The Power List 2019

SEPTEMBER 2019 # 58

OfficialOfficial society society partner partner of ofThe The Pathologist Pathologist

Upfront In My View NextGen Sitting Down With Analyzing the The emotional impact A new esophageal Anant Madabhushi’s sncRNA of animals of laboratory error sampling method computational career

10 12 – 13 44 – 46 50 – 51

The Power List 2019

100 of the trailblazers leading pathology and laboratory medicine into the future

16 – 39

Case of the Month

A 70-year-old woman underwent hysterectomy and salpingo- What are these tumors frequently associated with? oophorectomy for endometrial adenocarcinoma. The left ovary was enlarged and showed the following macroscopic and a Paraneoplastic syndromes microscopic appearance. b Estrogenic changes Which of the following immunostains would be most helpful to confirm the diagnosis? c Meigs syndrome

a Calretinin c CK AE1/AE3 d Lynch syndrome

b p53 d SMA

Answer to last issue’s Case of the Month… cell count and are more likely to present in accelerated or blast phase than their adult counterparts. Both populations often B. More likely to obtain deep molecular response with present with splenomegaly, but it may be more noticeable imatinib therapy in children. Adult patients with CML are more likely to achieve remission with imatinib tyrosine kinase inhibitor (TKI) Courtesy of PathologyOutlines.com. Case by K.V. Vinu therapy. Whether children may respond better to second Balraam and S. Venkatesan, Armed Forces Medical College, generation TKIs is under investigation. Pediatric patients Pune, Maharashtra, India; discussion by Genevieve M. Crane, presenting with CML tend to have a higher white blood Weill Cornell Medicine, New York, USA.

To register your guess, please go to http://tp.txp.to/0919/case-of-the-month We will reveal the answer in next month’s issue!

www.thepathologist.com Contents

10 50

03 Case of the Month Upfront In My View

08 ForgingForging a New PathPath 12 Bamidele Bam Farinre shares her 07 Editorial thoughtsthou on medical laboratory You Have the Powerwer 09 A Longer Life With errors,error their emotional impact on by Michael Schubertert LiverLiveer CancerCaC ncer healthcarehealt professionals, and how theythey serve as learning experiences. 100 A DayDay att thethe (sncRNA)(ssncRNAA) ZoZooo 13 PediatricPedi pathologist Charles van On The Cover HHeyningeney discusses the unique

SEPTEMBER 2019 # 58 neeneedsd of a subspecialty devoted

OfficialOfficial society society partner partner of ofThe The Pathologist Pathologist

Upfront In My View NextGen Sitting Down With Analyzing the The emotional impact A new esophageal Anant Madabhushi’s The faces of the topp 1100 sncRNA of animals of laboratory error sampling method computational career to children’sch laboratory medicine.

10 12 – 13 44 – 46 50 – 51

The Power List 2019

100 of the trailblazers leading pathology and laboratory medicine into the future trailblazers who fefeatureaturerer 16 – 39 in the 2019 Powerr LiLisLList.i tt. ISSUE 58 – SEPTEMBER 2019 Editor - Michael Schubert [email protected] Assistant Editor - Luke Turner [email protected] Content Director - Rich Whitworth [email protected] Publisher - Lee Noyes [email protected] Business Development Manager - Sally Loftus [email protected] Business Development Executive, America- Danny Crowe [email protected] Head of Design - Marc Bird [email protected]

Designer - Hannah Ennis [email protected] Designer - Charlotte Brittain [email protected] Digital Team Lead - David Roberts [email protected] Digital Producer Web/Email - Peter Bartley [email protected] Digital Producer Web/App - Abygail Bradley [email protected] Audience Insight Manager & Data Protection Officer- Tracey Nicholls [email protected] Traffic & Audience Database Coordinator- Hayley Atiz [email protected] Project Manager - Webinars - Lindsey Vickers [email protected] Traffic Manager Jody- Fryett [email protected] Traffic Assistant Dan- Marr [email protected] Events Manager - Alice Daniels-Wright [email protected] Event Coordinator - Jessica Lines 44 [email protected] Marketing Manager - Katy Pearson [email protected] Social Media Manager - Joey Relton [email protected] Commercial Director - Richard Hodson From the ASCP NextGen [email protected] Finance Director - Phil Dale [email protected] 15 Leadership in a 44 Giving Cancer the Brush-Off Accounts Assistant - Kerri Benson Changing Environment Robert Odze discusses Barrett’s [email protected] Chief Executive Officer - Andy Davies Our profession’s achievements esophagus, esophageal dysplasia, [email protected] are not only worthy of and a new sampling technique Chief Operating Officer - Tracey Peers recognition, but also act as a to improve early diagnosis and [email protected] Senior Vice President (North America) - foundation for future greatness. esophageal cancer prevention. Fedra Pavlou [email protected] Change of address: [email protected] The Pathologist, Texere Publishing, 175 Varick St, New York, NY 10014. Feature Sitting Down With General inquiries: www.texerepublishing.com [email protected] 16 The Pathologist’s 50 Anant Madabhushi, F. +1 (646) 876-0852 2019 Power List Alex Nason professor II of [email protected] Distribution: We celebrate 100 of the Biomedical Engineering and The Pathologist North America (ISSN 2514-4049) is published monthly by foremost trailblazers in their Director of the Center for Texere Publishing, 175 Varick St, New York, NY 10014. Single copy sales $15 fields – the people who are Computational Imaging and (plus postage, cost available on request info@ helping to bring pathology Personalized Diagnostics, Case texerepublishing.com) Non-qualified annual subscription cost is available on request and laboratory medicine into Western Reserve University, Reprints & Permissions – [email protected] The opinions presented within this publication are those of the authors and do the future. Cleveland, USA. not reflect the opinions of The Pathologist or itspublishers, Texere Publishing. Authors are required to disclose any relevant financial arrangements, which are presented at the end of each article, where relevant. © 2018 Texere Publishing Limited. All rights reserved. Reproduction in whole or in parts is prohibited. Take a closer look iMScope TRIO – revolutionary Imaging Mass Microscope

Imaging Mass Spectrometry Imaging mass spectrometry is a revolutionary technology. The iMScope TRIO combines the benefits of an optical microscope with the features of a mass spectrometer: iMScope TRIO takes high-resolution morphological pic tures while identifying and visualizing the distribution of specific molecules. Qualitative Analysis Superimposed images based on optical and mass-spectrometric principles High resolution, accurate images Optical Microscope with spatial resolution down to 5 μm Structural analysis Broad application fields using IT-TOF technology with MSn<10 such as medical research, pharmaceutical development and food analysis www.shimadzu.eu/imscope-trio You Have the Power How does the Power List come to pass each year – Editorial and how can you shape its future?

elcome to our 2019 Power List – an endeavor I’m sure you’ve heard a lot about over the past few months. It’s one of my favorite issues each Wyear because I learn so much about the movers and shakers in the field – more so than ever this year with our “trailblazing” theme. Rather than the equivalent of a “lifetime achievement” award, this year’s list highlights the people who are bringing pathology and laboratory medicine into the future. But, as pleased as I am to bring you this year’s results, I know that the Power List may seem like a black box to many of you. Nominations go in and the list comes out – but what happens in between? Some of you believe the list operates like a nomination aggregator or a popularity contest, wherein the more nominations a person receives, the more likely they are to make the final cut. But that is not accurate – in fact, each nominee is added to the selection process, whether they are nominated once or a hundred times. What happens next? The full list of nominations (including name, institution, and a brief biography that incorporates nominators’ comments) are submitted to a panel of expert judges, all of whom work in the field of pathology and laboratory medicine. We keep the jury as diverse as possible – in terms of career stage, location, field of expertise, and more – so that we can trust that every candidate has a fair chance of selection. Once the judges return their results to us, they are combined into a single ranking that reveals the year’s 100 winners. For us here at the headquarters of The Pathologist, this is the most exciting part – our own private preview of the year’s superstars. It’s a feeling we hope we’re able to replicate as we finally share The Power List with you. Best of all, it’s exciting to see how diverse the list is each year, and how creative the nominees are with their efforts to further pathology, laboratory medicine, and patient care. The Power List is a celebration – our thanks to you for your devotion to your field. And, because it’s your list, we’d like to ask: is there anything you’d like to see in future iterations? Is there a theme you’d like us to focus on, or a particular group of people you’d like to see recognized? Let us know (edit@ thepathologist.com) and you may see your suggestions – and your nominees – on a future Power List!

Michael Schubert Editor

www.thepathologist.com 8 Upfront

Upfront Reporting on research, innovations, policies and personalities that are shaping pathology today. DoDo yyouou want to sharsharee Don’t post anything that could identify Forging a your patient – and don’t post anything you somesome interesting research might regret later! With those cautions or an issue that willwill New Path in mind, pathologists and laboratory impactimpact pathology?pathology? medicine professionals can benefit greatly Points of interest from the from social media. 2019 annual meeting of the Email: Association of Pathology Chairs The Future of Pathology [email protected]@thepathologist.com Is informatics the future of our discipline? Early Education Karen Kaul thinks so – and notes that How can we help undergraduate medical the conversation is increasingly shifting students achieve their potential – in from “traditional” digital pathology to pathology and beyond? Alan Rampy artificial intelligence (AI). The goal? To presents an integrated curriculum, tested make systems foolproof for primary care at his institution, that includes case- providers and to encourage them to use based learning, student feedback, and laboratory data. Alexis Carter adds that PILLARS: professionalism, inquiry, interoperability is the key to widespread learning, and leadership through active adoption, particularly with the rise of AI. research and synthesis. Robin LeGallo Currently, we lack good standards for AI in further explores how to assist a struggling medicine, but with greater adoption comes student by identifying the problem and greater experience – and pathologists are developing a plan that includes deliberate vital to its continued improvement. practice, feedback, and self-assessment. How can educators promote success? By Leading the Way giving students permission to change, Pathologists and laboratory medicine presenting reasonable challenges, setting professionals interested in leadership an expectation of growth, providing roles often find themselves unsure of how connections to faculty and peers, and to proceed. Pathology’s wide-ranging offering them choice. influence on other medical disciplines makes us ideally positioned for educational Social Media Strengths leadership – but those opportunities must Valerie Fitzhugh recommends using be made available to those who desire social media platforms for education and them. Paul Hemmer introduces Schein’s interaction – but she warns: follow your classification of occupational subcultures institution’s social media policy, don’t use and suggests that current leaders often your academic account for private content, adopt the “executive” style, whereas policy- remember that everything you post on based leadership requires a move toward the Internet is public (even on a private the “engineer” style and evidence-based account), and take great care over HIPAA. leadership mandates the “operator” style. Upfront 9

