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Brian Jackson

Bruce, I respectfully differ with your prediction of the impact of imaging on eminence-based surgical pathology. In an increasingly consumer-driven world, branding (i.e. reputation) will become much more powerful than under the old 3rd party reimbursement/commodity mindset.

I envision a near future in which patients request (and pay for out of pocket or out of health savings accounts) 2nd opinions and consults directly from pathologists. These consults will be greatly facilitated by digital imaging. And they won't go to Dr. Jones, the generalist surgical pathologist down the street; they'll go to Dr. Big Cheese with the national/international reputation.

Julie McDowell

I'm working on a story on the business case (for or against) digital pathology for the next issue of Washington G-2 Reports Laboratory Industry Report. Anyone from the pathology and/or lab community who wants to comment/sound off on this, please contact me at [email protected]. Thanks!!

bev M.D.

I think Dr. Pemberton's observation probably does represent the long term future of pathology, but every pathologist knows that sampling error can be lethal in tumor diagnosis, and what is seen on one microscopic slide of a tumor may differ from the next slide. It remains to be seen whether such morphologic heterogeneity will carry over into the molecular analysis realm. But Dr. Friedman makes an important point - currently pathology remains highly subjective and susceptible to "eminence bias" -e.g., the tumor name is "X" because Dr. Bigwig says it's "X". I have seen these bigwigs be wrong or, worse, make the correct diagnosis in retrospect (such as when the tumor has already metastasized and the original pathologist is being sued) to maintain their "eminence". Hopefully the "killer app" could serve as a bridge between the current situation and the perfection of molecular analysis.

Jackson Pemberton

Bruce, I'm not sure that even this "killer app" would enable a good business case for converting to digital pathology. I suspect appropriate molecular testing on fresh samples of morphologic puzzling tumors is the future of our speciality, and will be used for diagnosis, treatment direction, and prognosis. The morphology will be of variable importance, depending on site and tumor type. In many cases the microscopic exam will serve more as a quality control check.

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