Lessons from the Power List: trends

See the complete Power List here.

Caddie Laberiano: I find everything related to cytology very exciting, especially when it involves new modern techniques like molecular testing. The goal of cytology has always been to improve diagnosis with less material, and I believe this should be explored by current residents, fellows, and pathologists in general.

Casey P. Schukow: Digital pathology and the flexibility to work from home. When I entered medical school, I wasn’t sure which direction to take my career in. As I completed more courses and clinical rotations, I realized that the day-to-day routine of many medical and surgical fields was not my forte – mainly due to schedule rigidity. I noticed that I valued the flexibility when I practice, particularly in my daily schedule.

Another major element that drew me into pathology was that my patients are on glass, whether through a microscope lens or digitalized via a computer screen. In the next few years I hope to become a father, which will make it crucial for me to be able to step away from my work at a moment's notice for family emergencies. As a healthcare employee, my family's well being is my priority and, in most other fields, you aren't given the flexibility many parents and carers require – you must be with physical patients from dusk till dawn. As a pathologist, I’m able to see my “glass” patients and provide superior patient care at any hour of the day, while still being prompt in diagnostic turnaround times.

As digital pathology becomes more tried, tested, and true, it's only a matter of time until I can complete part of my clinical duties from home without compromising personal or professional obligations. As with any team-based organization, we must balance our onsite and at-home duties to maintain a sense of team camaraderie, trust, and high morale, especially as the digital age expands. But, anecdotally at least, a lot of medical students are looking for opportunities to work from home – so why isn’t our academic pathology community sharing more about the developments of digital pathology that allow for flexibility and remote working? We should also be training future pathologists from day one to be comfortable in using digital and computational pathology, which is undoubtedly where the field is heading.

These trends are exciting, but we need to make more of an effort to embrace, highlight, and refine them to direct our field in the right direction. The next generation needs to see pathology as an attractive and competitive speciality for 21st century medical students to consider pursuing it further down the road.

Cullen Lilley: In surgical and medical pathology, I think we’ve seen exciting developments in the areas of spatial transcriptomics and proteomics. There are certainly still challenges in this area to work through, however, even if spatial omics does not get integrated into the pathology workflow, I think the knowledge gained form this field will ultimately impact how we understand diseases and histopathologic findings.

Of course, we can’t discuss exciting developments without mentioning digital pathology and informatics, which is likely to completely alter how pathology is practiced and taught in the upcoming years. The ability to digest large amounts of data and more accurately quantify certain histopathological findings is sure to strengthen our field and support the delivery of higher quality patient care.

Stephanie Whitehead: The field of laboratory medicine is experiencing exciting advancements in molecular pathology and personalized medicine. With an enhanced understanding of the genetic underpinnings of diseases, we can offer more targeted and personalized treatment recommendations based on an individual's genetic profile. This approach is revolutionizing the management of conditions such as cancer, where therapies are tailored to the specific genetic mutations present in tumors.

Additionally, there is a growing focus on the role of pathology in preventative medicine and public health. By identifying biomarkers and early signs of disease, laboratories are at the forefront of early detection and prevention strategies, ultimately improving patient outcomes and reducing healthcare costs.

Woo Cheal Cho: One of the most thrilling advancements, particularly in dermatopathology, is the integration of advanced molecular testing into routine practice. This evolution enables the identification of potentially targetable genetic abnormalities, accurate diagnosis of complex lesions, and even the discovery of novel tumor types based on specific molecular alterations, such as gene fusions. This transformation not only enhances diagnostic precision but also opens up new avenues for personalized treatment strategies – ultimately improving patient outcomes.

Emily Nangano: The rapid advancement and expanding roles of pathologists’ assistants (PAs), particularly in fields such as forensics and research. PAs are taking on more responsibilities in the preparation and examination of surgical specimens and autopsy cases, contributing to more efficient workflows and allowing pathologists to focus on complex diagnostic tasks. In forensic pathology, PAs are increasingly involved in autopsy procedures and the analysis of forensic evidence, playing a crucial role in criminal investigations and legal proceedings. In the research domain, PAs contribute to the collection and analysis of data, supporting the development of new diagnostic techniques and treatments.

The combination of advanced digital tools and the growing expertise of pathologists’ assistants is transforming the field of pathology, leading to more accurate diagnoses, improved patient outcomes, and exciting new possibilities in research and forensic pathology.

John Overton: Learning about pathology clinics, where patients come and discuss their diagnoses and review slides with pathologists, has been super exciting. I would love the chance to see one of these in action!

