Pathology perspectives for the next 10 years

Transkript

1 Pathology perspectives for the next 10 years Årsmøtet DNP mars 2011 Inger Nina Farstad, Department of pathology, Oslo university hospital

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3 Ca 2500 employees (incl research activities)

4 What questions were asked when we organized Department of Pathology? How can we descrive the Department to doctors, cooperative partners, the Hospital in general? (4 hospital departments, additional molecular lab) How can responsibility be handled; information, decisions, implementing change How can we visualize our activities Is the organizational chart also a tool to achieve strategic plans? Laboratories with similar acitivties colocalize Subspecialization of pathologists; 9 diagnostic groups Integrate science and diagnostic pathology as much as possible

5 Avdeling for patologi Avdelingsleder Inger Nina Farstad Adm rådgiver Adm konsulent Strategiråd/ Faculty Seksjon for diagnostiske faggrupper Seksjon for hematopatologi Seksjon for hist og obd Seksjon for spesiallaboratorier Seksjon for kvalitet Seksjon for driftsrelatert støtte Seksjon for eksperiment. patologi Seksjon for forsknings støtte/kjerne fasiliteter Gastro, HPB Hjerte, Nyre, Lunge Hud, Øye Nevropatologi ØNH, Ben, Bløtvev, Barnesvulster Gynekologisk- og mammapatologi Urogenital patologi Perinatal, sv. skapsrelatert og obd patologi Molekylærlab Non-hematopat FLOW (lab) Hematopatologi (Leger og forskere) Molekylær-lab Hematopat Histologi Ullevål Obduksjon Histologi RH/Radium Histologi Aker Cytologi US inkl immuncyt Cytologi RH/Radium Immun/ FISH felles Elektronmikroskopi (RH/US) Kval råd LIS Kontor, Ekspedisjon Adm. støtte, Sakarkiv, Økonomi For gr JMN For gr BD For gr ZS For gr QP For gr VF For gr RH For gr OPC For gr FPR For gr FJ For gr IHM For gr HH Biobank Vevshåndtering for eksterne oppdrag Avansert mikroskopi Lab for forskningsstøtte (immun, vevsmatriser,) For gr GH For gr TS For gr JM For gr BR

6 Flyttinger internt Avdeling for patologi 2011 Eksterne gastroprøver (fra Lovisenberg) 1 overlege, 1 bioingeniør, 1 assistent fra Aker til RH Aker utestasjon Frsyesnitt, møter med klinikere, løpende relevant diagnostikk Rikshospitalet Hjerte-nyre-lungepat Hudpatologi Gastro-HPB-patologi Nevropatologi ØNH-patologi Cytologi Lab: EM, histologi, immun Gastrokirurgiske og medisinske preparater 1 overlege, 1 LIS, 1 bioingeniør, 1 sekretær fra Aker til UUS * Avd leder, adm rådgiver, obduksjon? Kvalitetsråd fra RH til Ullevål Uropatologi, thyreoidapat, 1 overlege, 1 LIS, 1 bioingeniør fra Aker til Dnr * Elektronmikroskopi, nyrediagnostikk, deler av hud-diagnostikk 2 overleger fra UUS til RH Ullevål Perinatal- og obduksjonspatologi Gastro-HPB-patologi Lungepatologi Ikke-malign gyn og mammapatologi Cytologi (inkl lav-terskel poliklinikk Lab: Histologi, immuncyt, obduksjon Radiumhospitalet Hematopatologi Ben-og bløtvevspatologi Uropatologi Gyn- og mammapatologi Thyreoideapatologi Cytologi Lab: Molekylær, flow, histologi Hematopatologisk diagnostikk, gyn kreft, 1.5 overleger. 1 LIS fra UUS til Dnr * * Det settes opp en turnus der overleger og bioing fra Ullevål og Rad vil betjene utestasjonen på Aker

7 Challenges/possibilities for the future Influence from the clinic Requests for molecular tests increase Diagnostic accuracy standardized reports with many details, large sections for many surgical samples Protocols for clinical trials Subspecialization by pathologists is requested Digitalization Integration of different modalities Sentralization Consequence of using specialized techniques demanding particular equipment and skills (flow cytometry, molecular testing, electron microscopy) Networking?

