Cancer 101: What Is a Pathologist?

February 1, 2018 | by Kevin Chesley

Sophia Apple Sophia Apple, M.D., M.S.
Pathologists are the doctors responsible for giving the final diagnosis for all cancer patients. Sophia Apple, M.D., M.S., is a clinical professor in the Division of Anatomic Pathology in the Department of Pathology at City of Hope. She explains how the latest imaging and diagnostic techniques help pathologists make diagnoses with the precision that this vital job demands.


When It’s Time for Pathology

But first, there are numerous tests involved before a woman’s case is brought before a pathologist. “A radiologist can find breast abnormalities using mammograms, ultrasounds or MRIs,” Apple says. “Any concerns or suspected lesions are targeted with a core needle biopsy. We then make a slide and look at it for a final diagnosis.”


No Room for Error

Whether their condition is benign or malignant, most patients will never meet their pathologist. “We are behind the curtain — the critical medical doctors that are the brain of the entire medicine. We provide the diagnosis of any diseases and if we provide it wrong, everybody will go down the wrong route.”


Radiology and Pathology Integration

Because the final diagnosis is so important, pathologists and radiologists examine the patient in different ways. “Radiologists look at the shadow of the disease, whereas a pathologist actually looks at the tissue. We have to work together for a correlation,” Apple explains. To ensure this, they enact what is called “the triple test,” which matches clinical findings with imaging and pathology findings. All three must match for an accurate diagnosis.

The relationship between radiologist and pathologist is vital, as is taking the correct actions based on which department finds what. “Let’s say the radiologist targeted a lesion and performed a core needle biopsy, and I called it benign,” Apple says. “Then, since the final diagnosis was benign, the patient has nothing to worry about. Whereas, on the other side of the coin, if the radiologist called it malignant, she has a diagnosis and has to act on it, such as with surgical removal and endocrine therapy.”


The Future of Pathology

Electronic health records and improving technology are looking to remove some of the barriers between pathology and radiology. Apple is hopeful about an interpersonal side of that future, too. “I hope that one day the curtain will be removed and I will see patients and provide critical information in face-to-face interactions.”

Allowing patients to actually see visuals of their cancer is a method that Apple considers to have great potential. “Sometimes the radiologist will show a patient their ultrasound and mammogram findings, and they can show a mass lesion or a suspicious calcification. But I’ve seen a patient come to a pathology office because they wanted to actually see the visual image of their own tumor. It’s a very different image if you have a malignancy versus a benign image. It’s not difficult to identify which one is abnormal and which is not.”

City of Hope’s Department of Pathology is known worldwide for its diagnostic excellence, highly sophisticated technologies and renowned investigators like Apple. As we continue to integrate our diagnostic reporting system, our overall quality of patient care will continue to grow, echoing Apple’s dreams of the future. “If a patient has speculation or is suspicious, then the visual helps them trust medical professionals more. It really helps them emotionally, too.”

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