Courtney Lawrence: In the Medical College of Georgia Forensic Pathology Fellowship Program at the Georgia Bureau of Investigation, an exciting trend is emerging: sharing information about our field with younger people or anyone interested in learning more. This is essential, especially given the current shortage of medical examiners in the country. It takes about 13 years of education to become a forensic pathologist, so we're starting early to build interest in the field.

We're actively engaging with younger people by allowing them to attend court appearances, participate in shadow days, discuss their educational plans, and more. By building relationships with them now, we're laying the foundation for them to possibly join us in the future and help address the shortage of forensic pathologists.

Program Director Rachel Geller, past fellows, and I take every opportunity to promote forensic pathology. Some of our efforts include:

• Speaking at high schools across the state about the importance of forensic pathology.
• Providing virtual lectures to high school students on the dangers of drug use, distracted driving, and speeding.
• Offering virtual lectures on forensic topics for residents.
• Setting up electives at nearby medical schools, allowing students to observe our work firsthand.
• Hosting shadow days for pre-med and medical students.
• Giving high school tour groups a look at human skeletal remains and histology slides while explaining our work.
• Hosting rotations for residents who may apply for our fellowship program.
• Attending specialty fairs at local medical schools.
• Discussing the current shortage with prosecutors, investigators, interns, and coroners to improve collaboration and ensure timely case completion and report releases.

These efforts aim to spark interest in forensic pathology and create a future workforce to address the shortage in this crucial field.

Nicole Aqui: I may be biased because it’s my field, but the expanding role of pathologists into therapeutics is incredibly exciting. Chimeric antigen receptor T cells (CAR-T) and gene-modified stem cells are revolutionizing the treatment of hematopoietic cancers and hemoglobinopathies. With several FDA-approved cellular products, pathologists play a major part in these innovative, personalized therapies by providing the starting material for manufacture of the product. Our expertise in cell collection, processing, and quality control uniquely positions us to shepherd these research breakthroughs into clinical use. At the University of Pennsylvania (UPenn), for example, cells are collected in our apheresis unit and, in some cases, the gene-modified product is also infused here. On a personal note, it is gratifying to participate in the entire process, vein to vein.

Leonie Wheeldon: Technological advancements with regards to digital telepathology and AI. At MDT, I’ve observed how effective the lung cancer screening programme is in radiology, with early detection leading to curative surgical treatment. There are many parallels between radiology and pathology and the implementation of AI and digital telepathology would be key for enhancing workflows, automating routine tasks, and automating image analysis.

Implementing telecytology ROSE in our trust has really demonstrated the benefits for multi-site centers where procedures are performed at peripheral sites. This equipment improves accessibility to patients without heavy resource burdens on cytology laboratories. Telecytology also provides opportunities for training, learning, and development with no geographical boundaries or limitations (provided the IT infrastructure is available so opportunities for network-based care can be facilitated).

Niki Boisso: This isn’t a product placement (I doubt our lab will ever purchase one!), but I'm really excited about the technology behind the Cision InVisionTM unit for helping with lymph node searches.

It's well known that finding more lymph nodes leads to better prognosis for patients. Whether it's because removing cancerous lymph nodes lowers the risk of recurrence or because it helps with more accurate staging, every grosser knows they can't stop searching after finding a set minimum number of lymph nodes for a specific cancer type. This can lead to long, frustrating searches, often requiring multiple attempts or extra tissue samples to meet the necessary count. The InVisionTM unit uses shortwave infrared technology to highlight the difference between the water content in lymph nodes and the surrounding fat, providing a real-time image that helps the grosser spot more lymph nodes without relying solely on touch.

This tool would be great for teaching residents and new grossers what to look for during a lymph node search. Explaining what lymph nodes feel like can be tough because touch is subjective, and there's nothing in everyday life that feels like lymph nodes in fat. Even when I guide a resident's fingers to a lymph node and say, “Here! This is a lymph node! This is what you are palpating for!” they often still seem unsure. The real-time image from the InVisionTM unit would make it easier for them to recognize and associate what they’re feeling.

New learners spend a lot of time in the gross room and often find cancer resections intimidating because of the required lymph node searches. The InVisionTM makes these cases a bit less daunting. While it doesn’t replace the need for a manual search, it helps find tiny nodes and those in previously treated cases, saving time on large cases and allowing grossers to move on to other tasks. Anything that makes teaching easier and reduces stress is definitely something to get excited about.