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Does anyone go into Cytology? I am really failing to see the appeal.
Why....
- Thread starter BlondeDocteur
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How do you mean by 'go into cytology'? As a resident I knew faculty who rotated through the cytology service along with their surg path work, but I didn't see any pure cytology people aside from the cyto techs. I imagine some labs employ such people and I agree - that sounds like a horrible job. I'm not a surg path guy myself, but I do see the appeal of a cytology fellowship to complement one's general diagnostic skills in community based pathology practice.
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I've inspected a few cytopathology only labs. They do exist or at least did. The last one I inspected sold out to labcorp and doesn't exist any longer.
You may not like cytology but you never know what situation you may end up in. Pulmonologists are doing a lot of endo FNAs nowadays and if you end up in Kentucky, where cigarettes are still fairly cheap, you will be assisting many. Providing on-site evaluation is really important for a number of reasons and it's pitiful how small the reimbursement is.
You may not like cytology but you never know what situation you may end up in. Pulmonologists are doing a lot of endo FNAs nowadays and if you end up in Kentucky, where cigarettes are still fairly cheap, you will be assisting many. Providing on-site evaluation is really important for a number of reasons and it's pitiful how small the reimbursement is.
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I was initially interested in other fields (heme, derm, GI), but ended up doing cyto and loved it--particularly because the faculty were great (most amiable & easy to work with), but it was the best year of my training.
As a private practice cytopathologist, I see daily that one of the biggest deficiencies amongst my peers is cytopathology. I believe that having a good grasp of cytology not only makes you a better cytopathologist, but also a better surgical pathologist. Many pathologists are "architecturally handcuffed" meaning that most of their surgical diagnoses are predicated solely on architecture. If you don't believe me, pass around a tubular adenoma with a question of high grade dysplasia and see what sort of agreement you get. So, even if you hate the subspecialty, a solid handle on cytopathology will make you a better overall pathologist.
In terms of the attractiveness of the subspecialty, I think you have to like (or love) FNA. I operate an ultrasound guided FNA clinic in our practice. I like interacting with the patients and being able to render a diagnosis just by sticking a needle in it. Believe me, the patients like it too. They love getting a diagnosis immediately. Not having to wait a week to hear whether or not they have cancer makes a big psychological impact. US guided FNA still pays well too if you can do it yourself.
EUS-FNA of many lesions, particularly pancreas has become standard of care in many areas. Likewise for EBUS-FNA in the diagnosis and staging of many lung cancers. As an aside, I would take an EUS-FNA of a pancreas lesion over a CT guided core biopsy all day long.
In order to like and appreciate cytopathology you have to embrace the challenge of rendering a diagnosis using only a few cells and limited architecture (there is such a thing as cytoarchitecure). Cytopathology also allows you to directly interact with patients if you can learn to perform FNAs well. Fluid cytology can be tedious but so is looking at an entire tray of normal GI biopsies.
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In terms of the attractiveness of the subspecialty, I think you have to like (or love) FNA. I operate an ultrasound guided FNA clinic in our practice. I like interacting with the patients and being able to render a diagnosis just by sticking a needle in it. Believe me, the patients like it too. They love getting a diagnosis immediately. Not having to wait a week to hear whether or not they have cancer makes a big psychological impact. US guided FNA still pays well too if you can do it yourself.
EUS-FNA of many lesions, particularly pancreas has become standard of care in many areas. Likewise for EBUS-FNA in the diagnosis and staging of many lung cancers. As an aside, I would take an EUS-FNA of a pancreas lesion over a CT guided core biopsy all day long.
In order to like and appreciate cytopathology you have to embrace the challenge of rendering a diagnosis using only a few cells and limited architecture (there is such a thing as cytoarchitecure). Cytopathology also allows you to directly interact with patients if you can learn to perform FNAs well. Fluid cytology can be tedious but so is looking at an entire tray of normal GI biopsies.
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The American Society of Cytopathology is in Dallas this weekend. Its like the cytology church there.
Another thing to add about cyto is that it lets you see an entirely different set of patients with metastatic disease. You may get the Stage 1-2 lung cancer patient's resection. On surgical pathology, you hardly ever get the patients that have metastases to a supraclavicular lymph node.
Another thing to add about cyto is that it lets you see an entirely different set of patients with metastatic disease. You may get the Stage 1-2 lung cancer patient's resection. On surgical pathology, you hardly ever get the patients that have metastases to a supraclavicular lymph node.
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I do non-gyn cyto, don't think I could do it purely. I think it is helpful for my duties to do non-gyn cyto, you learn and appreciate different ways of seeing things. I did not do a cytopath fellowship and I don't do paps.
Cytopath fellowships are popular because they generally help your marketability. Outside of academics there aren't too many pure-cytopath pathologists as far as I know. It's also hard to outsource because a lot of it doesn't reimburse well and other parts are often stat.
Cytopath fellowships are popular because they generally help your marketability. Outside of academics there aren't too many pure-cytopath pathologists as far as I know. It's also hard to outsource because a lot of it doesn't reimburse well and other parts are often stat.
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Being comfortable with cytopathology is probably one of the best things you should get out of your training. While I don't sign out cytopathology (yet), my practice does LOTS of assessment of adequacy for specimens that are going off for further testing. And despite being heme path by fellowship training, I was hired in large part because I can do cytopathology competently.
