Still exploring? Not really sure about pathology?
Well, you're not alone!
Pathology is a notoriously underrepresented and misrepresented medical specialty. Checking out the ASCP website is a great start, and we commend you on your initiative!
Let us tell you a little bit about what, exactly, we do:
Contrary to popular belief, pathology is NOT just autopsies. In fact, most pathologists spend very little (if any!) time performing autopsies. (If you are interested in autopsies, there are certain subspecialties, like autopsy or forensic pathology, that focus almost exclusively on deceased patients. These subspecialties are exciting in their own right - which is why they feature so heavily in sensational TV dramas!)
General pathology training is divided into anatomic pathology (AP) and clinical pathology (CP): anatomic pathology involves diagnosing disease based on examination of patient samples (organs, tissues, resections, biopsies, etc); clinical pathology enables diagnosis and assessment of disease processes through laboratory analysis of body fluids (e.g. blood, serum) and tissues. Both anatomic and clinical pathology encompass numerous subspecialties.
The “bread and butter” of anatomic pathology is surgical pathology. The surgical pathologist examines every piece of tissue that is taken out of/from a patient. After processing and thoroughly examining it, both macroscopically and microscopically, the surgical pathologist renders a diagnosis, which usually guides treatment and contributes to accurate prognostication and follow-up. Surgical pathology specimens range from small biopsies of large organs (e.g., skin, stomach) to small resections of local tumors to massive resections of large portions of the body (e.g., hemi-pelvectomies!!). The entire multidisciplinary healthcare team, including the primary care physician, surgeon, and oncologist, relies on the surgical pathologist’s input at almost every stage of good patient care.
Cytopathology, while closely related to surgical pathology, focuses more on the appearance of individual cells, rather than overall architecture, and usually involves less patient material and less invasive procedures. For example, a patient with a clinically or radiographically suspicious thyroid nodule will undergo a fine needle aspiration (FNA) of the nodule. Many times, it is the pathologist who performs the procedure, whereby a very small needle is stuck into the nodule and cells are aspirated, put on a slide, and stained. A preliminary diagnosis of benign versus malignant can often be rendered on the spot, saving the patient from the anguish of waiting. This is extended to any nodule or mass that is accessible via a needle, be it superficial (e.g., thyroid, salivary gland, superficial lymph nodes, etc.) or deeper in the body (e.g., pancreas, stomach, etc.). Thus, a good cytopathologist can spare the patient from more invasive, painful surgical procedures.
Clinical pathology tends to be more laboratory-based and includes, but is not limited to, microbiology, clinical chemistry, toxicology, coagulations studies, cytogenetics and transfusion medicine. The basic chemistry panel you ordered on your patient—how are those numbers generated? How are they measured? How do we ensure that the results are meaningful? These are the issues with which a clinical chemist is concerned. Does your patient have a positive blood culture? How do we identify the organism? How do we know that it is not a contaminant? How do we test for antibiotic susceptibility? The microbiologist comes to the rescue! Your patient needs blood products? It's the Pathologist in the blood bank who helps to coordinate the safe and appropriate administration of blood products. The clinical pathologists are the doctors who are behind the actual laboratory results.
Hematopathology is a fairly unique subspecialty in that it bridges both anatomic and clinical pathology. It relies on tissue diagnosis by looking at things like lymph node and bone marrow morphology; yet it also heavily utilizes laboratory tests such as flow cytometry, cytogenetics, and molecular results. Hematopathologists, like the cytopathologist, will often perform the actual procedure (bone marrow biopsy) him- or herself.
Molecular pathology is also unique and, arguably, one of the most exciting fields within pathology. As the molecular and cytogenetic underpinnings of diseases become better understood (which is happening at a stunningly rapid pace), molecular pathology emerges as the critical determinant of treatment modality and prognosis.
Find your nearest Pathology Department and get to know us a little better.
This is but a brief taste of what pathologists do. We are everywhere in most medical centers. We play important roles in multidisciplinary tumor conferences, medical and clinical education, laboratory administration, and blood product administration. This is only a general overview and we do a whole lot more!