The work of a pathologist is shrouded in many myths. Often people imagine them as cynics who can butcher a corpse with one hand and finish a sandwich with the other. In fact, the anatomical theater is far from the main place of the pathomorphologist’s work. Often the patient’s life depends on the conclusion of the pathologist. What these doctors are doing, “MK” said the expert of the medical platform for pathological laboratories Alexander Ninburg.
Imagine the situation that at this very minute a patient is lying on the operating table, he is undergoing surgery on the stomach. An organ tissue sample is sent for urgent analysis, where the doctor conducts real-time examinations while the operation is underway. Based on the results of the tests, the surgeon will decide whether to save the patient part of the stomach or remove it completely. The doctor who at this moment conducts the study as soon as possible is a pathologist.
Fiction has given pathologists a reputation as doctors who exclusively deal with autopsies of the dead, but in fact 90% of his time the pathologist deals with living people. In oncology, the diagnosis is based on the results of a histological analysis carried out by a pathologist, in fact, his conclusion in most cases is the diagnosis. And this is especially important for cancer patients. After all, cancer is treatable in most cases precisely in the early stages, and human life often depends on the correct diagnosis.
What is the state of the pathomorphological service today?
“The service is in a deplorable state,” says Alexander Ninburg. – Due to a complex of reasons: this is a poorly paid, very responsible job, extremely stigmatized. Even people with a medical background believe that the main job of pathologists is autopsy. She has never been popular. In the middle of the last century, there was a strong domestic school of pathologists in the country. True, isolated from the world, and this also had its negative consequences. Then medicine and pathology began to commercialize, and those who possessed knowledge and had access to Western literature earned money. Most of them did not want to teach anyone, so as not to breed competitors. As a result, now we are witnessing the extinction of the specialty: there are very old specialists who are still working, but have already dropped out of the professional context and cannot keep up with the dynamic development of the specialty. There is a gap in the middle age category, that is, among people in the prime of their professional powers, who should already have work experience, but still have the strength and desire to develop and teach someone. I am glad that young and active specialists appear who want to study and develop in this specialty, which is actually very multifaceted and interesting. One of the limiting factors is that such specialists often have to be self-taught, and this is rather bad, since it is not possible to master the specialty from books and videos, at least only a few can do this. But as technology advances, pathologists will increasingly be able to immerse themselves in the profession through telepathological training.
– That is, you still observe a trend of growing interest in the profession of a pathologist? Are the students going? What is the shortage of doctors?
– The profession still cannot be called prestigious, but interest in it has increased significantly in recent years. First of all, of course, thanks to programs to combat cancer, because in this fight everything is based on morphological diagnosis. The number of people wishing to enter the specialty is growing, but here another obstacle arises – this specialization is often chosen as an alternative alternate airfield (fewer points are needed for admission). If a person does not pass to other specialties in a medical school, he goes to pathology. You have to spend time teaching those who do not need it, are not interested, it is just not his area of interest.
The shortage of doctors in different regions varies significantly, in the department of the largest oncological institute of the country, in accordance with regulatory requirements, doctors overwork 2–2.5 times, while their laboratory is in a very good situation in terms of personnel today. I think that the average estimate of the personnel shortage at the level of 60% is quite true, and if we take into account that in fact today much less morphological research is being carried out in the country than is necessary, then the shortage is even greater.
– In 2020, pathologists increasingly began to appear in the media and comment on COVID cases. Do you think this will affect the interest of young professionals?
– In my opinion, it is very important to tell correctly about this profession. These are legendary specialists who are passionate about their work. With a huge amount of knowledge. The more young specialists with shining eyes come to the sphere, the better will be pathological diagnostics in our country. In fact, a pathologist is the very primary and important diagnosis that is talked about so much.
– What are the main directions of the pathomorphologist’s work? What’s new today, technologies that can improve the accuracy of conclusions?
– The main area of work – the so-called intravital diagnostics – is the study of biopsy and surgical material. This applies not only to tumors, the mass of acute and chronic infectious, inflammatory diseases, developmental anomalies, metabolic disorders, etc. The direction of the study of post-mortem changes is, of course, also preserved – the establishment of the causes and mechanisms of death.
World science and practice are following the path of standardizing this subjective diagnostic method both from the point of view of the approach to analysis and from the point of view of reporting, that is, the formulation of a conclusion. The revolution, of course, was made by the emergence and introduction of immunohistochemistry. For example, let’s take a solid carcinoma – one pathologist is sure that it is adenocarcinoma, the other that it is squamous cell carcinoma. Without immunohistochemistry, there was no tool for reconciling these two, and with IHC there are markers that are stained for adenocarcinoma and not stained for squamous cell carcinoma.
Technology advances and gives us more opportunities. In particular, in the field of artificial intelligence. The variety of options for cytological characteristics and the fact that we have a two-dimensional picture of three-dimensional structures in an arbitrary plane greatly complicates the interpretation and labeling of images for training artificial intelligence models. The quality of the markup is strongly influenced by the number of elements and structures in one image. To solve problems, in most cases, we take 200x and 400x magnification so that the nuclei of the cells are visible. This became possible thanks to the development of optomechanical processes.
In general, I would like to believe that the emergence of new technologies will increase interest in this very important profession for all of us in the coming years.
A corpse is a noble cause