The Pathologist–PA Team
The emerging and essential role of the pathologists’ assistant in interventional pathology
Karen Villar Zarra, Maria del Mar Olmo Fernandez, Santiago Nieto Llanos, Hector Enrique Torres Rivas, Luis Manuel Fernandez Fernandez, Carla Macleod Beltran | | Opinion
For a long time, pathologists’ assistants (PAs) have worked silently and diligently (and often unrecognized) in hospitals across the world. Their work represents an important link in the chain of duties required of a good pathology service. PAs in our institutions perform gross examinations, including complete description, mapping, evaluation/inking of margins, and sectioning of surgical pathology specimens, as well as processing all cytology samples. In addition, they are always ready to learn new techniques that give added value to their profession.
At the moment, our institutions are focused on a new professional activity for pathologists: interventional pathology techniques. These activities are important because they improve diagnostic and economic efficiency (1,2,3), shortening the time to diagnosis for the patient. Interventional pathologists do not limit themselves to waiting behind the microscope for samples, but perform the procedures to obtain cells, ensure sufficient representative samples, and optimize management of the material obtained (4). And because interventional pathologists make real-time decisions, it’s the PA’s intimate knowledge of the requirements for each potential procedure that allow optimal sample management. And, if another sample is required, it’s the PA who prepares for complementary techniques, such as ultrasound-guided core needle biopsy, and assists the pathologist in performing them.
While the pathologist conducts ultrasound-guided puncture sampling procedures, the PA maintains the interface between the skin and the probe with repeated applications of quickly evaporating solutions, such as chlorhexidine (because gel interfaces may result in artifacts or obscure cells needed for cytological evaluation). The PA also knows what type of fine needle will be chosen according to the tissue and the depth of the lesion; they assist in the aspiration, prepare direct smears as needed, and immediately assess the adequacy of the sample, if the pathologist is not available.
Indeed the PA is integral to the entire process – from obtaining each patient’s informed consent, to managing the ultrasound, to including patient data in the ultrasound imaging consultation, to changing probes, taking pictures, freezing images, and measuring and applying color Doppler to areas of interest.
PAs are also trained to handle common pathology laboratory techniques and prepare for rapid staining so that the pathologist can perform rapid on-site evaluation of samples or pursue ancillary testing if needed.
In this new interventional scenario, the pathologist–PA team must work well together to ensure optimal flow of the interventional pathology consultation and, ultimately, accurate and complete diagnosis. Good coordination between pathologist and PA is achieved through training – and after performing a few procedures. From that point on, the synchronization of tasks should be practically seamless. And that’s why, at our institutions, we consider PAs the “right hand” of interventional pathologists. Without their training, assistance, and motivation, we would be less fluid and efficient.
Most pathologists already know how fundamental PAs are to their daily work and to the smooth operation of the laboratory. And this reality is only intensified in interventional pathology, where the PA’s work is indispensable to efficient procedures, optimal sample use, and – most important of all – the best possible outcome for the patient.
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- HK Grohs, “The interventional cytopathologist: a new clinician/pathologist hybrid”, Am J Clin Pathol, 90, 351 (1988). PMID: 3414606.
- SD Rollins, “Pathologist ultrasound-guided fine-needle aspiration: take the plunge and reap the benefits”, Pathol Case Rev, 20, 230 (2015).
- JS Abele, “The case for pathologist ultrasound-guided fine needle aspiration biopsy”, Cancer Cytopathol, 114, 463 (2008). PMID: 18956459.
- K Villar Zarra et al., “Una nueva figura en la anatomía patológica actual: el patólogo intervencionista”, Rev Esp Patol, 49, 94 (2016).