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Pathology Obituary ! --- Time to act !
- Thread starter redapple123
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While I have some suspicions of the long term practicality of in-vivo microscopy, I don't think it's something to entirely ignore either. Be aware, heck if you get a chance be involved in the comparative studies, but I wouldn't go crawling into a grave just yet.
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the clinicians would have to do a whole lot of extra training to be able to do interpret in vivo microscopy on their own (i bet it would be easier for a pathologist to learn to interpret this as it is still microscopy)... i doubt that in addition to all their training, they could do also this and eschew pathologists from diagnoses on any cases completely.. but maybe it will help with patient care.
i've been asked by a fellow from a team of clinicians at my institution to help on a project studying this. i plan to say yes and not thwart technology for the sake of keeping them away from my turf..
maybe pathologists will have a role in in-vivo microscopy.. that would be worth exploring...
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Is it plausible that the clinician doesn't take any biopsies at all? I thought the in vivo microscopy was to screen which lesions to biopsy. It doesn't seem likely that the clinician would want to base the patients final diagnosis on their own ability to interpret microscopic images.
Wouldn't it be in the clinicians interest to have pathology read the images? Probably the majority of the reimbursement would be for the procedure, and the investment of time to learn how to interpret the images might not be worth it for them.
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Yeah maybe we should try to let them interpret the images. If they think it's so easy and are so unappreciative of pathologists and think they can do away with us, let them figure out how to differentiate all the subtypes of carcinomas and atypias. Let them be liable for their own interpretations. I wish them luck in learning internal medicine and histopathology in residency. Just don't come to me begging for my opinion on a difficult case. In fact, let us do the endoscopy part and they can do the in vivo microscopy part 🙂
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Questions on the RISE this year, brought up this emerging technology. I don't know what to think of it yet. It seems the CAP believes this could hurt pathology by the publications that I've seen.
If so, I wonder if they take this sort of technology into account when they assess future demand for pathologists.
What are the benefits of this technology over histology?
-More money for the clinician
-Immediate diagnosis
-It's out, they can evaluate their own margins, toss the tissue afterwards.
-No need to bring the patient back
-No need to wait for a report or ambiguous diagnoses.
They can always send the very difficult things to the pathologists. But we could potentially lose the majority of the bread and butter cases.
The following is from http://www.nature.com/modpathol/journal/v18/n4/fig_tab/3800330f1.html#figure-title
Dense clusters: RCSLM images (a) in an acquired nevus (in the inset: corresponding 200 dermoscopic image), (c) in a melanoma and (e) in a Spitz nevus (in the inset: corresponding 200 dermoscopic image) and (b), (d), (f) their histopathologic correspondence.
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