A Longer Life With Liver Cancer

Could anti-IL-6 antibodies that downregulate PD- IL-6 levels and L1 expression prolong poor prognosis. immunotherapy? On the potential applications of their Statistics for patients diagnosed with liver discovery, Hung says, cancer are bleak – only 18.4 percent survive “Anti-IL-6 antibodies past five years in the US (1). The most could be used to prevent PD- common form of primary liver cancer, L1 glycosylation, leading to PD-L1 hepatocellular carcinoma (HCC), is downregulation as well as impeding its notoriously difficult to treat, with localization on the cell surface.” Given multikinase inhibitors, such as sorafenib that immune checkpoint inhibitors have patients, who currently lack access to and regorafenib, only extending overall been shown to stimulate IL-6 production, effective treatment,” says Hung. survival by less than three months. But blocking the IL-6 pathway could also the future looks brighter; new research lessen the side effects of immunotherapy References from a team led by Mien-Chie Hung at and extend its duration for HCC patients. 1. National Cancer Institute, “Cancer stat facts: the University of Texas MD Anderson After showing synergistic efficacy in liver and intrahepatic bile duct cancer” 2016. Cancer Center shows that a cellular animal models, a combined therapy Available at: https://bit.ly/2j97Dnm. Accessed pathway closely linked to cancer may of anti-IL-6 and anti-Tim-3 certainly August 13, 2019. prolong immunotherapy and reduce its appears promising. “We are looking 2. LC Chan et al., “IL-6/JAK1 pathway drives side effects. forward to collaborating with the PD-L1 Y112 phosphorylation to promote cancer The pathway in question forms scientific and medical community to immune evasion”, J Clin Invest, 129, 3324–3338 when the interleukin-6 (IL-6) protein initiate clinical trials to treat HCC (2019). PMID: 31305264. activates the Janus kinase 1 (JAK1) enzyme. This process often occurs in tumors and has been linked to the regulation of programmed death ligand 1 (PD-L1), a protein known to suppress the immune system. “We discovered that the IL-6/JAK1 pathway enhances PD- Advanced Optical Technology for L1 expression in HCC cells, making it a promising target for the development of Pathology and Cytology treatments,” Hung explains. To combat the action of the IL-6/JAK1 The BX53 upright microscope combines a range of ergonomic components with an pathway, the team found that combining LED illuminator that delivers outstanding anti-IL-6 antibodies and anti-T-cell brightness, so you can comfortably view immunoglobin mucin-3 (anti-Tim-3) your samples in their true-to-life colors. boosted T cell-killing effects in mouse • Bright LED illuminator with a color temperature optimized for purple, cyan, and pink dyes models (2). They also showed that, across • Light Intensity Manager automatically adjusts 183 HCC patients, those with high IL-6 brightness when you switch objectives, helping expression had elevated PD-L1 expression minimize eye fatigue – confirming the link between high • Easily acquire multi-color ﬂuorescence images • Work comfortably with ergonomic components

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Olympus is a registered trademark, and Your Science Matters is a trademark of Olympus Corporation. data points per patient, which leaves us actual expression data available. When we A Day at the with numerous miRNA features. But evaluated and compared the data across because patient cohorts are typically species, we found that miRNA sequences (sncRNA) Zoo small, machine learning methods have and expression were even more conserved difficulty recognizing true biomarker than previously thought. Now, we can What the genetic signatures signatures without overtraining the models. incorporate our findings into computer of animals can tell us about Confounding patient factors, such as age, models to improve our ability to find reliable miRNA biomarkers in humans gender, and ethnicity, add to the diversity biomarkers in the future. of miRNA profiles and increase this Small noncoding RNAs (sncRNAs), such complexity. Our aim is to exclude miRNA How many animals do you aim as microRNAs (miRNAs), are ubiquitous signatures that are likely artifacts. to analyze? and play an important role in the control Evolutionarily conserved biomarkers that The more animals we sequence, the better! of cellular processes, making them suitable occur in different species in similar form There are currently 40 different animals targets for the investigation of human and function are much more likely to be in the database and we continue to make disease. But before we can fully understand resilient. And that’s where the animals discoveries with each new species. But we their function, we must distinguish between come in. We took 21 blood samples from don’t just want more species; it will also be valid miRNAs and false positives – a task 19 different species – including a coati and a beneficial to sequence a number of different with which machine learning methods Humboldt penguin – and performed next- animals of the same species to build on the often struggle. In an attempt to elucidate generation sequencing of the miRNAs data. Finally, we want to apply a variety of the most resilient miRNA biomarkers, a expressed in their blood cells. technologies alongside bulk sequencing, team from Saarland University took an such as single-cell RNA sequencing of unusual approach by sequencing the blood How does the conservation of miRNA animal blood cells. of different animals (1). We spoke to lead expression between different species researcher Andreas Keller to find out more. help with human disease biomarkers? Reference Studies on sncRNAs often rely on 1. T Fehlmann et al., “The sncRNA Zoo: a Why analyze the blood of animals? genomic sequence similarity rather than repository for circulating small noncoding RNAs When we collect sncRNA data from expression data. We realized that, for many in animals”, Nucleic Acids Res, 47, 4431–4441 humans, there can be up to 20 million conserved animal miRNAs, there was no (2019). PMID: 30937442. Introducing, someone you already know.

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We healthcare professionals have been Mistakes encouraged, as part of our professional In My obligation, to be open and transparent Happen when things go wrong, so that errors can be constructively analyzed and dealt with View Alleviating the emotional – and so that lessons can be learned to impact of medical errors prevent another occurrence. on healthcare staff But that brings about the question: In this opinion section, what constitutes a mistake or error? I experts from across the would succinctly define it as “a deviation world share a single from accuracy or correctness.” In our professional duties, we all strive for strongly held view or excellence and perfection – which key idea. means that openly accepting mistakes can be difficult. Despite the recent push Submissions are welcome. by the UK’s National Health Service to encourage “no blame” cultures – a patient Articles should be short, safety initiative involving the introduction focused, personal and of Freedom to Speak Up champions in passionate, and may hospitals nationwide – mistakes are still By Bamidele Farinre, Senior Executive viewed as shameful, embarrassing, and deal with any aspect of Officer (HCS), Clinical Services Unit, demoralizing events. laboratory medicine. National Infection Service, Public Health When an error occurs, our principal They can be up to 600 England, London, UK concern as healthcare professionals is for the welfare of the patient. words in length and “Oh, no! What have I done? Now they Unfortunately, this often means that we written in the first person. won’t get this patient’s result in time for ourselves are left behind to contemplate treatment because of my mistake. How the consequences and deal with not Contact the editor at could I do this? What’s wrong with me only the professional and personal today? I performed the wrong test on that implications, but also the emotional [email protected] precious sample – and now I don’t have distress. Healthcare professionals have enough for the right test. I can’t bring varied emotional responses to mistakes myself to call the ward and tell them – I’ll – most commonly guilt, anxiety, anger, have to speak with my manager...” shame, and embarrassment. Because After work, this laboratory staff laboratory medicine professionals believe member is still thinking about what that we should not make mistakes, these happened. She can’t seem to get the emotions can have permanent or long- mistake out of her head. The emotional lasting consequences including loss turmoil is unending! of self-confidence, sleeplessness, self- We have all been there before; we’ve blame, reduced job satisfaction, anxiety all had that hollow pit-of-the-stomach about a harmed reputation, and fear of feeling after an avoidable error. Making a disciplinary action. mistake at work can leave anyone lacking Elbert Hubbard said, “The greatest confidence and unsure how to proceed mistake you can make in life is to – and the feeling only intensifies for continually fear you will make one.” I medical staff, who are responsible for can remember my first mistake during the health and wellbeing of others. The my period of training as a biomedical emotional and psychological effects of a scientist. I was very upset with myself. mistake can be deep and long-lasting. That feeling, and the thought – “How In My View  13

could I have done something like that?” – available to us as healthcare professionals “Mistakes are painful when they happen stayed with me for the rest of the week. in the aftermath of an error? but, years later, a collection of mistakes is It significantly affected my confidence To learn from an error, you must first what is called experience.” because I know that any error has the understand how it happened. Enter root Understanding why mistakes happen potential to negatively affect patient cause analysis, a retrospective technique is key to decreasing their impact – but management. But efforts to avoid used to identify the contributory factors not just on the patient. It can also help mistakes can sometimes backfire; I often involved in the error by providing a laboratory medicine professionals identify find that I am most prone to making structure for reviewing patient safety procedural problems, resolve guilt, and put mistakes when I am trying my hardest incidents. When we gain insight into place action plans that can alleviate to avoid them! into the causes of errors, we are the emotional impact of the error. With It’s not possible to eliminate errors empowered to implement corrective our goals aimed squarely at improving completely, so handling them in the right changes to prevent them or to reduce patients’ outcomes, it’s important not way when they occur is of paramount the deleterious impact of future to overlook the other people in care – importance. So what resources are occurrences. Denis Waitley once said, ourselves and our colleagues.

