Corey Post
Hematopathology Fellow, Michigan Medicine, USA
Biggest challenge in pathology? The changing regulatory environment in which laboratories must operate. The FDA’s “Final Rule” is a prominent example, but the recent overturning of the Chevron deference also helps to highlight the major shifts occurring within the federal regulation landscape. While proper regulation of laboratory testing is essential to ensure quality patient care, proper balances must be maintained to allow for innovation and equitable access to testing.
Changes to enforcement that aren’t well understood, rolled out too quickly, or are incongruent with healthcare practice trends can cause further burdens on healthcare systems and pathology practitioners. As we move forward, I expect it will be important for pathologists to remain ahead of these changes and maintain compliance, while also serving as advocates to influence future regulations.
Exciting developments and trends? The increasing adoption of digital pathology. Whole slide imaging and digital workflows offer multiple opportunities to improve current practice patterns, while also allowing for the development and adoption of powerful new tools.
From a practical perspective, digital slides greatly simplify asset management and case assembly. Once scanned, slides can be automatically added to cases and preserved indefinitely, without worrying about misplacing or mishandling fragile glass slides or diminished stain quality overtime. Digital slides can also be quickly shared and retrieved, facilitating consultation about difficult cases (no matter how far apart the consulting pathologists may be), as well as reducing barriers to retrieving old cases for reference/comparison. This also has important implications for teaching and sharing research of rare or interesting cases – allowing for unlimited viewers without relying on static images or depleting tissue with recuts.
With my background in informatics, I’m particularly excited about the role of scanned slides to allow for development and adoption of analytic and AI tools. Powerful image analytics could support discoveries of subtle morphological clues with important implications for patient diagnosis or prognosis. These tools can also perform quantitative tasks, such as enumerating the exact number of cells with specific features (e.g., counting mitoses or quantifying Ki-67 proliferative index), as well as allowing for more exact measurements (e.g., tumor size or depth of invasion).
AI approaches could eventually allow for digital “screening” of cases by directing pathologist attention to areas with atypical features, identifying rare events, or helping overlay stains. While the implementation of these tools in clinical workflows will require significant work and scrutiny, the potential advantages are certainly very exciting.
Attracting talent… It's no secret that perhaps one of the largest challenges toward recruitment in pathology is visibility. A good understanding of who pathologists are and what we do is relatively rare, even among other clinical specialties. As such, the first step in recruiting talented scientists has to be improving awareness of pathology. Of course, this is much easier said than done, but I believe great work is already being done in this area.
Social media has certainly played a large part in this, allowing us to connect with trainees and foster interest in what we do. SImilar mechanisms are also being used to connect with patients to help understand their diagnosis and disease process. These tools are helping improve quality of care alongside sharing the benefits of our field with wider members of the public.
I also think it's imperative that pathologists remain involved with the medical school curriculum. A current trend in medical training is to shorten the preclinical curriculum, which is reducing exposure to pathology. Pathology educators need to find new ways to engage in medical training. For example, Michigan Medicine school requires pathology rotations during clerkship, ensuring all students get exposure. Elective pathology rotations should also be engaging for all students, not just those interested in pathology. By increasing the visibility of pathology, we can attract new aspiring scientists.
