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Gutmann EJ. Pathologist-Patient Visits-Revisited. Am J Surg Pathol 2022; 46:e94-e96. [PMID: 35220353 DOI: 10.1097/pas.0000000000001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Direct pathologist-patient encounters are infrequent, but there has been a modest movement toward such interactions in the past 2 decades. The present article places that movement in perspective. It includes a discussion of diverse factors-including congressional laws, the views of department chairs, and progress in artificial intelligence-that could promote pathologist-patient interactions and also reviews factors that might deter such encounters.
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Affiliation(s)
- Edward J Gutmann
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon
- Dartmouth (Geisel) School of Medicine, Hanover, NH
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2
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Border SP, Sarder P. From What to Why, the Growing Need for a Focus Shift Toward Explainability of AI in Digital Pathology. Front Physiol 2022; 12:821217. [PMID: 35087427 PMCID: PMC8787050 DOI: 10.3389/fphys.2021.821217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 01/09/2023] Open
Abstract
While it is impossible to deny the performance gains achieved through the incorporation of deep learning (DL) and other artificial intelligence (AI)-based techniques in pathology, minimal work has been done to answer the crucial question of why these algorithms predict what they predict. Tracing back classification decisions to specific input features allows for the quick identification of model bias as well as providing additional information toward understanding underlying biological mechanisms. In digital pathology, increasing the explainability of AI models would have the largest and most immediate impact for the image classification task. In this review, we detail some considerations that should be made in order to develop models with a focus on explainability.
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Affiliation(s)
- Samuel P Border
- Department of Pathology and Anatomical Sciences, SUNY Buffalo, Buffalo, NY, United States
| | - Pinaki Sarder
- Department of Pathology and Anatomical Sciences, SUNY Buffalo, Buffalo, NY, United States
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Fischer G, Anderson L, Ranson M, Sellen D, McArthur E. Public perceptions on pathology: a fundamental change is required. J Clin Pathol 2021; 74:812-815. [PMID: 33097589 PMCID: PMC8606462 DOI: 10.1136/jclinpath-2020-206873] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/19/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
Pathology has been mostly invisible for the public. The missing recognition affects the pathologists' reputation, and efforts with recruitment and advocacy. Our survey with 387 respondents confirms that the public knowledge on the role of the pathologists has not improved despite campaigns and advocacy efforts. Pathology was identified as a medical specialty by 79.1% of the respondents. Only 34.8% assumed that it takes more than 8 years of post-high school training to become a pathologist. Most commonly, another medical specialist was identified as the ultimate diagnostician on Pap tests (gynaecologist), breast biopsies or malignant surgical excisions (oncologist), gastrointestinal biopsies (gastroenterologist) or prostate biopsies (urologist). The experience gained by undergoing these procedures had minimal impact on understanding the pathologists' role, since they were identified as ultimate diagnosis makers by the minority of these patients (13.8%-36.4%). The integration of pathologist-interactions into patient care may be a potential solution with benefits beyond improved perceptions.
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Affiliation(s)
- Gabor Fischer
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health Diagnostic Services, Winnipeg, Manitoba, Canada
| | - Leslie Anderson
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marc Ranson
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Sellen
- Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric McArthur
- Pathology, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
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4
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Shachar E, P Hasson S, Fayngor R, Wolf I, Hershkovitz D. Pathology Consultation Clinic for Patients With Cancer: Meeting the Clinician Behind the Microscope. JCO Oncol Pract 2021; 17:e1559-e1566. [PMID: 33797957 DOI: 10.1200/op.20.00948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Traditionally, pathologists have been branded the doctor's doctor, with a position behind the microscope and limited interaction among patients, despite their rich understanding of disease development and ability to navigate personalized medicine in an era of dynamic molecular testing. METHODS We piloted a unique patient-pathology consultation service, whereby pathologists review tissue specimens with oncology patients, facilitating a platform for heightening patient understanding of their disease and guiding additional genetic and molecular evaluation. We conducted a retrospective survey assessing patient experience. RESULTS Fifty-nine patients participated in the patient-pathology clinic consultation, with a median age of 64 years and a female predominance (33, 55.9%). The majority of patients were treated for sarcomas (11, 18.6%), breast cancer (10, 17%), and GI tumors (10, 17%). Half of the participants consulted regarding a metastatic disease (28, 47.5%). Thirty patients (50.8%) were referred to additional workup, 11 patients (18.6%) to a second opinion, and 25 participants (42.4%) were counseled to complete genetic sequencing or additional molecular profiles on their pathologic samples. Twelve patients (20.3%) were referred for pathology revision within our institution. Three patients (5.1%) had a change in treatment plan resulting from the clinic visit. The majority (90%) would recommend the patient-pathology clinic to other oncology patients. CONCLUSION To our knowledge, this is the largest study of patient-pathologist consultation services implemented at a single institution. Our work suggests that the program may provide effective patient understanding and reinforce the role of the pathologist as the patient's doctor. This work surfaced the concerns of patients, regarding their pathology reports, and demonstrated that the patient-pathology clinics are a valuable platform to address patients' distress regarding uncertainty of their diagnosis and an integral resource engaging directly with patients, driving additional evaluation and patient-targeted treatment.