for instance, would have been a normal need for reference center provision of Not Just result for a growing child – but, without esoteric tests. including age-related reference ranges, An editorial in 2009 described a Small Adults the report may not have conveyed this worldwide PLM network (3). The opinion information. Some of the earliest books was expressed that children cannot just be The ongoing evolution of to describe pediatric reference intervals regarded as small adults – a fundamental pediatric laboratory medicine were published in the 1980s by Blackwell approach that holds for diagnostic services Scientific Publications and by the American for the management of sick children. Association for Clinical Chemistry – and, In 2017, leading international specialists from then on, we have become increasingly in the field reflected on reasons for aware of the many differences between developing a PLM subspecialty distinct younger and older populations. In fact, an from adult pathology and laboratory experienced pathologist suggests that the medicine (4). In many countries, young greatest advances in pediatric biochemistry patients are treated in children’s hospitals. over the last 40 years have been in newborn The blood volumes available for testing screening and more accurate pediatric are lower than those for adults, and urine reference intervals (1). collection can be problematic – issues that By Charles van Heyningen, Clinical The authors of a 2002 review concluded make microanalysis especially useful. The Biochemistry Representative on the that the practice of pediatric laboratory test menu is different for children, too, Specialty Advisory Committee for medicine (PLM) involves unique particularly with regard to the diagnosis of Prenatal, Perinatal, and Pediatric challenges related to development, inborn errors of metabolism and follow-up Pathology at the Royal College of nutrition, growth, and diseases during of newborn screening. A good network of Pathologists, UK different periods of infancy, childhood, reference laboratories is needed to evaluate and adolescence (2). They proposed that rare diseases presenting in childhood. For most of the 20th century, laboratory subspecialty pediatric laboratory testing All of these considerations favor the investigations for children were usually offers many opportunities for improved provision of specialist pediatric clinical undertaken as part of a service for pediatric patient care, research, and education laboratory support for the management patients of all ages. There was limited – and that it is best practiced with close of childhood disease. appreciation of the differences between collaboration between pathologists and The International Federation of Clinical results for adults and those for children. clinicians. They described the many Chemistry (IFCC) Task Force on Pediatric What might be a concerningly high serum challenges involved, including the need to Laboratory Medicine was established in alkaline phosphatase activity for an adult, deal with small sample volumes and the 2006 as the successor to the International

www.thepathologist.com 14  In My View

best laboratory techniques for use in both believe that it would be of value to have pediatric specialist and non-specialist full specialty recognition by one or more “Many experienced clinical laboratories alike. And it is already professional regulators and a curriculum, making a difference; a recent audit of sweat courses, and a recognized qualification scientists work testing in the UK was carried out and, from to cover laboratory blood sciences for the evidence obtained, recommendations children – especially clinical biochemistry, in pediatric on sample collection were made. Further hematology, and immunology. Qualified differences have been recognized specialists might run clinics for inborn biochemistry between pediatric and adult laboratory errors of metabolism or lipid disorders for medicine, such as different typical both children and young adults so as to laboratories – presentations, test repertoires and provide continuity of care. priorities, and the higher proportion of Because of the many important but it is difficult abnormal results in children. Testing differences between children and adults, may require greater urgency and different PLM is rapidly becoming a pathology to recruit new critical action limits. specialty in its own right. The scope of In the UK, many experienced knowledge typically covers the pediatric staff with scientists work in pediatric biochemistry aspects of various non-histopathology laboratories – but it is difficult to disciplines, mainly clinical biochemistry, suitable specialty recruit new staff with suitable specialty metabolic medicine, toxicology, hematology, experience. Discussions have started on blood transfusion, immunology, genetics, experience.” establishing pediatric metabolic training microbiology, and virology. This evolving with a curriculum and funding. But these focus is likely to result in better medical care advances are not exclusive to the UK; we for the children of the future. Association of Pediatric Laboratory now have good evidence that several of Medicine. The task force has several the initiatives to establish this specialty References aims: to coordinate the establishment of elsewhere have been successful. The first 1. J Coakley, “40 years of paediatric chemical worldwide reference ranges for laboratory edition of a textbook entitled “Pediatric pathology – a personal view”, Pathology, 47, test results in pediatric patients of all age Laboratory Medicine” was published in 14 (2015). groups; to form a sound support basis 2017 (6) and is intended as a resource 2. CM Coffin et al., “Pediatric laboratory for the continuation of the successful for basic PLM training. It discusses medicine: current challenges and future International Congresses of Pediatric the unique characteristics of pediatric opportunities”, Am J Clinical Pathology, 117, Laboratory Medicine; and to create a practice and covers a range of biochemical 683 (2002). PMID: 12090415. worldwide network of scientists working aspects, as well as molecular diagnostics, 3. KP Kohse, “A worldwide paediatric laboratory in laboratories that specialize in pediatric microbiology, and hematology for children. medicine network: the International Federation of medicine. In keeping with this mission, The UK metabolic biochemistry network, Clinical Chemistry Task Force on Paediatric the triennial congresses focus on scientific MetBioNet, is a good example of what we Laboratory Medicine (IFCC TF-PLM)”, J Clin and technological achievements in all can achieve through collaboration and Pathol, 62, 193 (2009). PMID: 19251950. areas of pediatric clinical and diagnostic networking. Its participants have developed 4. VL Grey et al., “Paediatric laboratory medicine laboratory medicine. The most recent one, a range of useful resources, delivered – some reflections on the sub-specialty”, Clin in South Africa, was the most successful analytical quality improvements, and are Biochem, 50, 648 (2017). PMID: 28410851. yet (5), and next year’s meeting in South addressing training and educational needs. 5. SM Geaghan, “Successful 14th International Korea, will tackle emerging technologies. By engaging with other strategic groups, Congress of Paediatric Laboratory Medicine in To address the challenges and such as the national newborn screening Durban garners record number of Scholarships issues specific to PLM, specialists in and inherited metabolic disease groups, and merit awards, diverse global representation, the United Kingdom formed a new MetBioNet has helped to influence the novel scientific programme and charity for national collaborative network in 2014: provision of children’s laboratory services children” (2018). Available at: the Pediatric Laboratory Medicine in the UK. https://bit.ly/2UoxzMk. Accessed April 17, 2019. Network (PaLMnet). The network aims Current pediatric pathology training 6. PM Jones et al., Paediatric Laboratory Medicine, to provide expertise and advice on the in the UK focuses on histopathology. I 1st edition. McGraw-Hill Education: 2017. From the ASCP  15

Leadership in a Changing Environment

We must not only recognize, but build upon, our profession’s achievements

By E. Blair Holladay, CEO of the American Society for Clinical Pathology, Chicago, USA

Once a year, ASCP recognizes the top 40 Under Forty pathologists, laboratory professionals, and residents across the world. It’s a chance to acknowledge and celebrate those who are making This year’s group joins the program’s It is hopeful and inspiring to see those a difference, changing the way we 200 alumni, adding to the constellation who follow build on what the previous practice, and helping us to achieve better of rising stars within pathology and generation began. patient care. laboratory medicine. These men and Moving science forward is no small This is our sixth year of recognizing women rigorously and relentlessly pursue effort. Harnessing the power of our ASCP’s 40 Under Forty, including our advancement and accomplishments, research findings, or developing new Top Five honorees, who are selected by inspire others, lead by example, and testing methods and putting them committee and through member voting. effect change locally and globally. It is into practice, takes time and support. remarkable what they have achieved, and Recognizing and building upon others’ acknowledging their work is critical to achievements is exactly what gives our the success of our science now and in profession momentum and solidifies our the future. position as the linchpin of healthcare. “When we expand But the ASCP 40 Under Forty program Today’s leaders in pathology and laboratory is about more than just recognition. It’s medicine embody the belief that there is and encourage the also a glimpse of how these leaders of strength in collaborative efforts – that we tomorrow will shape our science and are #StrongerTogether. diversity of thought move it forward. It’s an opportunity When we expand and encourage the to see where pathology and laboratory diversity of thought and leadership and leadership that science is headed in an ever-changing that exist within our profession, we environment, based on what these stellar strengthen our position as leaders in exist within our scientists are bringing to the table and healthcare. When we hold others up how they are positioning not only and appreciate what they’ve done for profession, we themselves, but pathology and laboratory the profession, we can more accurately medicine, for growth. Each generation and completely guide the direction strengthen our shapes the trajectory of our science based of the evolving healthcare landscape. on myriad factors, from technology to We laboratory scientists are at our position as leaders political climate to advances in science most powerful and our most effective or educational initiatives. It’s exciting when we share our knowledge and in healthcare.” to see just how profoundly things can accomplishments – and recognize both change – or stay the same – over time. as essential to better healthcare.

www.ascp.org Welcome to

Breakthroughs at the bench, in the clinic, and in every facet of the laboratory have helped diagnostic medicine grow from strength to strength. But whom do we have to thank for those breakthroughs? After months of collating reader nominations and judging by an expert panel, we proudly present The Pathologist’s 2019 Power List, featuring 100 of the industry’s top trailblazers.

Celebrating 100 inspirational and inﬂuential professionals in laboratory medicine Feature  17

1 // JJerade Gardner the professional use of social media platforms. An active volunteer in numerous sarcoma and FewFew peoplepeop fit the description of trailblazing rare disease patient groups on Facebook, he pathologistpatholog better than Jerad. As Associate uses the opportunity to conduct formal medical ProfessoProfessorr of Pathology and Dermatology research and to advocate for patients. aatt the UniversityU of Arkansas for Medical “Over the next few years, molecular Sciences,Sciences, Jerad is one of the leading adopters pathology will answer many questions, but ofof social media in pathology, commanding also create many new ones. Although artificial anan onlinonlinee influence of almost 20,000 Twitter intelligence will begin to help pathologists, followers.followers He uses this platform to discuss it will not replace us. Also, the use of social cases,cases ddisseminateis valuable information from media will become an essential skill – not just live events, and engage with an ever-growing a fun hobby – for pathologists who want to get online community. fellowships, leadership positions, or jobs,” says Talking about the most unexpected moment Jerad. His best advice? “Join Twitter now! Aside of his career, he says, “There was a point last year from working with the amazing mentors who when I realized that my YouTube pathology made me the pathologist I am today, social videos were being viewed every single hour of media has definitely been the most powerful every single day, meaning that I am teaching and effective tool in my career. It has taken me even while I am sleeping! As an educator, that further than any paper I’ve ever published – it’s is powerful and meaningful.” Jerad speaks the best way to get rapidly plugged in to the regularly at national and international meetings global community of pathologists and, from on bone and soft tissue tumors, skin disease, and there, the sky is the limit.”

