molecular/immunoloigy in path

[reddirtgirl]

In a CLINICAL (as opposed to research) setting, how large a role does molecular biology & immunology (techniques) play in pathology?

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[LADoc00]

In a CLINICAL (as opposed to research) setting, how large a role does molecular biology & immunology (techniques) play in pathology?

No idea what youre asking but....Yes the technology is important. Yes you sort of need a good working understanding of things of clonal gene rearrangements and translocations etc. No you do not need to know exactly how to PCR crap up, that is what your technicians are for. Lots of people think Pathology is a good choice if you are from a hardcore mol bio background but honestly in the community practice of path ALL these tests are sendouts to big commericial labs like ARUP and the market for people who know this stuff is very very small.

SOooOo...Mol Path and Imm play a large theoretical role in pathogenesis, research, heme but a very small practical role overall in the clinical day-to-day practice of Pathology.

 

[reddirtgirl]

No idea what youre asking but....Yes the technology is important. Yes you sort of need a good working understanding of things of clonal gene rearrangements and translocations etc. No you do not need to know exactly how to PCR crap up, that is what your technicians are for. Lots of people think Pathology is a good choice if you are from a hardcore mol bio background but honestly in the community practice of path ALL these tests are sendouts to big commericial labs like ARUP and the market for people who know this stuff is very very small.

SOooOo...Mol Path and Imm play a large theoretical role in pathogenesis, research, heme but a very small practical role overall in the clinical day-to-day practice of Pathology.

thanks. you answered my question- which should be rephrased as "is any of this molecular crap gonna be useful after I get into med school?" I gotta keep up w/ the molecular/immuno crap because it's the best way to pay the bills... for now.

What's POH??

 

[bananaface]

POH = poor

 

[LADoc00]

thanks. you answered my question- which should be rephrased as "is any of this molecular crap gonna be useful after I get into med school?" I gotta keep up w/ the molecular/immuno crap because it's the best way to pay the bills... for now.

What's POH??

Yes POH=Poor as in a Pohboy sandwich or the Poh Crack *****

And no, by and large hardcore experimental mol bio and immuno are a near complete waste of brain space once you get into med school.


Uncle Sam says pay dem bills!

PS- I have it on good information strippers have a higher average income than many different medical specialities, might wanna look into that. Just a tip.

 

[yaah]

Molecular path is probably going to become more important as time goes by - lots of research ongoing, looking at different marker expressions in certain cancers, particularly for prognostic or treatment issues. Case in point is the molecular test for the BCR/ABL translocation in CML and other diseases - everyone who gets the diagnosis gets the test for the translocation. As more is discovered, this might happen for many more tumors. Still though, as said above, it is not likely anytime soon to be a test that will be done at East Bum**** Community Hospital.

 

[PuGanDoo]

Another example: Her2/neu positive breast cancer and herceptin treatment...

 

[LADoc00]

Molecular path is probably going to become more important as time goes by - lots of research ongoing, looking at different marker expressions in certain cancers, particularly for prognostic or treatment issues. Case in point is the molecular test for the BCR/ABL translocation in CML and other diseases - everyone who gets the diagnosis gets the test for the translocation. As more is discovered, this might happen for many more tumors. Still though, as said above, it is not likely anytime soon to be a test that will be done at East Bum**** Community Hospital.

Yes molecular pathology will become more important but I dont see pathologists really having that big of role in it. Lots of reasons why, like many other types of CP tests, MolPath is partly automated, partly technician driven with interpretation largely done by med techs and cosigned by PhD directors. Even the tests themselves are often specifically ordered by clincians, for example, Hem-Onc attending gets a case of probable acute leukemia, looks at the differential himself, sees morphologic features of APL and orders t(15;17) by PCR himself, the pathologist is not in the loop except providing
QA/QC for the molpath operation as a whole. BCR-ABLs, same thing. The ? is not whether MolBio is GOOD, yes it is good, but is not and will likely not be that critical to traditional pathology.

Sadly, I see lots of people jumping on the bandwagon of doing a molpath training program with very little payback possible. Once you are out looking for a job, you are competing in a very niche environment (totally different and separate from cytogenetics/clinical biochemistry) against PhDs who can do the job as well and can be paid far less. In addition, molpath is getting concentrated into fewer and fewer hands everday due to commericial lab consolidation. One MD, PhD or MDPhD with a molpath certificate can oversee tens of thousands of tests a year.

This is purely from a tradeskill perspective and not a research one. Yes, reasearch in MolPath is good, cutting edge stuff no question.

This brings up a very valuable question as to what place traditional tissue based pathology will occupy not in the near future but in 20-30 years. Lots of smart people think technologies will develop (ala array based Dx) to make morphologic and immunophenotypic analysis obsolete. You cant argue with this, IT WILL HAPPEN. The only big ? is when and when it does what will happen to us (meaning us traditional surgical path types).

