The pathologist is the physician specialized in Pathological Anatomy, a branch of medicine that is in charge of the study of the lesions of the human body through samples extracted from it, ranging from cytology, through biopsies, surgical pieces to the practice of medical autopsy, trying to find the lesions that caused the death.
Through the study of this material, the pathologist will issue a diagnosis of the disease, which is linked to a prognosis and treatment, sometimes specific.
What tools does he use?
The main tool for the pathologist’s work is the optical microscope. Cytology or biopsy specimens are technically processed into a glass (slide) containing the sample, which is stained with dyes so that it can be viewed under the microscope. But this is not the only tool.
The pathologist also uses other complementary techniques such as immunohistochemical stains, immunofluorescence, molecular biology techniques (FISH, PCR, RT-PCR,…) and electron microscopy.
It must therefore be understood that although the microscope is basic to their work, the final diagnosis is made by integrating clinical information, radiological imaging techniques, the macroscopic aspect of the lesions, microscopy and all the complementary techniques used.
It should be added that nowadays, with the advent of digitalization, the way of diagnosing is changing and the pathologist is progressively moving from the microscope to the high-resolution screen, with the advantages that this entails in terms of image analysis.
How do you make diagnoses?
Like any other medical specialist, the pathologist has knowledge of the different diseases and lesions, especially their morphology, which is what is observed under the microscope. This knowledge is based on study and also on experience. The more years accumulated, the more expert the pathologist should be considered.
Also, as more information and knowledge is accumulated, pathologists (as well as other medical specialists) are becoming super-specialized, so that there are pathologists specializing in skin lesions or diseases of the gastrointestinal tract or urinary system, etc. So the ideal is to look for a pathologist who specializes in the subject that interests you and has years of experience.
It should be noted that diagnoses are not made by a machine but by a person. Perhaps someone thinks that the samples go to a machine that analyzes and issues the diagnosis, but this is not the case. We are still far from this happening and today the diagnosis is made by a pathologist based on his knowledge and experience.
What diseases or disorders does he/she treat?
The pathologist does not treat patients but issues diagnoses for other physicians (clinicians, surgeons,…) to treat them. That is why he is often not known as he is not visible to the patient. But it should not be forgotten that his report implies a prognosis and a certain treatment: giving one diagnosis or another implies one treatment or another.
The lesions handled by a pathologist are those with an organic base that can be biopsied. They include a wide range of lesions, from inflammatory, degenerative, infectious, etc., but especially tumorous. Nowadays, tumor pathology represents a high percentage of the pathologist’s specimens, being his key role in determining whether the tumor is benign or malignant, in addition to the type of tumor.
Transcendence of the role of the pathologist
It is in this field of oncologic pathology where the pathologist is acquiring a fundamental role in the management of patients, since the study of neoplasms reveals not only their diagnosis but also the necessary data on their prognosis, possible treatments and predictive data on response to specific drugs.
In order for oncologists to apply a “target” treatment (therapies that are very widespread nowadays), they require the pathologist to have carried out specific studies on the tumor tissue, without which this treatment cannot be applied.
In short, although patients do not see and often do not know the pathologist, his role is essential for diagnosis and for guiding the treatment of lesions.