2 // Christina Arnold

Christina is Chief of GI Pathology, Associate Director of the GI pathology fellowship, and pathology faculty lead for the clinical gastroenterology fellows at The Ohio State University. She was nominated for the Power List thanks to her passion for creating the next generation of leaders in pathology through both faculty development and her 3 // Melissa P. Upton work with medical students. She created the #PSIG and #FASTPath hashtags on social “My greatest influences were my parents, who media to assemble exciting, interactive instilled in me my conviction that access to teaching sessions and share mentorship, education is the most powerful tool for good,” support, and tips for students. Christina is says Melissa, Professor Emeritus and Associate particularly interested in novel GI injury Director of the Pathology Residency Program patterns, including inflammatory bowel at the University of Washington. Currently disease and mimics, infectious agents, President of the American Society for Clinical and emerging drug injuries. “I would Pathology (ASCP), she has been responsible never have guessed that my phone would for launching crucial conversations and play such a dominant role in my career,” initiatives in the ASCP to enhance diversity, she says. “Social media provides instant createcreate inclusiveinclusive workplaces,workplaces, andand empowerempower connectivity with the world and helps me tthehe lleadershipeadership potentiapotentiall ooff patpathologistshologists anandd feel supported, engaged, and surrounded laboratory pprofessionalsrofessionals around the world. by all the good that is in pathology. It has Why does she love pathology?pathology? “As“As an academic also bestowed profound opportunities that pathologist,pathologist, not ononlyly ddoo I enjoy hhelpingelping I would not have had access to without patientspatients to gegett the correct diagnosis, allowing developing a presence on social media, such themthhem to get aappropriateppropriate care,care, butbut I aalsolso lloveove as invited lectures, leadership roles, research workingworking wiwithth mmedicaledical stustudents,dents, residents, and collaborations, and more.” fellowsffelllows in pathology.pathology. There iiss nothingnothing more more satisfyingsatisfyiy ng tthanhan hhelpingelping ththemem to gagainin insiginsightht intointo tthemselveshhemsellves tot mmaximizeaxa imize ththeireir popotential.”tential.”

www.thepathologist.comwww.thhepathologogistt.com 18  Feature

4 // Eva Wojcik to local patients. As a founding member of the Paris System Working Group, she also Eva is Chair of the Department of Pathology and led a team of world leaders in cytopathology Helen M. and Raymond M. Galvin Professor and urology to conceive a standardized of Pathology at Loyola University Stritch platform for the cytologic interpretation School of Medicine in Maywood, Illinois. of urine samples when diagnosing bladder After completing her medical training at the cancer. Nominators commend her career as Academy of Medicine in Gdansk, Poland, “a testament service to others” and describe she moved to the US to begin her illustrious her as a “champion for the underserved.” career in cytopathology. One of Eva’s major Her best advice? “Coincidence can lead you contributions is her support for the “See, Test to a very fulfilling and satisfactory career; & Treat” program at Loyola, which provides just don’t be afraid to say yes. If I can do it, free cancer screening and health education so can you!”

5 // Kamran Mirza medical fields. His passion for teaching has been recognized through various honors, such “My favorite part of pathology is the ability to as the 2019 Teaching Excellence Award from give a definitive diagnosis and start a patient The Ohio State University Pathology Student on a journey to recovery. I enjoy nothing more Interest Group. He was also voted one of the than being part of the team that helps patients top five honorees in ASCP’s 40 Under Forty feel better,” says Kamran, Assistant Professor in 2017. On the future of the field, Kamran of Pathology and Laboratory Medicine and says, “I see the role of the pathologist becoming Medical Education at Loyola University more widely understood and valued. Add Stritch School of Medicine in Maywood. With to this the routine inclusion of molecular an active and influential presence on social pathology as part of oncology testing and media, Kamran was nominated for his tireless the explosion of algorithm-assisted and AI- contributions to pathology and laboratory involving diagnostics, and I think the accuracy medicine education and his work to improve with which we can render a diagnosis is set to communication between pathology and other improve further still. It’s an exciting time!”

6 // Fergall Magee

Fergall is Provincial Department Head of Pathology and Laboratory Medicine at the University of Saskatchewan. He specializes in pediatric pathology and his biggest interests include pediatric autopsy and prenatal and newborn screening. Nominators praise his strong leadership within the Royal College of Physicians and Surgeons of Canada, his contact with patients and families, and his work with medicalmedical studentsstudents andand residents.residents. Notably,Notably, hhee was recognizedrecognized fforor hhisis eeffortsfforts in in h ostinghosting an an outreac outreachh program for high school students to help expose themthem to laboratory careers from an early age. He is aalsolso a ffoundingounding organizer anandd presenter forfor thethe ChoosinChoosingg WiselWiselyy SaskatchewSaskatchewanann cconference,onnference, whichwhich encourages aappropriatepproprp iaatte test utilizationutilization andand management byby providingproviding educationeducattion too all healthcare pprofessionals.rofef ssionals. AwAAwayay ffromrom the laboratory,laboratory, FeFergallrggall eenenjoysjoysy artarrt galleries,galleries, cross-croso s- ccountryountry skskiing,kiiingg, andannd kayaking.kak yakingg. Feature  19

7 // Michael Arnold

“As technical barriers, costs, and regulatory hurdles continue to drop over the next five years, I envision that digital interactions among pathologists will include educational and clinical activities that incorporate whole slide images,” says Michael, Director of Surgical Pathology at Nationwide Children’s Hospital in Columbus, USA. A practitioner whose specialties include gastrointestinal and sarcoma pathology, Michael co-founded an online pathology journal club set up to discuss and scrutinize new research in live sessions on Twitter. Nominators describe him as a trailblazer in pediatric pathology and social media, and Michael’s recent videos on grossing and other aspects of the medical laboratory 8 // Richard Scolyer perform important research that correlates have made him a viral sensation on pathological and clinical features with Twitter and beyond. He can be found Richard is a pathologist, medical researcher, patient outcome data in large cohorts.” via the #PediPath hashtag, which he uses and the current Co-Medical Director at Richard’s research discoveries have changed to contribute to education on pathology Melanoma Institute Australia. He is also clinical and pathology practice worldwide; and oncology in young patients. “The best the president of the Australasian Division he is a leader in determining mechanisms of pieces of advice I got in training were to of the International Academy of Pathology enhanced response versus resistance to drugs not be afraid to try something outside and clinical professor at the University of in development, such as immunotherapies your comfort zone and to always look for Sydney. “My biggest influence has been the – data that underpins the design of current new ways to do something. Social media Melanoma Institute Australia Research clinical trials. His biggest wish? “That people was definitely outside my comfort zone Database that was set up by the late Gerry of all ages, but especially young people, were when I started, but it has been worthwhile Milton 60 years ago,” he says. “This is now more vigilant in protecting themselves from to meet so many wonderful people and the largest melanoma patient database in the sun. UV exposure leading to sunburn is learn so much!” the world, with over 50,000 patients, and the single biggest risk factor for developing is a major international resource that has skin cancer, which claims one Australian life provided me with many opportunities to every five hours.”

9 // Eduardo Alcaraz Mateos

With a particular interest in cytology and dermatopathology, Eduardo currently works as a pathologist and cytopathologist at the Hospital General Universitario Morales Meseguer in Murcia, Spain. One of his most innovative achievements to date was the invention of FioNA, a simulator that helps students practice fine needle aspiration. Eduardo is also an active social media educator, using his influential online presence to discuss cases and give advice. Nominators describe him asas a pioneer who makes pathology more visible forfor memedicaldical stustudents,dents, sometsomethinghing hhee mamakeskes a conscious effort to achieve. “Pathology’s visibilityvisibility is somethingsomething that I trytry to changechange on a ddailyaily bbasis,asis, not onlyonly at tthehe hhospital,ospital, bbutut aalsolso throughthrough social media,” Eduardo says.says. “My“My favoritefavorite partpart ofof tthehe jjobob is providingprovidi ing solutionssoluutions to ppatientsatients one bbiopsyiopsy at a titime,me, anandnd I aalsolso enjoyenjoy the collaborationcollaboratioon with rradiologistsadioologig sts and gastroenterologistsgastroenterologists whenwwhenen completingcoompletting rapidrapid on-on- sitesite patient evaluation.”evaluation..”

www.thepathologist.comwwwwwwww.thepaeppap thohoologoggisti .com 20  FeatureFeature

10 // Rachel Jug

Rachel is a resident and future cytopathology fellow at Duke Health in Durham, North Carolina. She was nominated for her passion and dedication to innovations in education and patient care, which nominators say are at the level of a pathologist with many more years in practice. Rachel is driven by her ambition to improve the practice of medicine, from the way that feedback is given and received, to making ultrasound phantoms for ultrasound-guided fine needle aspiration training, to bringing pathologists to the forefront of communication and patient care. When asked what she would change about the field if she could, Rachel says, “I would give pathologists a stronger voice to advocate for their patients. Pathologists are Abdulkarim remarkable educators with a unique breadth Hasan Kohail and depth of knowledge; they are best suited to help patients, their clinical colleagues, Abdulkarim can be found at Al-Azhar hospital administrators, and health policy Faculty of Medicine in Cairo, where makers understand disease processes and drive he is a histopathologist and pathology evidence-based, cost-effective care.” lecturer. Formerly an observer at University Hospital of Wales, he was nominated for his trailblazing approach Adam L. Booth to education, engaging teaching style, and innovative learning materials “I never anticipated that I would be so involved that help students and trainees better with social media when I started out in understand the practical aspects of pathology, but it has opened doors to research, pathology. Talking about the future collaboration, and leadership opportunities that of medical education, Abdulkarim have made me a stronger trainee,” says Adam, says, “Integrated medical education a resident in Anatomic and Clinical Pathology will become the norm worldwide. at the University of Texas Medical Branch. He Pathology as a basic science subject was nominated thanks to his unrelenting desire will take its place in most modules to improve connections between pathologists, in more interesting and informative foster collaboration and education, and develop ways, linking basic general pathology pathology’s image. To achieve this, Adam uses with practical anatomical pathology.” social media to increase patient interaction and to inspire the next generation of pathologists through advocacy.

Adrian Newland andand ChairChair ofof tthehe UKUK’s’s NationaNationall PatPathologyhology ImplementationImplementation anandd OOptimisationptimisation DeliveryDelivery Adrian, a consultant hematologist for 30 Group,Group, AdrianAdrian works to achieve the kind ofof years, has been a Professor of Hematology changechange in ppathologyathology thatthat willwill ensure long-long- at Barts and The London NHS Trust since term sustainasustainability.bility. “I“I hhaveave alwaysalways beenbeen 1995. He is a past President of the Royal ddrivenriven to pproviderovide a qualityquality service withwith College of Pathologists and has chaired oldold andand new diagnosticsdiagnostics mademade universallyuniiversallly the London Cancer New Drugs Group. available, both internationallyinternationally aanandd inn tthehe Currently, as Specialist Clinical Advisor UK,”UK,” sasaysys AAdrian.drian. FeatureFFeaature  21

AAgustínggusttíín Acevedo

Agustín is Head of the Pathological AnatomAnatomyy Service at Hospital Universitario Quiron PozueloPozuelo in SSpain.pain. Having worked in the field for more than 25 yyears,ears, AAgustíngustín has extensive scientific and clinical experience, with a special interest in the diagnosis of neoplastic processes – especially lymphomas and other hematological processes. He was nominated for both his trailblazing work in bone marrow pathology and his successful integration of clinical, pathologic, and molecular issues to achieve a diagnosis.

Alison McEvoy

Alison is Hematology Laboratory Operational Manager at Milton Keynes University Hospital NHS Foundation Trust in the UK. She is a brilliant leader who always has the needs of her team in mind and involves them in decision- making, something that is reflected in the laboratory’s continually improved outcomes. “Alison achieves all this with a gentle touch, a smile, and hard work,” according to her nominators – attributes that have earned her a place on the Power List.

