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How intra-operative pathology led to improved cancer surgery


Dark Daily) about how one pathologist's innovations in cancer surgery and treatment has led to untold number of saved lives and improved outcomes.

In 1905, Mayo Clinic Chief of Pathology Louis B. Wilson, MD pioneered the frozen section method for intra-operative pathology. As detailed here, Dr. Wilson invented a way to quickly freeze pieces of specimens (using carbon dioxide), then apply dyes to them so he could very rapidly assess the situation and better determine the malignant or benign properties. This meant that surgeons could now respond faster to the results, while the patient is still on the table. For many operations, it's only suspected malignancy or else the issue facing the patient is a neoplasm of uncertain behavior (to use the ICD-9 language). Once surgeons get confirmation that what he is dealing with is, in fact, cancerous — and furthermore, what type of cancer and how far it has progressed — then they can proceed accordingly and appropriately treat the actual problem facing the patient. That difference of minutes or days can be a lifesaver, dramatically altering the outcome for a patient based on when the surgeon is able to intervene.

So therefore one can see how pathologists actually ARE in the operating room with patients. It's their quick turnaround time that determines how the surgeon will proceed with the rest of the procedure. So even though the intra-operative frozen section results can seem like nothing more than a quick line in the surgeon's dictation, or a detailed list included in a patient's chart, it's a hugely important action where the pathologist is interacting with the patient. Of course, in this instant the patient is anesthetized, so there's still no conversation — but make no mistake, the pathologist is in the operating room with you.

Rapid turnaround is one benefit to electronic reporting. While the forms to fill out may be long — depending on the data that needs to be captured — being able to send the report upon completion immediately to multiple audiences allows for a faster response by those audiences. Upon submission of a structured data, synoptic report, it can be sent into EHR for all involved parties. Or it can go to referring physicians so they are able to review it as they are consulting with the patient. Far too often in medicine, treatment comes down to timing. Catching something a few days or even hours before it worsens can be the determining factor in a patient's outcome. Having that data entered into a system, and easy to read quickly without combing through text or interpreting various vague descriptors, aids physicians in making those real-time rapid decisions that can decide the fate of a patient's life.

Pathology labs are usually not anywhere near the area where patients receive treatment. Often times they are actually off site, located in another building entirely. Patients see some names attached to a results page, or else their general practicioner is relaying the findings to them. When something is out of sight, or when there is no direct interaction, it's easy to forget about the contributions it makes. It's easy to assume that pathologists are disconnected from a patient's treatment when all they interact with are a few specimens from that person. But thanks to many innovations, including electronic reporting and the intra-operative diagnostic work of Dr. Wilson, pathologists are intimately involved in providing care to their patients. In fact, their ability to provide information in a timely fashion can end up having the greatest of consequences on a patient's health.

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