Niki Boisso
Pathologists’ Assistant, NYC Health and Bellevue Hospital Center, USA
Exciting developments and trends? 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.
Controversial opinion? The lab is the most important clinical department in the hospital and all clinical staff involved with specimen collection should spend time shadowing within the lab. Nowadays, there aren’t a lot of diagnoses that are made without the lab’s help, yet clinicians routinely call us asking how to collect samples or what order to place for certain tests or where to drop specimens off. And we often have to track down clinicians because incorrect orders are placed, specimens are submitted to the wrong department, or requisition forms are not filled out. All of this leads to delays in patient care and potential degradation of specimens.
It would be incredibly informative for clinical staff, particularly those involved in tissue collection, to spend time in anatomic pathology so that they understand what the process is from excision to diagnosis. The process involves a grosser dissecting and examining the specimen, allowing time for the tissue to fix, then a histotech embedding, cutting, and staining slides. Finally, a pathologist examines the slides to make a diagnosis. While some steps are automated, most of the work is still done by hand. We often get calls from clinicians asking for results before we even have the specimen or asking us to rush results for large cases. They don’t always realize that the process in anatomic pathology takes time and has its own set of limitations.
Intro to pathology? Like many people in laboratory medicine, I found my way to anatomic pathology by accident. I went to school for forensic science and during my education completed internships at a coroner’s office. I realized that the medico-legal aspect of forensics, particularly autopsy, was what I enjoyed. I began looking for jobs that would allow me to do autopsies without being a doctor and came across the American Association of Pathologists’ Assistants website, which detailed the role of PAs and the many services they can provide, including completing autopsies. I didn’t really know anything about laboratory medicine or pathology outside of (primarily) forensic autopsy before going to PA school; it just seemed like a good fit because it would allow me to use and further develop skills and interests I already had.
Pathology is such an exciting field. Autopsies are not part of my work responsibilities, however, there is always plenty to do in the surgical pathology gross room. In our day-to-day work, we handle things that most people will never see. I love the problem-solving aspect of grossing; how recognizing various patterns can indicate different processing techniques. This makes every specimen a little unique and challenging and makes every day different.
