"It is a time, in short, for a new generation of leadership---new men to cope with new problems and new opportunities." John F. Kennedy July 15, 1960
For centuries, pathologists have investigated, discussed and scientifically clarified concepts of human disease by personally procuring and examining samples of human tissue and fluids with ever increasing sophisticated techniques and technologies. But, at the very top of the specimen sample tissue and fluid evaluation "tree" is the adequacy (quantity and quality) of the sample obtained (harvested) from the patient as to whether or not an eventual, meaningful final pathology report can be issued.
In the radiology suite, operating room, outpatient clinic or other care locations, who better than a trained, competent pathologist, can simultaneously procur, after informed consent from the patient is obtained, the needed tissue or cytology specimen, then perform an immediate "specimen adequacy check", or even render a rapid diagnosis to the patient? The short answer is "no one can do it better than a pathologist". Many non-pathologists performing interventional procedures are proceduralists who may be able to get "something" to put into the specimen collection vial or tube but very few of them can, for example, position three or four core biopsies of a diseased kidney correctly under a dissecting microscope and immediately state, "Yes or No", there are sufficient glomeruli (yes...you have to count them!) in each tissue core for separate submission of one renal core each into formalin, immunofluoresence and glutaraldehyde containing vials.
The sensitivity to attain a diagnosis by fine needle aspirate and biopsy has been shown to be 90% when proper technique is used and the interventionalist takes the requisite time to make sure adequate tissue or fluid has been obtained with the procedure. True life stories are well known wherein the interventional radiologist did not obtain an adequate lung or renal biopsy specimen and discharged the patient home (who may have driven over many miles to have the interventional biopsy procedure performed) or back to the ward only to have the pathology report state the specimen was inadequate for comprehensive pathological examination and another biopsy is needed. As a medical specialty, the scope of pathology need not to be defined by non-pathologist healthcare providers. In the words of Jack Welch, former chairman of General Electric, "Control your destiny or someone else will". Interventional pathology is one trail being blazed by nimble and transformative pathologists to further advance the importance of pathology in value-based healthcare.
When a pathologist adds interventional pathology into his or her scope of practice, it is important to know the common elements to all interventional procedures: Common Elements of INTERVENTIONAL PATHOLOGIST ® Procedures. Feasible procedures to be performed by the interventionalist include the following: Bone marrow aspirate and biopsy, skin biopsies (shave, punch, incisional and excisional biopsies), lumbar puncture for CSF evaluation, thoracentesis for pleural effusion, biopsy of pleura, paracentesis for evaluation of ascites, liver biopsy, thyroid biopsy, lymph node biopsy, and biopsy of nodules or masses that are easily accessible anywhere within the body. More difficult to access anatomic sites such as the retroperitoneum, kidney and intrathoracic structures should be coordinated with the surgical or imaging services department unless the pathologist has been properly trained in ultrasound assisted biopsies. (Archives of Pathology and Laboratory Medicine : October, 2010, Vol. 134, No. 10, pp. 1541-56; Archives of Pathology & Laboratory Medicine: January 2013, Vol. 137, No. 1, pp. 100-119.) Professional pathology associations, such as USCAP and ASCP, offer educational "short courses" on the use of ultrasound by pathologists performing fine needle aspirates and core biopsies. Checklists for each interventional pathology procedure should be used. For example, here is the author's checklist for skin punch biopsies.
INTERVENTIONAL PATHOLOGIST ® is professional medical and diagnostic services on human body fluid and tissue specimens that are personally and carefully obtained at any point of patient care (such as, the operating room, radiology suite, in-patient or outpatient bedside, etc. ) by board-certified actively practicing pathologists. Our services include bone marrow aspiration and biopsy, fine needle aspirate cytology and biopsy, skin biopsies, and more. For more information on INTERVENTIONAL PATHOLOGIST ® , our professional services and location sites, please feel free to contact Byron L. Barksdale, M.D. by telephone at 308-530-3759 or by INTERVENTIONAL PATHOLOGIST ®
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