 

[geddy]

This brings up a very valuable question as to what place traditional tissue based pathology will occupy not in the near future but in 20-30 years. Lots of smart people think technologies will develop (ala array based Dx) to make morphologic and immunophenotypic analysis obsolete. You cant argue with this, IT WILL HAPPEN. The only big ? is when and when it does what will happen to us (meaning us traditional surgical path types).

But whatever you do, don't go into research to give yourself a career insulated from such changes!

 

[b&ierstiefel]

But whatever you do, don't go into research to give yourself a career insulated from such changes!

Damnit Jim! You just spoiled things for me.

Poopants.

 

[LADoc00]

But whatever you do, don't go into research to give yourself a career insulated from such changes!

That is what I call "Crackhead Logic". An analogy would be Donald Trump predicting one day, the real estate market is gonna crash, so he might as well start selling churros from a cart on the sidewalk....

 

[PathOne]

Sadly, very little real technological progress has been made in path diagnostics for many many years, except in immunohistochemistry (which is cell specific, not tumor specific).

The only area where molecular diagnostics is really used routinely is heme, as pointed out by Yaah. Yes, you can perform certain subtyping tests in e.g. sarcomas, breast and certain hereditary cancers, but by and large NO real progress has been made in the diagnostics of solid neoplasms, despite 20 years of intense genetically-based research. Currently, it's the EM of pathology - nice to have, but certainly not need to have.

So if you're only concerned about marketability in private practise, it's a fairly safe bet that traditional light microscopy will remain the gold standard for many years to come.

However, and I feel this is an important point, the vast majority of research in molecular pathology is made by Ph.D's who wouldn't be able to dx ANY tumor, let alone grade it, even if it was staring in their face. Consequently, I've seen countless DNA/RNA-extractions and cDNA Microarrays where the researcher would perform analysis on an entire slide, with both cancerous and normal cells. And you don't have to be in line for a Nobel prize to realize, that that's a recipe for ambigious results.

So if you're an experienced pathologist going for an academic career, I think it does make sense to try to instill some common path knowledge into the research loop. Like performing laser capture microdissection and focus more on the diagnostically relevant aspects of molecular analysis, rather than that ellusive search for "THE" cancer gene/inhibitor/whatever.

It is still a fundamental problem in path diagnostics, that the tumor may have spread too widely by the time you get a slide under the microscope and can make a solid dx. I think all of us wants to help our patients by finding cancers at a point where complete eradication is still an option, and become better at subclassifying tumors to help devise better treatment options. And that goal can, in my mind, only be attained if pathologists and genetic researchers pool their expertise far more efficiently than is currently the norm.

So I personally feel that it would be advantageous if far more academically focused pathologists get involved in molecular genetic pathology (and I'm not just talking about getting a co-authorship for supplying some tissue to a Ph.D. first author).

 

[geddy]

The only area where molecular diagnostics is really used routinely is heme, as pointed out by Yaah. Yes, you can perform certain subtyping tests in e.g. sarcomas, breast and certain hereditary cancers, but by and large NO real progress has been made in the diagnostics of solid neoplasms, despite 20 years of intense genetically-based research. Currently, it's the EM of pathology - nice to have, but certainly not need to have.

Good points. 2 things will be needed before molecular diagnostics becomes widespread in solid tumors: 1) a method to easily and quickly analyze tissue and 2) clinical significance. As you said, heme path is where most of the molecular is now, but that's because of the history - first, the cancer cells are pretty easy to get and analyze (flow cytometry). In addition, it's clinically relevant - different therapties have been developed for different cancers, not based on morphology but on protein expression profiles (flow).

For solid tumors, the analogous method to flow may be IHC, or possibly laser-capture microdissection. However, the latter is awfully time consuming and expensive at the present time. What is really lagging in order to make molecular diagnostics essential for solid tumors, however, is clinical relevance. Right now, it largely doesn't matter if you find expression of X, because that won't change your therapy that much. There are thousands of proteins over- or under-expressed in tumors. Exceptions, of course, are thing like ER/PR or her2 expression in breast cancer, and the recent example of the effectiveness of gefitinib in lung cancers with EGFR mutations. These are great examples of what will drive the use of molecular diagnostics in solid tumors - clinical relevance. This will take time, however, and I don't see it it putting many pathologists out of work any time soon.

 

[yaah]

One other place where molecular path has become important is looking for HPV subtypes in patients with abnormal paps - but again, this is becoming so automated that it doesn't require a ton of work for a pathologist. Some suggest that the pap smear as a screening tool is going to be phased out over the next few years to decades as this test becomes more popular (because almost all cervical SCCs are related to certain HPV subtypes). I wouldn't cry about pap smears going away personally. But again, so far molecular tests only supplement diagnoses, they do not make them for the most part. They will probably become more important for soft tissue tumors (right now cytogenetics is being used occasionally as an adjunct to diagnosis or determing prognosis), but still, what is on the glass is going to be making the diagnosis for a long time to come.