Ahmed Kalebi Amy H. Deeken As Founding Partner, CEO, and Chief Consultant Pathologist at Lancet Group “Pathology is one of the most exciting and Laboratories, East Africa, Ahmed has dynamic fields in medicine. With the onset successfully brought affordable, quality, of social media and digital pathology, the and accessible pathology services across distance between continents and barriers the region. He was nominated for the to collaboration are quickly disappearing,” positive impact he has had on medical says Amy, Assistant Professor of Pathology practice, pathology resident education, and Director of Hospital Autopsy at Summa and research in Africa. “I had my Health. She is an art enthusiast and regularly epiphany moment when I was told to uses photography to create captivating images look at a Merkel cell tumor. I literally saw from the tissue she examines as a pathologist. the proverbial light down the microscope “It’s so exciting to be part of this generation of and realized that pathology provides the physician visionaries who have followed the diagnosis and enables appropriate patient natural path to explore what pathology looks management. I immediately decided like in this uncharted digital space.” that I wanted to become a pathologist rather than a surgeon,” Ahmed says.

www.thepathologist.com 22  FeatureFeeata uru e

Anant Madabhushi

As the Director of the Center for Computational Imaging and Personalized Diagnostics at Case Western Reserve University in Cleveland, Anant works on numerous multidisciplinary projects focused on computer-aided diagnostics, pattern recognition, and image analysis tools. Angela Douglas His pioneering work on the spatial architecture of immune cells has allowed us to use machine Angela is a Consultant Clinical Scientist learning methods to better predict which lung who has worked in the National Health cancer patients will benefit from chemotherapy. Service (NHS) in genetics for over 38 “The collaborative teams that I have been part of years. In her role as Deputy Chief and the ability to provide that multi-disciplinary Scientific Officer for NHS England, education and training to my students ranks as she is partly responsible for the 50,000 the most exciting and inspiring aspect of my healthcare scientists working in the career thus far,” says Anant. NHS. In 2016, Angela was commended in the Queen’s 90th birthday honors list as a Member of the Order of the British Empire for her contribution to research and mentoring students. “If I could change one thing, I would ensure Anil Parwani that all healthcare science professionals had genomics and genetics included in Anil is Professor of Pathology and Vice their training,” says Angela. Chair and Director of Anatomic Pathology at The Ohio State University, and Director of Pathology Informatics and of the Digital Pathology Shared Resource at The James Cancer Hospital. Anil’s research focuses on diagnostic and prognostic markers in bladder and prostate cancer and molecular classification of renal cell carcinoma. He says, “My favorite part of the job is the ability to stay at the cutting edge of new technologies […] I love using these tools to train the next generation of pathologists, who can become as excited and passionate about pathology as I am!”

Bamidele Farinre

Bamidele is Senior Executive Officer (HCS) Bennet Omalu of the Clinical Services Unit, National Infection Service, for Public Health England Bennet is the President and Medical Director in the UK. Nominated for her dedication to of Bennet Omalu Pathology. He was the first encouraging women and minorities into to identify and describe chronic traumatic STEM subjects, she works with numerous encephalopathy (CTE) in athletes in 2002, organizations, including the British Science providing the first evidence that American Association, to achieve this goal. On the football can cause permanent brain damage. future of her field, Bamidele says, “Virology He has since campaigned to raise awareness of will continue to develop and expand due to CTE, leading the National Football League driving forces such as an increased viral disease to make rule changes to protect players. “If burden, changing patient demographics, and I could make one change, I would include further technology improvements.” business communication and management in the training of pathology residents. I believe it would make us more effective, more innovative, and more significant in the business of health and patient care.” Validation tools for diagnostics Consistency from assay development to routine monitoring

• Mimic patient samples with well- characterized, commutable controls • Design a reference standard specific to your application www.horizondiscovery.com Bobbi PPrittritt

BobbiBobbi is DirecDirectortor ooff tthehe ClClinicalinical PaParasitologyrasitology Laboratory in Mayo CliClinic’snic’s DeDepartmentpaartmment ooff LaLaboratoryboratory MeMedicinedicine anandd PatPathology.hology. ShShee is widelywidely renowned as a trailblazer thanksthanks to her tireless work in parasitologyparasitology education, includingincluding “Parasite“Parasite Wonders”Wonders” – Bobbi’sBobbi’s wwebsiteebsite and blblog,og, which showcases the ccreepy,reepy, yeyett ffascinating,ascinating, worworldld ooff paparasites.rasites. Thef funniestunniest momentmoment ofofhe herrcareer career?? “I “Iwas was once able to diagnose a large foreign body in a man’s bladder as a fishing lure – but only because of its similarity to fishing lures I had sent to my lab as mock specimens on April Fool’s Day three years before!”

Caddie Laberiano Fernández Catarina Shaletich Caddie is a researcher at MD Catarina is an anatomic pathologist at Anderson Cancer Center in Houston, the Dr. Prates Laboratory of Surgical a post she took up after several years Pathology in Brazil. An experienced as a cytopathologist at the Arias anda d well-respected we espected figure, gu e, CataCatarinaa Stella Institute of Pathology and hashas pupublishedblished papers on numeronumerousus MolecularMolecular BioloBiologyg in Peru. She was totopics,pics, including malignant chondroidchondroid nominatednominated forfor heher trailblazing series syringoma.syringoma. ShShee was praisedpraised byby herher ofof YouTube videvideos,o in which she aims nominatorsnominators to ththee PowerPower ListList forfor to eeducateducate otherother medical specialties herher ““never-endingnever-ending kknowledgenowledge of aboutabout basic prproceduresoc in pathology dermatopathologydermatopathology andand other fields, whichwhich toto ffosteroster eeffectiveffective communication and makesmakes herher one-of-a-kind.”onne-e of-a-kind.” collaborationcollaboration withwith clinical colleagues. “The“The most most une unexpectedx moment of my ccareerareer came when I was asking a particularparticular sspeakerpe questions at a conference,”conference,” sayssays Caddie.C “It ultimately ledled me to start a rotationro in the US!”

Cécile Badoual

Cécile is an anatomic cytopathologistytopathologist at tthehe Georges Pompidou Hospitalspital anandd a teacteacherher at the Paris Descartes FacultyFaculty of Medicine in France. Spearheadingng thethe fightfight againstagainst human papillomavirus (HPV), Cécile was instrumental in establishingshing France’sFrance’s fifirstrst multidisciplinary medicalcal consultation for patients affected by HPV-relatedV-related cancer. cancer. She She was nominated for the Power List ddueue to the worldwide impact of her research on the immune microenvironment of head and neck cancers associated with HPV. “As pathologists, we must never forget our essential role in patient management,” says Cécile. “We are part of a care team and must be innovative with multidisciplinary approaches.” While at the CAP19 Annual Meeting Visit Booth #200 for the Patient ID Journey an interactive augmented reality experience in oncology diagnostics

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Christina is a ConConsultantsuultant CyCytopathologisttoppathologist atat GeorgeGeorge PaPapanicolaoupanicolaou GGeneraleneral HosHospitalpital in Thessaloniki.Thessaloniki. She She was was nominated nominated for for herher ppassionateassionate aapproachpproach to cytocytopathologypathology education – something that transcends geographicalgeographical bboundaries.oundaries. ChristinaChristina inventedinvented anan algorithmalgorithm called DiaDiagnosticgnostic Medicine César Augusto Alvarenga ABCDE, which is now an important guideline for medical image interpretation César was nominated to the Power List in not only in pathology, but also in radiology recognition of his dedication to patients – a and nuclear medicine. She was the winner of a theme that arises frequently when his name 2018 Digital Pathology Association award for is mentioned and that has placed him on her work on informatics. Her favorite part of two prior Power Lists. Having previously the job? “I am intrigued and fascinated by the held observerships in thyroid pathology at emerging role of cytopathology in the world IPATIMUP and in soft tissue pathology of minimally invasive medicine.” at Brigham and Women’s Hospital, César currently works at the Instituto de Patologia de Campinas in São Paulo, Brazil, where he specializes in surgical pathology and immunohistochemistry.

Christopher D.M. Fletcher

Christopher is Director of Surgical Pathology at Brigham and Women’s Hospital in Boston and Professor of Pathology at Harvard Medical School. As Chairman of the World Health Organization Working Group for the Classification of Tumors of Soft Tissue and Bone, Christopher has challenged the more traditional aspects of tumor classification and endeavored to extend our knowledge of soft tissue neoplasia at the genetic level. Looking to the future, Christopher says, “We need to reverse the trend of diminishing pathology content in medical school curricula, which is gradually becoming a worldwide problem, to ensure the future supply of high-quality trainees.”

Dana Razzano

“Pathology is no longer a field typified by Daniel Holmes doctors hiding behind microscopes; pathologists truly are at the forefront of patient “My career has put me in a position to help care now more than ever,” says Dana, Chief patients at their greatest time of need and Resident of Anatomic and Clinical Pathology vulnerability. Although I don’t often meet at New York Medical College, Westchester. them, patients are always in my line of sight Dana appeared in the ASCP 40 Under and this helps me to keep perspective on what’s Forty in 2018 and has worked alongside important when deliberating on administrative CAP and ASCP to promote involvement in matters,” says Daniel Holmes, Clinical Professor global health. “I believe that we will see a of Pathology and Laboratory Medicine and mindset change in the next five years whereby Division Head of Clinical Chemistry at the pathology will no longer be considered the University of British Columbia. Daniel is neglected cornerstone of global health, instead renowned as a leader in clinical lipidology, serving as the unshakeable foundation.” endocrinology, and mass spectrometry. Feature  27

Darren Treanor

According to his nominators, Darren – who is Consultant Pathologist and Honorary Clinical Associate Professor at the University of Leeds – has “fostered trust and confidence” for all stakeholders within the pathology department at St. James’s University Hospital in the UK. Driving full adoption of digital pathology for diagnosis, he is lauded for having set standards for its safe use – in addition to accurate and effective validation – laying a solid foundation for his colleagues to build David Wells on in the future. As Head of Pathology Services Consolidation at NHS England and NHS Improvement, David continues to drive the type of unprecedented change in UK pathology that has attracted global attention, especially due to his excellent work with networking and consolidation. He strives to embed pathology into the heart of healthcare by supporting the adoption of digital systems, while also influencing key Elaine Jaffe national health policies and government- funded initiatives. His trailblazing approach Elaine is Head of the Hematopathology Section to the modernization of the field is ensuring at the US National Institute of Health’s National the sustainability of pathology expertise for the Cancer Institute. She has led pioneering studies future – but he still manages to find time to in relation to the classification of malignant inspire future laboratory medicine professionals. lymphomas and sits at the forefront of an international effort for consensus among clinicians and pathologists. Nominators are effusive in their praise for her trailblazing work, which has been instrumental in the establishment of a new paradigm for lymphoid neoplasm classification. “Hematopathology has always been an ideal subspecialty for me because of the integration of pathology with clinical information, and the incorporation of modern molecular techniques,” says Elaine.