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Affiliation(s)
- Eliya Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira P Hasson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rochelle Fayngor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dov Hershkovitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Gibson B, Bracamonte E, Krupinski EA, Briehl MM, Barker GP, Weinstein JB, Weinstein RS. A "Pathology Explanation Clinic (PEC)" for Patient-Centered Laboratory Medicine Test Results. Acad Pathol 2018; 5:2374289518756306. [PMID: 29582001 PMCID: PMC5862367 DOI: 10.1177/2374289518756306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/15/2017] [Accepted: 01/04/2018] [Indexed: 11/15/2022] Open
Abstract
This concept paper addresses communication issues arising between physicians and their patients. To facilitate the communication of essential diagnostic pathology information to patients, and address their questions and concerns, we propose that "Pathology Explanation Clinics" be created. The Pathology Explanation Clinics would provide a channel for direct communications between pathologists and patients. Pathologists would receive special training as "Certified Pathologist Navigators" in preparation for this role. The goal of Pathology Explanation Clinics would be to help fill gaps in communication of information contained in laboratory reports to patients, further explain its relevance, and improve patient understanding of the meaning of such information and its impact on their health and health-care choices. Effort would be made to ensure that Certified Pathologist Navigators work within the overall coordination of care by the health-care team.
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Affiliation(s)
- Blake Gibson
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Margaret M Briehl
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Gail P Barker
- Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Ronald S Weinstein
- Department of Pathology, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, USA.,Arizona Telemedicine Program, The University of Arizona, Tucson, AZ, USA.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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6
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Pitman MB, Black-Schaffer WS. Post-fine-needle aspiration biopsy communication and the integrated and standardized cytopathology report. Cancer Cytopathol 2017; 125:486-493. [PMID: 28609004 DOI: 10.1002/cncy.21821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 11/09/2022]
Abstract
Communication between cytopathologists and patients and their care team is a critical component of accurate and timely patient management. The most important single means of communication for the cytopathologist is through the cytopathology report. Implementation of standardized terminology schemes and structured, templated reporting facilitates the ability of the cytopathologist to provide a comprehensive and integrated report. Cytopathology has been among the pathology subspecialties that have led the way in developing standardized reporting, beginning with the 1954 Papanicolaou classification scheme for cervical-vaginal cytology and continuing through the Bethesda systems for gynecological cytology and several nongynecological cytology systems. The effective reporting of cytopathology necessarily becomes more complex as it addresses increasingly sophisticated management options, requiring the integration of information from a broader range of sources. In addition to the complexity of information inputs, a wider spectrum of consumers of these reports is emerging, from patients themselves to primary care providers to subspecialized disease management experts. Both these factors require that the reporting cytopathologist provide the integration and interpretation necessary to translate diverse forms of information into meaningful and actionable reports that will inform the care team while enabling the patient to meaningfully participate in his or her own care. To achieve such broad and focused communications will require first the development of standardized and integrated reports and ultimately the involvement of cytopathologists in the development of the clinical informatics needed to treat all these items of information as structured data elements with flexible reporting operators to address the full range of patient and patient care needs. Cancer Cytopathol 2017;125(6 suppl):486-93. © 2017 American Cancer Society.
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Affiliation(s)
- Martha B Pitman
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - W Stephen Black-Schaffer
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Gutmann EJ. Ships that pass in the night: The cancer cytopathologist and the patient - caring and communication. Cancer Cytopathol 2017; 125:446-448. [DOI: 10.1002/cncy.21820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Edward J. Gutmann
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center; Dartmouth (Geisel) School of Medicine; Hanover New Hampshire
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8
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Ly A. Talking to patients about a diagnosis of malignancy in a fine-needle aspiration clinic setting. Cancer Cytopathol 2013; 121:339-40. [DOI: 10.1002/cncy.21315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/12/2022]
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Herbert A. Disclosure of cervical cancer audits: how to be honest without making matters worse. Cytopathology 2013; 24:73-6. [DOI: 10.1111/cyt.12059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Herbert
- Department of Cellular Pathology; St Thomas's Hospital; London; UK
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10
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The invasive cervical cancer review: psychological issues surrounding disclosure. Cytopathology 2013; 24:77-80. [DOI: 10.1111/cyt.12057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 11/26/2022]
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Davies P. Public awareness and cervical cancer screening. Cytopathology 2012; 23:143-5. [DOI: 10.1111/j.1365-2303.2012.00984.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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