.

The documents that reveal a diagnostic disconnect

A diagnostic disconnect is revealed by comparing a small set of documents against each other in date order, because no single one of them shows the conflict on its own. These are the sources a record reviewer cross-references.

• Outside and in-house pathology reports. The full text of every pathology report on the same or related specimens, including the gross description, the microscopic findings, the diagnostic line, and any addendum or amended report issued later.
• Specimen and accession identifiers. Accession numbers, collection dates, block and slide identifiers, and any documented transfer of slides between facilities, which is how two reports are matched to the same tissue.
• Repeat and confirmatory testing. Repeat biopsies, second-opinion reads, immunohistochemistry, imaging, and tumor marker results, plus the dates they were ordered and resulted.
• The clinical narrative around the decision. Office notes, consultation letters, tumor board or multidisciplinary conference documentation, informed consent forms, and the pre-operative history and physical.
• The operative note and surgical pathology. What the procedure describes, and what the pathology on the removed tissue documents afterward, which is often the moment the record resolves the conflict.

Assembling and cross-referencing these across custodians is the work of a medical chronology, and it usually begins with medical record retrieval so the outside lab file is in hand rather than summarized second-hand in a referral note.

What a reconciliation trail looks like on paper

A reconciliation trail is the documented evidence that someone recognized a discrepancy and addressed it before acting on the diagnosis. It is worth knowing what that looks like, because litigators are often asking about its presence or absence rather than about the clinical content of the reports.

On paper, reconciliation typically appears as a specific, dated action: a repeat specimen ordered after the discordant result, a formal second-opinion pathology consultation with a report of its own, additional stains or molecular testing on the original block, a tumor board entry that records the discussion and the plan, a note that documents the conflict and the reasoning for proceeding, or a consent discussion that references the uncertainty. When one of these exists, it sits at a fixed point in the timeline and can be located and cited.

When none of them exists, that absence is also a documented fact, and it can be stated precisely: between these two dates, the record contains no repeat testing, no second-opinion read, and no note addressing the conflicting results. A record reviewer can flag that gap with dates and source pages. What it means clinically and legally, including whether it reflects a departure from the standard of care, is for the retained expert and counsel to determine.

Where diagnostic record review goes wrong

Diagnostic conflict review tends to fail in four predictable places, and each is a records discipline problem rather than a clinical one.

The first is the missing outside file. If the outside lab’s complete pathology report is never retrieved and the chart carries only a referral note summarizing it, the two documents can never be compared. The conflict becomes invisible because half of it was never collected.

The second is summarizing instead of comparing. A chronology that records "biopsy positive for malignancy" on one date and "biopsy negative" on another has captured both facts and still missed the point. The value is in the explicit cross-reference that places them side by side, notes they concern the same or related specimen, and asks what happened between the two dates.

The third is the unread addendum. Pathology reports get amended and addenda get issued weeks or months later, sometimes after the treatment decision. An addendum filed at the back of a record set can change the entire sequence, and it is easy to miss when reviewing by page order rather than by date and specimen.

The fourth is interpretation creep. Once a conflict surfaces, the pull toward writing the sentence that says what it proves is strong. That sentence belongs to the retained pathologist or gynecologic oncologist, not to the record reviewer. A disciplined chronology states what each document says, states what the record does and does not contain between them, and stops there.

What a strong diagnostic chronology looks like

A strong diagnostic chronology reads as one dated account of how a diagnosis was reached and acted on, drawn from every custodian, and written so counsel and a retained expert can use it without returning to the raw file.

It presents every pathology and laboratory result in date order with the reporting facility named. It matches reports to specimens using accession and collection details, so two documents about the same tissue are visibly linked. It quotes the diagnostic language rather than paraphrasing it, because the difference between "suspicious for" and "consistent with" carries weight. It defines clinical terms for a legal reader, so a litigator understands what an immunohistochemistry panel or a frozen section adds. It flags discrepancies, absent confirmatory testing, and the interval between them with dates and source pages. And it ties every entry to a page in the produced record, so the timeline holds up in deposition and at trial.

How experienced litigators build a diagnostic conflict file

Attorneys who handle diagnostic cases well collect from every custodian before forming a theory, because the outside lab file is where the conflict usually lives and it is the record most often left behind. They ask for a chronology organized by specimen and date rather than by provider, so related reports line up. They treat the interval between a discordant result and the treatment decision as its own question, and they ask what the record contains inside that window. And they keep the record reviewer and the retained expert in separate lanes, so the chronology can inform the opinion without pre-empting it. Plaintiff and defense teams both benefit from the same discipline, since the same timeline that surfaces an unreconciled conflict can also surface the second-opinion read or tumor board note that shows the discrepancy was addressed.

If you want to pressure-test a diagnostic chronology before it reaches your expert, these questions help.

Questions to ask about a diagnostic chronology

• Has the complete pathology file been retrieved from every facility involved, including the outside lab, rather than summarized from a referral note?
• Are reports matched to specimens by accession number, collection date, and any documented slide transfer?
• Is the diagnostic language quoted directly, including qualifiers such as "suspicious for" or "consistent with"?
• Have amended reports and addenda been located and placed at their issue date rather than their filing position?
• Is the interval between a discordant result and the treatment decision described, including what the record does and does not contain within it?
• Are repeat testing, second-opinion reads, and tumor board documentation surfaced where they exist and flagged where they are absent?
• Does the chronology stop at the documented facts, leaving standard of care and causation to the retained expert?

The bottom line on conflicting lab results

Diagnostic cases are usually won and lost on documents that were already in the file. In the Philadelphia case, two pathology reports on the same patient pointed in opposite directions before an irreversible surgery, and the litigation examined what the record showed about reconciling them. Neither document was hard to read. The difficulty was that they lived in separate files, from separate custodians, on separate dates, and nothing in the ordinary flow of a chart forced them into the same view.

That is what a cross-referenced chronology is for. Put every pathology and laboratory result on one dated timeline, matched by specimen, quoted rather than paraphrased, with repeat testing and second reads surfaced where they exist and flagged where they are absent. LezDo TechMed compares, organizes, and flags what the records document. Your retained pathologist or oncologist interprets it, and you build the case. Ready to see what your diagnostic file looks like on a single timeline? Partner with LezDo TechMed, or start with a short pilot.

Source Credit: Case details are from reporting on Spencer v. Trustees of the University of Pennsylvania et al. (Philadelphia Court of Common Pleas, No. 230100053; verdict reported November 25, 2025) by The Philadelphia Inquirer, The Daily Pennsylvanian, Expert Institute, and Tissuepathology.com, and describe the plaintiff’s allegations and the reported verdict, which may be subject to post-trial proceedings. LezDo TechMed service figures are published company benchmarks and are scope-dependent, not per-case guarantees. LezDo TechMed organizes, cross-references, and flags documented medical information for review by the appropriate qualified legal, medical, insurance, or claims professional, and does not diagnose, interpret pathology, or determine standard of care, negligence, or causation.