Emilio Madrigal Elizabeth Montgomery Emilio is an Assistant in Pathology Specializing in gastrointestinal (GI) and soft and a Fellow in Clinical Informatics at tissue pathology, Elizabeth is a Professor Massachusetts General Hospital. “I’m of Pathology,gy, Oncology,g and Orthopedic passionate about building innovative, data- SurgerySurgery at Johns HHopkinso School of driven platforms to facilitate diagnostic Medicine. She is describeddescrib by nominators as decisions and improve educational “a“a worworldld expert wwhoho hhasas shaped the careers delivery. Working alongside a gifted of many pathology resiresidentsd and fellows.” A computational pathology team allows successfulsuccessful teacteacherher andand mentor,m Elizabeth is us to quickly advance from concept to aalsolso an innovator – she foundedf Innovative completion and bring tangible solutions PathologyPathology Press, a producerpro of surgical to our department,” says Emilio. He is pathologypathology books.books. Her biggest influences? an active member of several national “Sharon Weiss, JeanneJeanne Meis, and the late and international committees and is co- FranzFranz EnEnzingerzinger all eenabledna me to spring founder of pathCast (pathologycast.com), offff i ntintoo G IGI pat pathology.”hology.” which broadcasts free pathology lectures across the world. Estherher YoudYoud

A histopathologistopathologist basedbased inin SouthSouth WWaWales,les, Esther also has a nationalnationall ppositionoositioon aas CChairhair of the AAcademycademy Medical RRoyaloyyal CollegesCoolleges Wales andand is an AssistantAssistant RegistrarReegisstrar withwitht thethe Royal CollegeCollege of PatholoPathologistsggists and ononee oof tthehe first doctorsctors inin tthehe UKUK toto ququalifyualify asas aa MMedicaledical Examiner.ner. SpSpeakingeaking about hhowoww toto grgraspasp neneww opportunities,unities, Esther says, ““AlwaysAlwaays putput yoyourselfurrseself forwardd fforor lleadershipeadership roroles…les… YoYouu dodon’tn’t hahavevee to be thehe foremost expert in youryour area;areae ; youryour experienceence and knowledge willwill contributecoc nttribbutee Emily Volk to the eexistingxisting weawealthlth ooff views anandd yoyouu wiwilllll play a partpart in promoting high standards andannd Emily is currently the Senior Vice improvinging patientpatient care.” President of Clinical Services at University Health System in San Antonio and Assistant Professor of Pathology at the University of Texas. Over the past two Felipe S. Templo, Jr. decades, she has endeavored to ensure that patient safety is a top priority throughout Few have been as active as Felipe in harnessing healthcare; more recently, she has worked social media’s power for pathology education. with state and federal governments to He is an anatomic and clinical pathologist, achieve this. On her favorite part of the program director of the Pathology Residency job, Emily says, “It’s a privilege to touch Training Program at the Philippine Heart so many patients’ lives each day. Almost Center, and Assistant Professor at the every patient in the hospital is impacted University of the City of Manila College of by the policies we set and the oversight Medicine. His trailblazing work promoting we provide in the laboratory.” pathology via social platforms is particularly innovative in the context of developing countries such as the Philippines, which have limited resources for medical education. Looking to the future, Felipe says, “Through social media, the presence of pathologists will increasingly be felt by patients and the general public.”

Genevieve Marie Crane

“Pathology provides a truly unique opportunity to build a niche based on your passion and skillsets, directly impacting the field and potentially the lives of others,” says Eve, Gemma Clark Assistant Professor of Pathology at Weill Cornell Medicine in New York City. Gemma can be found at Nottingham University Alongside her research interest in investigating Hospitals NHS Trust, where she works as a the influence of host and environmental clinical scientist. A leader in innovation, she factors on lymphoma development, she is has introduced new technologies and delivered also passionate about education and outreach, quality laboratory service in her institution. especially through social media. With over Her specialty lies in molecular diagnostics for 5,000 followers on Twitter, she frequently infectious diseases and molecular microbial uses her powerful online presence to prompt typing methods. Her favorite part of the job? and engage in discussions surrounding her “The fast-paced and continually evolving nature specialty – diagnostic hematopathology. of clinical virology. We are constantly learning new things about viruses and this creates a real challenge for the field of diagnostic virology, in which we are tasked with detecting and monitoring viruses that have significant impacts on human health.” Spend Your IHC Budget Wisely Enzo’s Comprehensive Antibody Portfolio

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www.enzolifesciences.com/IHC For Research Use Only. Not for Use in Diagnostic Procedures. Han van Krieken

As a Professor of Pathology at Radboud University Medical Center, Han specializes Jaime Arturo Mejia in blood and digestive tract diseases, Iffat Jamal especially lymph node cancer. He played Jaime has been a practicing pathologist for a key role in the discovery of mantle cell Iffat is an Assistant Professor in the over 20 years. He combines academic and lymphoma as an entity, founded the Journal of Department of Hematology at the Indira community practice effortlessly and has served Hematopathology, and has received numerous Gandhi Institute of Medical Science in Patna. as Professor at both the Universidad del Valle awards – including an honorary fellowship She was nominated for the Power List thanks to and Universidad Santiago de Cali. He is of the Royal College of Pathologists and a her hard work and dedication to the field. Why currently CEO andd founder of the Instituto knighthood by the King of the Netherlands. did she choose pathology? “It is the science of de Patología Mejiaia Jimenez in Colombia.Colombia. Han says, “Early and complete diagnosis is all sciences because all medical fields are related Nominators praise hhisis kind, unassuming, and becoming increasingly crucial for patients, to it. What we see behind the microscope considerate nature,e, saying hhee hhasas a territerrificfic which requires that histopathologists collect paves the way for clinicians in terms of the sense of humor in addadditionition to bbeingeing a bbrilliantrilliant and integrate information from many sources, appropriate management of patients. Pathology pathologist. His quest for knowledge is including genetics, radiology, and other forms is fascinating and breathtaking; I am proud to relentless and he regularlyegularly bbringsrings hhisis uniuniqueque of clinical pathology.” be a pathologist!” viewpoints to conferenceserences and meetingsmeetings..

Jason Wasserman

Jason is a head and neck pathologist at The Ottawa Hospital and an Assistant Professor at the University of Ottawa. Although he has only been in practice for one year, he was nominated for the website he created to explain pathology reports to patients (mypathologyreport.ca). It now includes articles from pathologists across Canada and is recommended for patients in several cancer centers. “As experts, we have a responsibility to empower patients by helping them find answers,” Jason says. “Pathologists are going to need to learn how to communicate increasingly complex results not only to other doctors, but also to patients.” Jo Martin Jason Hornick “I love my job!! I learnlearn allall thethe time, work with great colleaguesll and d Jason is Director of Surgical Pathology and students, discover through research, Director of the Immunohistochemistry and I especially value the privilege Laboratory at Brigham and Women’s of highlighting the contribution Hospital, as well as a Professor of Pathology pathologists make to care – both at Harvard Medical School. Jason’s main human and veterinary,” says Jo research interest lies in soft tissue sarcomas, Martin, President of the Royal including evaluating histologic and College of Pathologists. Jo leads the immunohistochemical parameters that predict UK pathology community in matters clinical outcome and identifying diagnostic of quality, training, exams, and and predictive biomarkers. He serves on 12 recruitment. Under her leadership, editorial boards and was nominated for his this year – for the first time in years prolific research on soft tissue pathology, – all the histopathology junior doctor having published around 400 original papers, training posts were filled. “The biggest review articles, and book chapters. influence on my career has been my colleagues and students – I am always supported and encouraged by them.”  31 Jon Morrowrow Feature

Jon is Raymondond Yesner ProfessorProfessor of PPathology,atholoogy, Chair of the Department of PatPathology,hoology, and Chief of Pathologyathology at YaYalele NNewew HHavenavenn Hospital. Hiss innovative researchresearch hashas focusedfocused on the structure,cture, function, and geneticsgeenetics ofof complex cell membrane scaffoldsscaffolds. These studies were among the first to reveal the molecular basis of several hereditary blood cell disorders Joanne Horne most commonly afflicting young children, as well as that of movement disorders such as Recently crowned Biomedical Scientist hereditary ataxia. His hopes for the future? of the Year for 2019, Joanne continues to “Pathologists should embrace emerging trailblaze in GI histopathology, changing technologies and lead their adoption in the the face of modern medicine reporting and diagnostic process; those who can integrate ensuring that low consultant numbers don’t multiple analytical tools will be invaluable.” increase cancer waiting times to diagnosis. JJoanneoanne iiss proactproactiveive inin raisingraising thethe profileprofile oof bbiomedicaliomedical science usinusingg her stronstrongg sosocialcia mediamedia ppresenceresence anandd curatecuratedd tthehe hhighlyighl Jonathan Epstein popularpopular NHS TwitterTwitter account in JanuaryJanuar 2018. “M“Myy advice would be to work hahard,rd Jonathan is Professor of Pathology, Oncology, notnoot tatakeke rejection andand ffailureailure personapersonally,lly and Urology and Director of Surgical andannd try to sseeee the viewpoint of otheothers,”rs Pathology at the Johns Hopkins School of sayssays Joanne.Joaanne. ““It’sItt’s iimportantmportant to be bold anand Medicine. A world expert in uropathology, bravebbrave to cchallengehallene ge traditionaltraditional hhierarchiesierarchie Jonathan runs the world’s largest genitourinary andand babarriers!”rriers!” pathology fellowship, training four fellows each year, and previously won the Koss Medal for Advancement of Urological Pathology. His advice? “Find a niche where you can contribute based on access to unique patient groups or novel techniques, such that you can add to the literature in a meaningful way. Carve out a Jorge Reis-Filho couple of hours each day for things you want to do in your area of expertise!” The author of over 470 papers on rare cancer types, Jorge is currently the youngest-ever Fellow of the Royal College of Pathologists based on published work. He leads the way in integrating histopathology with Kalyani Bambal Juan Daniel Prieto Cuadra innovative genetics to discover new classes and characteristics of cancer genes. On his Kalyani is a surgical pathologist and molecular Daniel can be found at Virgen de la biggest influences, Jorge says, “Both my oncologist who trained at Tata Memorial Victoria Hospital, where he specializes in mentors and collaborators have taught me Hospital in India and the University of Illinois hematopathology and autopsy. He dedicates that, in this day and age, no professional is in Chicago. Having posted over 96,000 tweets, a lot of timeme to helping students understand able to comprehend the intricate complexities she is a prolific user of social media and regularly biopsies uundernder the microscomicroscopepe and uses his of every step in the journey from making a engages with her global following by sharing considerableble Twitter following to disseminate new scientific discovery to translating it informative content. Nominators describe cases and prompt discussion. “If I could make into patient benefit. Working together in a her as “an unselfish, hardworking pathologist one alterationtion to mymy field, it would be to chanchangege collaborative manner is absolutely essential.” who provides the online community with the perceptionption surroundingsurrounding clinicalclinical autopsies. invaluable educational material.” Kalyani is Hospital mmortalityortality is a serious care qqualityuality actively involved with teaching residents and problem,p, especiallysppyggecially givengiven the ggrowingrowing junior pathologists by moderating a numberer ooff numbernumber ofof immunocompromisedimmunocompromised online study groups, which she describes asas “a chronicallychronically ill patients.patients. We mission very close to my heart because I hholdold are tthehe llastast remainiremainingngg the firm belief that knowledge should befree free hospitalhospital mmedicalediccal ccommunityommmmunityy and open-access.” there to eexplainxpplainn thethee ccauseauusse of ddeatheathh wwhenhen alallll otothertheh r explanationsexplannatioonsn ffail.”aiil.” 32  Feature