8 The important questions Will clinicians continue to admit samples to pathology departments, or will other modalities take over (high throughput sequencing, PET-CT, and so on?) What will be the role of autopsy? How, or why, should pathologists continue to represent the hidden science behind clinical decision-making?

9 What do we learn from Dnp s yearly reports of pathology activity in Norway? Number of samples continue to increase, but not dramatically Number of blocks and slides increase much more (Large sections increase due to clinical protocols; in former RiksRadium by ca 25% per year) Supplementary tests increase; especially immunohistochemistry and other Cytology by pathologists (punksjoner) increases (?)

10 Example: Molecular tests

11 Example: flow cytometry 2010: 4150 samples : Increasing no of samples from external doctors/institutions

12 Challenges cont d Economy, economy, economy Lack of pathologists to meet increasing prevalence of people living with cancer But Norway is lucky; ca 200 pathologists for a population of 5 mill (1/2500 people) Many European countries have much fewer pathologists and struggle to recruit younger collegues Hazardous chemicals Formalin and xylene, and many others

13 European perspective (EAPCP training programme) - The pathologist of the future can only be a key player in the field of molecular diagnosis if s/he is well aware of new therapies, and actively involved in health care systems - To have more time for the increasingly complex diagnostic processes, the pathologist has to consider leaving the simpler diagnostic work to paramedically trained personnel (pathologist-assistants) - Pathologists will play an increasingly important role in the field of quality assurance

14 EAPCP cont d - Digitalisation and microscopical evaluation from the screen instead of through the microscope will have an impact on internal reporting and external consultation. A potential danger of this development is outsourcing of diagnostic work to commercial companies, resulting in less direct communication between the clinicians and the pathologist. This results-only service could also have an adverse impact on training - New imaging techniques as RAMAN and OCT could possibly replace histopathological diagnosis in some settings. More accurate imaging techniques will follow

15 So what? The pathology department: a strong diagnostic unit at low cost (?) Patient perspective: correct diagnosis from pathologist improves clinical decision making Only 1 out of 4 cancer patients benefit from chemotherapy, but all experience adverse effects (Smeland, several lectures)! Contribution from science and method/procedure improvement: survival impoves significantly (examples: lymphoma, sarcoma, lung cancer) Who do we want to be? The visible science providing optimised clinical decisionmaking pathology is cheap compared to treatment regimes; especially those that will not work

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17 Department of pathology OUS; Vision Digitalize diagnostic pathology Diagnoses are documented by photos (macro and micro) and by standardized reports Formalin is exchanged with another fixative (??) We have state-of-the-art supplementary methods to support diagnoses particular focus on molecular techniques We have PhD programs for residents and for basic science students combining basic science and diagnostic challenges As a basis for these PhD programs we accomodate research groups who define their projects independently of the Department We are assembled at one, or at most two, geographical sites (maybe with satellites )

18 How can we achieve this? Appeal to the Board of Pathology specialty: reduce the requested no of autopsies to giv more room for specialised techniques molecular pathology in particular Recruit the people we want Clear goals (vision) PhD programmes Research facilities Transparent H&R policy Career paths Speed up education and training of young pathologists; employ pathologist assistants

19 How Organize the infrastructure well Pathologists close to their labs Persons responsible for methods identified Educational programs for technicians (master degree) Establish and pursue diagnostic groups (g-i,-, uro-, skin-, etc pathology) to meet clinicians demands for suspecialization ( spisset kompetanse ) research integrated within these groups; leaders responsible for this activity Cooperation with pathology departments in Health Region South East Temporary positions (hospitering) Research projects