Diagnostic Demands: Part 2

Woo Cheal Cho: Despite the advancements in emerging immunohistochemical and molecular studies, what we need in our diagnostic toolbox is sharpened attention to detail. In dermatopathology, many significant diagnostic discrepancies I've observed over the years stem from inadequate histopathologic evaluation or misinterpretation of presented data. I’ve heard someone saying, “high-power (high-magnification examination) equals low IQ.” However, histopathologic diagnosis isn't a race; accuracy is paramount for patient care. I firmly believe that thorough evaluation – what I call "high-power" – translates directly into optimal patient outcomes.

Debbie Gonzalez: The recognition and commitment to the field of pathology and medical lab sciences. Often the last area to receive funding or capital investment, labs are working with sub-optimal equipment. Pathology must have a seat at the table when looking for the best patient outcomes and experience. We are not just the department in the basement!

John Overton: I’ve been very fortunate to work with amazing residents and faculty that have armed me with resources and time at a microscope alone so that I could preview cases and attempt to make diagnoses on my own. However, I know that this is not every rotating student’s experience during their anatomic pathology rotations. Making sure each student has the chance to do this is important and I think it really allows students to “try on” the specialty and imagine themselves as a pathologist. 

Swati Bhardwaj: I wouldn’t say that is missing right now, but the two things that shouldn’t be forgotten amidst all the exciting developments are good histology/morphology knowledge and the essential role of interdisciplinary collaboration. Yes, molecular techniques and AI are exciting new tools, but a good histologic evaluation and inter specialty discussions are the two fundamental elements of a pathologist’s diagnostic toolbox.

Aaron Odegard: The laboratory continues to add dynamic and innovative technology, but we still need the tools to negotiate and advocate for our lab teams. I have had the privilege of working with the team at ASCP, Christina Nickel, and Ihab Abumuhor on the ASCP CDC OneLab Toolbox that helps to meet that need – providing a data driven approach to advocate for the needs of the lab. We will continue to add tools necessary and educate laboratory professionals on this resource.

Adam J. Cole: It goes without saying that you can’t have access to AI tools unless you’ve made the leap into the digital pathology space – but that shift is currently expensive and not widely reimbursed. With reimbursements being cut, it's hard to justify the investment for most pathology labs.

Maggie Flanagan: A key gap in the diagnostic toolbox is the comprehensive integration of multi-omics data (genomics, transcriptomics, proteomics, and metabolomics) with traditional histopathological techniques. While extensive progress has been made in each area, combining them effectively in routine pathology diagnostics remains a challenge.

We need platforms that can merge omics data with histopathological images to help pathologists link molecular changes with tissue features. Standardized protocols and robust computational tools are essential for handling and interpreting this complex data in clinical settings. These tools should provide insights that can be directly applied to improve diagnosis and treatment.

Multi-omics approaches also require clinical validation and clear guidelines to ensure their reliability. Pathologists and lab personnel need training to interpret this data and integrate it with traditional methods. High costs and specialized expertise are barriers, so developing cost-effective solutions and improving access to these technologies is crucial.

Additionally, guidelines around data privacy, patient consent, and clinical use are needed. I believe that addressing these challenges would enhance diagnostic accuracy, improve patient outcomes, and advance personalized medicine.

Aadil Ahmed: As trainees, we focus on making the correct diagnosis without fully grasping the implications of our findings. This issue becomes particularly evident when the diagnosis is uncertain, leaving us unable to provide clear directions to clinicians. In such instances, lengthy narratives in our reports are not useful. It is crucial that our training incorporates the true importance of clinicopathologic correlation – not only for diagnostic accuracy but also for therapeutic implications. We need to learn how to write reports that are concise and helpful to both clinicians and patients, even when the diagnosis remains unclear.

Leonie Wheeldon: It’s not missing as such, but cytology service toolboxes – Rapid On-Site Evaluation (ROSE) – should be available across the board. ROSE is a real time morphological assessment of cytology samples, performed by a pathologist or biomedical scientist. It ensures sufficient diagnostic material is collected and appropriately managed to avoid the need for repeat or more invasive procedures.

Medical advances have resulted in smaller needles to minimize risk of complications to patients. However, these smaller samples require more extensive tumor profiling and molecular testing due to the rise of personalized therapies. This puts diagnostic cytology ROSE services in a crucial position for modern healthcare, especially for cancer, to ensure patients receive the highest quality of care.

Mustafa A. Barbhuiya: One important aspect missing from the diagnostic toolbox is the integration of pathology and laboratory medicine into the actual practice of healthcare. We should ask: How many medical students graduate with a strong understanding of concepts like the 'two-step Fagan's nomogram' and how to interpret diagnostic test results using pre-test and post-test values? This foundational knowledge is often overlooked and lacks reinforcement. That’s why I am dedicated to making pathology and lab medicine a central part of healthcare and medical education.

Image credit: The Pathologist