Kyle Bradley

Kyle is an Associate Professor of Hematopathology at Emory University Katrina Collins Hospital, Atlanta. He was nominated for his contribution to online education and his ability “As a resident, I decided early on in my training to create diagnostic algorithms. His favorite that I would never say no to an opportunity,” says part of the job? “The daily opportunity to Katrina, who is currently completing a surgical learn about anatomy, biology, physiology, and pathology fellowship at the University of Texas various diseases, all with my own eyes! Every MD Anderson Cancer Center. A former day is filled with scientific inquiry and the hematopathology fellow at Hartford Hospital chance to significantly impact patient care, all in Connecticut, she was nominated thanks to while sharing my love for the field by teaching the beautiful hematopathology cases that she medical students, residents, and fellows.” posts on her Twitter profile alongside detailed reviews of markers and flow histograms. “I am continuously amazed at the enormous impact of social media – it has allowed me to educate and learn from my peers while also bringing Lara Pijuan pathology closer to patients!” Lara is a Consultant in Pulmonary Pathology and Cytopathology and Coordinator of the Digital Pathology Project at Hospital del Mar in Barcelona. Her positivity and willingness to help others make her a true power pathologist, according to her colleagues. Lara was instrumental in the introduction of digital techniques in pulmonary pathology and regularly offers to help laboratories around Spain implement digital pathology into routine practice. Her advice to others? “Always do things that you enjoy and that make you happy.”

Luis Humberto Cruz Contreras

Luis is a Pediatric Pathologist at Hospital Materno-Infantil in Irapuato, Mexico. He is active on social media and enjoys sharing Liron Pantanowitz posts with his wide following for education and advocacy. “I have two big influences on my Liron is Professor of Pathology and career,” says Luis. “The level of commitment Biomedical Informatics and Vice Chairman I saw from Lourdes Cabrera Muñoz while for Pathology Informatics at the University I was training in pediatric pathology was of Pittsburgh Medical Center. He is also Lorand Kis contagious, and she taught me that there is the Director of Cytopathology and of always room for improvement. In addition, I the Pathology Informatics Fellowship Lorand is a pathologist at the Karolinska learn so much from my #PathTwitterFamily – Program. A founder of the Journal of University Hospital in Sweden. Specializing in the time, dedication, and passion they put into Pathology Informatics, he also published immunohistochemistry, he appears on the Power everything they share is incredible.” the subject’s first textbook. His most List thanks to his “clever and passionate approach unexpected moment? “When I found out to education,” a trait nominators praise. Lorand I was a natural on stage! At the American is active on social media and can be found on Society of Cytopathology’s annual meeting Twitter most days, sharing photos of interesting in 2017, I hosted a cytology ‘shark tank’ cases, discussing immunohistochemistry and event and I had a blast – the event was molecular pathology, and inspiring the next highly successful and I was invited back generation of pathologists in the process. “The for the following year!” people who had the biggest influence on my career were my PhD supervisors, Eva and George Klein,” says Lorand. Feature  33

Mariam Molani

An Anatomic and Clinical Pathology resident at the University of Nebraska Medical Center, Mariam is trailblazing with her use of technology and social media. She commands a large following across various social media platforms, which she uses to increase engagement with Malak Abedalthagaﬁ students, patients, and the wider public. On Malcolm Robinson her biggest influence, Mariam says, “My As a strong advocate for women in science, father is a community pathologist and my technology, engineering, and medicine in “My favorite part of the job is showing young mother practices family medicine. After Saudi Arabia and the Middle East, Malak patients the science behind their healthcare school during my childhood, my mother was nominated for her “passionate leadership and that there is someone working hard in would talk about different disease processes and great teaching” in clinical pathology, the laboratory to help them get better,” says and how she treated them, and my father anatomical pathology, neuropathology, and Malcolm, a biomedical scientist from Western would break down the pathophysiology. molecular genetics. Malak worked in a number of Sussex NHS Hospitals Foundation Trust. He These experiences helped shape my drive universities – such as Georgetown, Stanford, and founded a charity called Harvey’s Gang, which to pursue pathology.” Harvard – before becoming Founding Chair of gives children across the UK laboratory tours the genomics research department and Primary to show them the journey their blood samples Investigator of the Saudi Human Genome Lab take. His work with Harvey’s Gang crowned at King Fahad Medical City Research Center him Biomedical Scientist of the Year in 2018. in Riyadh. Her ultimate goal is to improve the “We aim to reduce fear, enlighten, educate, application of personalized medicine and targeted and empower these youngsters, who might therapy in the clinical management of patients. just become the next generation of scientists!”

Marilyn Bui Mario Prieto

Marilyn is an Anatomictomic and Mario is an anatomical pathologist at San Clinical Pathologistist and Chinarro Hospital in Spain; his research interests Scientific Directoro fof t hthee lie in hematopathology, breast pathology, and Analytic Microscopyy Core lymphoma. With an active presence on social at Moffitt CancerC enter.Center. media, he was nominated for his contribution to She is also Director of thethe online education through the #CaseOfTheDay Cytopathology Fellowshipwship hashtag, which he uses to prompt discussions into at the University of Southouth interesting and unusual cases. “My one piece of Florida Health Morsanisani advice would be to follow your own path; it can College of Medicine. SShehe be tempting to emulate the steps of your idols, but promotes the image ofof you should embrace the activities that increase pathologists in her manyany Mario Plebani your self-confidence and happiness,” Mario says. speaking engagementsnts – nominators call herher Mario is Professor of Clinical Biochemistry and humble, generous, andnd Clinical Molecular Biology at the University of supportive. “The mostost Padova and the Chief of the Department of unexpected momentnt ofof Laboratory Medicine at the University Hospital my career was duringing my in Padova. Recognized as a pioneer and trailblazer PhD study at the Universityniversr ity in patient safety, he is committed to reducing and of Florida,” says Marilyn.Marilyn. preventing laboratory errors through creating a “I received the President’sresiddennt’s system of quality indicators in the lab. Mario Outstanding Achievementvemennt and is a strong leader and has mentored a number Contribution Award, forfor whichwhiich of students throughout his career. His most I am grateful to my grgraduateaduaatte unexpected moment? “Becoming a member of program director andndn thetheh the Accademia Galileiana, a very prestigious leadership of my mentor.”orr.” recognition of my scientific work.”

www.thepathologist.com 3434  FeatureFeattuure

Marta Cohen

Marta is Head of the Department of Histopathology and Clinical Director of Pharmacy, Pathology, and Genetics at Sheffield Children’s Hospital. An Honorary Professor Marta Garrido Pontnou of the University of Sheffield since 2018, she was the first woman in the UK to be appointed Marta is an anatomical pathologist at Vall a Professor in Pediatric Pathology – and d’Hebron University Hospital in Barcelona, the Royal College of Pathologists recently Spain, where she is dedicated to pediatric designated her Academic Lead for Pediatric and developmental pathology and electron and Perinatal Pathology. “I am forever grateful microscopy. She was nominated for her to my friend and mentor Roc Kaschula, who had invaluable contributions to fetal and placental an enormous influence on my career by inviting pathology. Talking about her favorite part me to apply for a training position at Red Cross of her field, Marta says, “Understanding Children’s Hospital in Cape Town,” says Marta. a complex malformation can be a great challenge – I liken it to finding an exit door in a Minotaur’s labyrinth, but fetal autopsy is Martina Bosic a thorough and highly rewarding job.”

Martina is Assistant Professor at the Institute of Pathology at the University of Belgrade in Serbia. Specializing in chronic inflammatory skin disease, she was the first person to implement molecular pathology methods in her country. Her active work to bring molecular pathology into everyday practice and into residency programs wins her a place on this year’s Power List. On her hopes for the future, Martina says, “We need to be prepared to use genomics, proteomics, and other new methods in everyday practice to provide the best possible patient care.”

