In Vivo Microscopy- thoughts?

[BlondeDocteur]

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Can pathologists step up here?

https://www.phscpd.org/activities/a...copy-ivm-interpretation-for-the-practicing-pa

 

[Over9000]

We should.

The least we could do is insist we read the images. The other physicians can obtain them but the images should go to us.

What we really should do is learn how to use this technology to obtain the images ourselves, cutting out the clinical middle-man.

To do so will be difficult, because current pathology training does not provide any true clinical experience.

In my opinion, the following changes have to happen in pathology education for this to become a practice reality:

1. Residency programs must re-instate the rotating clinical internship across the board.

2. Forensics should become its own specialty separate from pathology. Autopsies have no business in non-medicolegal medicine. There is little overlap in the two fields. Time spent in one is time wasted for the other.

3. CP training should be de-emphasized, and clinical in-vivo diagnostics should replace it, eventually phasing it out.

My ideal curriculum would be something like this:

year 1: rotating clinical internship, with emphasis on services that provide care to cancer patients (2mo GenSx, 2mo derm, 2mo medicine, 1mo rad onc, 2mo hemeonc, 1mo uro, 1mo ENT, 1mo gynonc)

year 2: subspecialty AP signout (2mo general signout, 2mo derm, 2mo gyne, 2mo breast, 2mo GI, 2mo in-vivo)

year 3: further subspec AP signout (2mo thorax, 2mo hepatobil, 2mo H&N, 2mo ped, 2mo cyto, 2 mo soft tissue)

year 4: the final component of subspec AP (2mo heme, 1 mo neuro, 1mo kidney, 2 mo GU, 6mo straight in-vivo)

year 5: flexible

That's how I'd do it.

 

[WEBB PINKERTON]

Good luck with insisting on reading the images. Most pathologists just want to push glass all day and bitch online about their profession going in the toilet.

Lung, GI docs are very interested in interpreting images themselves I have found with the cell-visio system. In the future, I bet they biopsy far less often due to this technology.

http://www.maunakeatech.com/en-gb/content/patients-families-0

 

[Over9000]

Good luck with insisting on reading the images. Most pathologists just want to push glass all day and bitch online about their profession going in the toilet.

Lung, GI docs are very interested in interpreting images themselves I have found with the cell-visio system. In the future, I bet they biopsy far less often due to this technology.

http://www.maunakeatech.com/en-gb/content/patients-families-0

I wonder if I'd, as a patient, want a non-pathologist reading a microscopic image. It's like cardiologists reading upper-thorax CTs. Sure, the obvious stuff is obvious, but its the other more subtle deadly things that they'll certainly miss.

 

[coroner]

The patient isn't going to care one way or another what kind of physician is giving their diagnosis as long as they're being told benign/malignant. But, there's a huge difference with specialist surgeons interpreting their own radiology (which they should be able to) vs making the jump to diagnosis on a cellular level. Why would this be any different than adequacies on bronchs/FNA's that are interpreted by the pathologist? If the clinicians can't interpret that and rely on us just to say if they have enough of the right kind of cells, I don't see them being able to accurately render tissue-based diagnoses without extra training a la dermatologists doing a dermpath fellowship...

 

[BlondeDocteur]

Specialist surgeons should never, IMO, interpret their own radiology except in emergent situations. There's a reason radiology training takes four years, and for all the show surgeons put on about always looking at the scans yourself and coming up with your own interpretation, etc, no one would actually act on their own interpretation (again, barring emergency). And you're right, the vast majority of patients don't care at all who delivers the news-- they care about the news.

The big thing is re-introducing genuine clinical training into path residency.

 

[AZpath]

In an academic setting the results are good. However, these are the GI research pioneers that are working hard the learn the microscopic evaluation.
Typically, they spend hours and hours reviewing the results with staff pathologists until they are very well trained.
Then they publish how simple and great a tool it is.


The last article I read showed pretty poor accuracy in a community GI setting. This was study from Europe.

This article suggested that it is not easy tool for current GI docs to learn.
Also, the more time they spent behind the endoscope correlated with better results. So a lot will depend on how it is reimbursed.

If CMS places a high dollar amount on In Vivo that would justifies a clinician spending a lot more time per scope.
If it low they won't want to waste their time. Most of them just wan't to be in and out quickly.
A biospy or letting the pathologist review the image is going to be faster.

 

[Tissue issue]

I think I may have underestimated the importance of this new technology. The CAP sure thinks it's a big deal ... http://www.cap.org/apps/docs/meeting_calendar/pathologists_opportunities_in_ivm.pdf.

It looks like the CPT payment rate is $520. http://www.marketwired.com/press-re...d-reimbursement-cellvizio-optical-1742609.htm