Physician Assistant to MD bridge program

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Status
Not open for further replies.
Dude, we already have these systems in full force with pap smears. They have failed miserably, and constantly miss high grade dysplasia. They are on their way out.


This old thread has been resurrected, so it might be worth mentioning that technology may be making the reading of slides much more commoditized and automated in the future:

For example:
http://stm.sciencemag.org/content/3/108/108ra113.short

Systematic Analysis of Breast Cancer Morphology Uncovers Stromal
Features Associated with Survival
Andrew H. Beck et al.
Sci Transl Med 3, 108ra113 (2011); DOI: 10.1126/scitranslmed.3002564

Editor's Summary
An Automated Pathologist Reads Cancer Biopsies

"How is a camera different from the human eye? Only the eye's images undergo extensive secondary processing as they are interpreted by the human brain. But what if we could program a computer to do the secondary processing? A pathologist reading a cancer biopsy slide matches his or her brain's memory of certain cancer-related features (tubules, atypical nuclei, and mitosis) against the tissue. This decades-old scoring system is still standard in most places for prognosis and treatment of cancer, despite its variability and often unreliability. Now, Beck et al. have created an automated pathologist by replacing the human brain with sophisticated image processing software and instructing it to find quantitative aspects of breast cancer tissue that predict prognosis. The software located a set of features that strongly predicted breast cancer outcome in both training and validation samples.

With an image analysis protocol they termed C-Path, the authors set their program loose on a set of samples from patients in the Netherlands. From more than 6000 features, the software found a set that were associated with samples from patients who had died sooner. The key aspect of this analysis was that these features were not predefined by a pathologist as being relevant to cancer; instead, the software itself found the cancer-related features among the very large set of measurements of the image. Classifying the tissue as epithelial or stromal, an important part of cancer diagnosis, took a bit of extra work: The authors needed to provide the software with some hand-marked samples so it could learn the difference. The C-Path score yielded information above and beyond that from many other measures of cancer severity including pathology grade, estrogen receptor status, tumor size, and lymph node status. In another, completely independent group of women from Vancouver, the C-Path score was also associated with overall survival.

An unexpected finding was that the features that were the best predictors of patient survival were not from the cancer itself but were from the adjacent stromal tissue. Women with worse outcomes tended to have thin cords of epithelial cells infiltrating the stroma, which resulted in high-risk stromal matrix variability scores. These patients also tended to have more inflammatory cells in the stroma (picked up as dark areas by the software). Replacing the human brain with an unbiased image processing system can extract more information from microcopy images and discover new biological aspects of cancer tissue."

Members don't see this ad.
 
Members don't see this ad :)
re: automated slide readers

I haven't seen anything to suggest they're any good, even as a screening device. That may change, but it appears to be a long way off...not short term. Far more likely and near term, IMO, for cytotechs, path assistants, and/or simply other physicians to continue to creep in on slide reading/histology territory. Perhaps ironically, two of those three categories are employed by pathologists, or at least path labs -- everyone looking to save some bucks in the short term without realizing that the same question gets asked further up the line. Why use so many pathologists when they themselves are delegating to cheaper alternatives? For the most part this has already happened with PhD's in the clinical lab, and is expanding with clinical PA's/NP's, who are not far removed from not technically requiring MD "supervision."
 
Slide readers are the last technology to worry about. You will have to visit a pathology museum to see people reading slides at some point. "Notice the pathologist sitting at his scope" "Notice his atrophic limbs" At that point someone in the audience will say they cant believe people did that all day long.

LA doc was crazy to think pathology is immune to mid-level creep.
 
Dude, we already have these systems in full force with pap smears. They have failed miserably, and constantly miss high grade dysplasia. They are on their way out.


Have you really seen the imagers miss high grade dysplasia all day long?

Sales rep constantly coming in trying to get my lab to get that stupid thing. Before client billing was outlawed, it looked like we would have to get the darn thing cause the physician offices wanted to bill that more expensive cpt code. I have had no interest in it because I dont see any future/growth, plus we never have any missed cancers or even high grades on previous cases. So why fix what aint broken. Rather invest in a hpv RNA testing or something.
 
Slide readers are the last technology to worry about. You will have to visit a pathology museum to see people reading slides at some point. "Notice the pathologist sitting at his scope" "Notice his atrophic limbs" At that point someone in the audience will say they cant believe people did that all day long.

LA doc was crazy to think pathology is immune to mid-level creep.

hahha so true

My opinion on slide readers are they are 50-100 years off -- think about how inaccurate computer interpretations of ECGs are and how much simpler a 2D line graph is compared to an H&E slide -- there is absolutely NO comparison.
 
Here's a crazy idea, if you wanna be compensated the same, go to medical school to begin with. Otherwise deal with it. Physicians that paid dues and went through "chunks of the (educational) process" deserve the respect for not taking shortcuts.

Not that I normally reply to these discussions but some ideas are better thought to one's self than stated aloud. A brand new physician is due his respect for the title he earned from the people that work under him/her but should never be so pompous to think that a PA of 15 years does not deserve his. If that physican does not think that he can learn something from that kind of resource in a mutual manner, then he has even more learning left to do then he may think. Pride is one thing that does not make for a great provider.
 
  • Like
Reactions: 1 user
hahha so true

My opinion on slide readers are they are 50-100 years off -- think about how inaccurate computer interpretations of ECGs are and how much simpler a 2D line graph is compared to an H&E slide -- there is absolutely NO comparison.

CAD algorithms seem to be used pretty successfully in mammography, though at present just as a tool and not for primary diagnosis...
 
Not that I normally reply to these discussions but some ideas are better thought to one's self than stated aloud. A brand new physician is due his respect for the title he earned from the people that work under him/her but should never be so pompous to think that a PA of 15 years does not deserve his. If that physican does not think that he can learn something from that kind of resource in a mutual manner, then he has even more learning left to do then he may think. Pride is one thing that does not make for a great provider.

What's with all the necrobumping today?
 
Yaah, I motion to close this thread as you mentioned back in 2008 if it degenerates you will consider shutting this down and I think we've crossed that bridge. A six year old thread that's been "necrobumped" from someone who joined one day ago just for the sake of calling out Webb that physicians shouldn't feel overentitled is ridiculous and has nothing to do with pathology...
 
Last edited:
Status
Not open for further replies.
Top