Massimiliano Marco Corsi-Romanelli

Massimiliano is a Professor in the Department of Biomedical Sciences for Health at the University of Milan and Laboratory Head of the Diagnostic Department at IRCCS Policlinico San Donato in Milan. A dedicated educator and prolific publisher, he was nominated for his trailblazing Matthew Cecchini work with the study of epicardial adipose tissue. “My favorite part of the job is teaching clinical Mary Landau After completing residency in anatomical pathology and studying cellular and molecular pathology at Western University in Canada, pathology,” Massimiliano says. Mary is a practicing pathologist from Matthew is now a pulmonary pathology fellow Arizona who founded MPathy Art, a at the Mayo Clinic. On the future direction of website dedicated to showcasing beautiful the field, Matthew says, “I believe the advancing and intriguing artwork from the lab. She has fields of genomics, digital pathology, and always envisioned science as an art form and artificial intelligence will fundamentally change believes that scientists and artists are united the way we practice. These advances will allow by the fact that they’re dreamers. “I still feel us to better classify disease, share challenging as though pathology is the best kept secret in cases, and increase our accuracy and efficiency. medicine,” says Mary. “MPathy Art allows By embracing these emerging technologies, me to share the exquisite patterns of human pathologists will increasingly be able to stand up pathology while teaching the general public from behind the microscope to collaborate with a little about the role of pathologists.” our clinical colleagues and ensure the best care for our patients.” MichaelMichael LLaposataaposata

MichaelMichael is PProfessorrofesssor andand ChairChair ofof tthehe DDepartment of Pathology at the University of Texas Medical Branch at Galveston. He was instrumental in creating a diagnostic management team within his institution, a patient-centric process whereby pathologists are consulted to ensure the correct diagnostic tests are ordered. A leader in patient safety, he is eternally committed to the identification and prevention of diagnostic errors. His biggest inspiration? “Lockard Conley embraced me and became my career advocate when I was doing research in a hematology lab the summer before medical school; he built Michael Misialek the foundation for my career!” Michael is Associate Chair of Pathology and Medical Director of the Vernon Cancer Center at Newton-Wellesley Hospital, Michal Michal Massachusetts. He is active on social media and regularly shines a light on his profession Michal is a Professor of Urologic Pathology at via Twitter. His latest venture involves a Charles University in Prague, Czech Republic, collaboration with a founding member of and at the Department of Pathology in Pilsen. the popular band The Doors, in which he He is a true trailblazer in his field and has strives to raise awareness of the great work described several new entities in urologic of pathologists. On the future of the field, pathology, including mixed epithelial and Michael says, “AI will work its way into stromal tumor, renal cell carcinoma with widespread practice, immunotherapy will be (angio)leiomyomatous stroma, and signet further refined, and patient consults will be ring stromal tumor of the testis. Nominators more common. I believe the future is bright also commend his ongoing commitment to for pathologists.” educating the pathologists of the future.

Nicole Riddle Oana C. Rosca Patrick C. Mathias

Currently working at Tampa General “Every day of a pathologist’s career is “What I enjoy most is the ability to apply my Hospital as a pathologist, nominators praise unexpected; we touch patients’ lives in so many skills to help change the system and improve Nicole’s active and continued involvement ways,” says Oana, a molecular pathologist and care for patients from behind the scenes,” in pathology advocacy. In her role as a cytopathologist at Northwell Health Systems says Patrick, Associate Medical Director member of the Young Physician Section – Staten Island University Hospital in New of Laboratory Medicine Informatics and Governing Council for the American York. As an Associate Residency Program Assistant Professor in the Department of Medical Association, she has given Director and Assistant Professor at Donald and Laboratory Medicine at the University of pathology a strong voice to ensure that Barbara Zucker School of Medicine at Hofstra/ Washington School of Medicine. “By shaping the profession has a seat at the top table of Northwell, she enjoys teaching residents and our information systems and workflows, I am medicine. Given the chance, the one thing medical students and is involved in translational able to help my colleagues, from the front-line that Nicole would change about her field is research with a focus on molecular assays using staff to the laboratory professionals, across inter-specialty communication. “The lack limited material. “I believe in communication our whole organization.” Patrick’s ambition of basic understanding of what we do in as one of the greatest tools to educate and is threefold – to reduce the per capita cost of pathology often causes frustrations on both initiate change, allowing pathologists to play a health care, increase the health of populations, sides and, unfortunately, sometimes leads to significant role in the clinical team.” and improve the patient experience. patient care issues.” Paul van Diest

Paul is Head of the Department of Pathology at the University Medical Center Utrecht. A world-renowned breast pathologist, Paul has rearranged the infrastructure within his department to put digital pathology at the center of the diagnostic flow. This led to the creation of the world’s first academic routine digital diagnostic pathology department. His advice to those who wish to follow in his footsteps? “Think outside the box and believe in your own solutions.”

Pembe Oltulu

Peter M. Sadow Pembe is Associate Professor of Pathology at Necmettin Erbakan University, Meram “I love being part of each patient’s life – even Faculty of Medicine, in Turkey. With a focus though most don’t know it – and I enjoy helping on dermatopathology and hematopathology, them to find answers about their health,” says she devotes a lot of time to education and Peter, Director of Head and Neck Pathology at training through social media. She was Massachusetts General Hospital. He oversees nominated for her active use of Twitter at major the clinical service, quality initiatives, and global meetings to disseminate knowledge and head and neck fellowship training within for helping to create a dynamic and engaged the Anatomic Pathology Division. He is also pathology community on social media in Associate Professor of Pathology at Harvard Turkey. Her best advice? “Join the amazing Medical School and plays a prominent teaching #PathTwitterFamily to discover how advanced role within the hospital and on medical technology, social media platforms, and the education courses. Internet can all be used as useful tools for collaboration and communication.”

Pranav Patwardhan Ramineni Ashok Kumar Raul S. Gonzalez

Pranav works in the Department of Pathology Ramineni can be found at MNR Raul is a pathologist at Beth Israel Deaconess at Seth G.S. Medical College in Mumbai. With Medical College and Hospital in Medical Center and Assistant Professor of his educational Facebook page, “Understanding Hyderabad, India, where he works as a Pathology at Harvard Medical School. “The Pathology,” he provides a platform for over Professor and Medical Superintendent most unexpected moment of my career 5,000 pathology trainees around the world to of a thriving pathology department. was the response to my 2018 ‘tweetorial’ share practical tips. Pranav was nominated as a His nominators praised his on neuroendocrine neoplasms of the GI trailblazer for his algorithmic approach to organ “insightful and immense knowledge tract,” says Raul. “Although I delivered systems, which highlight relevant diagnostic of the subject,” his discipline, and it with pathologists in mind, I received features that help with histopathology specimen his dedication to the field. He has several messages from patients living with evaluation. “If I could make one change, I published on a variety of subjects neuroendocrine tumors. They shared stories would create a single platform for pathology ranging from unusual skin disorders with me and expressed their appreciation for education worldwide,” says Pranav. “That to rare congenital abnormalities. how my posts helped them to understand would enable all trainees to begin on an equal their disease. I now keep a larger audience footing, even those in institutions that lack in mind whenever I post on social media.” the latest technological advances.” Rifat Mannan FeatureFeeatture  377 Nominated for his excellent teaching and inspiring mentoring of residents, Rifat is Assistant Professor of Clinical Pathology and Laboratory Medicine at the University of Pennsylvania’s Perelman School of Medicine. Rola Ali Although still relatively early in his career, Rifat has already assisted Rola currently works as an Associate Professor in many residents, fellows, and budding Kuwait University’s Department of Pathology. pathologists with their research. He Nominators commend her educational tweets was a cofounder of PathCast, an and passionate approach to teaching, which open-access academic platform that has inspired many to pursue pathology. On aims to bridge knowledge gaps in the future of the field, Rola says, “In this part pathology by live-streaming lecture of the world, the demands on pathologists are series for a global audience. “I am Richard Levenson ever-increasing, with a shortage of pathologists passionate about globalizing medical and a growing number of increasingly complex education and helping to improve cases. Fortunately, digital pathology and social “There seems to be a crisis of confidence in patient care in the remotest corners media platforms have melted away geographic pathology. Fewer and fewer medical students of the world,” says Rifat. barriers, connecting pathologists from all over are choosing it for their residency training, and the world, and I think they will continue to play medical school curricula have relegated pathology an important role in enhancing collaboration to a sort of adjunctive contributor to the education and knowledge exchange.” process,” says Richard Levenson, Professor and Vice Chair for Strategic Technologies in the Department of Pathology and Laboratory Medicine at UC Davis Health. “We need to change pathology’s role in both education and the entire clinical domain to resurrect it.” Richard has been instrumental in the development of Microscopic Ultraviolet Sectioning Excitation (MUSE), which eliminates the need for conventional tissue processing.

Samson W. Fine

Samson is a genitourinary pathologist at Memorial Sloan Kettering Cancer Center in New York. He was nominated for being one of the early in situ pathologists who engaged with audiences on social media at USCAP. On his hopes for the future, Samson says, “As a pathologist involved in researching urologic cancers, I hope that we can increasingly embrace robust statistics. Instead of simply reporting more and different features of tumors, careful Sanjay Mukhopadhyay multivariable analyses will enable nuanced incorporation of histologic and molecular Sanjay is Director of Pulmonary Pathology at features to produce the most clinically relevant Cleveland Clinic. He recently first-authored a and actionable pathology reports.” landmark publication, which is the largest in the US to date to compare whole-slide imaging with conventional microscopy. A prolific user of social media for pathology education and advocacy, Sanjay established the #PathTweetAward that is now a popular educational tool on social media. On the future of the field, Sanjay says, “I see increasing acceptance of whole slide imaging for primary diagnosis, widespread recognition of social media platforms as vehicles for free global education and networking, and even more widespread use of immunotherapy across different tumor types.”

www.thepathologist.com Sarah Coupland

“I love Pathology for its contrasts and challenges – some cases are very simple, others extremely complex and demanding, like a hard-to-crack puzzle,” says Sarah, George Holt Chair in Pathology and Consultant Histopathologist at the University of Liverpool’s Institute of Translational Medicine. As Lead of the Liverpool Ocular Oncology Research Group, Santiago Prieto Sarah is trailblazing in ophthalmic pathology, oncology, and hematopathology. She recently Santiago is President of the Spanish contributed to the fourth volume of the World Association of Medical Biopathology Health Organization Tumors of the Eye – Laboratory Medicine and Head of the classification, published in 2018, and has won Clinical Laboratory at the Hospital of several awards, including the International Fuenlabrada in Spain. Throughout his Council of Ophthalmology’s Eye Pathology career, Santiago has placed considerable Award in 2018. emphasis on delivering a patient- centered strategy. He is a firm believer that everything a pathologist does should serve the patient and improve their health, an approach that has become much more Severino Rey prevalent in recent years. His biggest influences? “My father, Michael Laposata, Severino is Head of the Anatomical Pathology and listening to patients’ expectations.” Service at Hospital Universitario de Torrevieja, Spain. He has delivered lectures at over 80 national and international conferences and, in the last year, he has taught endocrine and mediastinal pathology courses internationally. Severino says, “There are some countries, such as in Latin America and Africa, where laboratory medicine is not well positioned – pathologists don’t get the recognition they deserve and young people don’t want to enter the field. I would love to work on international projects where universities, laboratories, and professionals from these countries are actively supported with training and resource exchange.”

Stephen Master Suzy Lishman

Based within the Division of Laboratory Suzy is a consultant cellular pathologist at Medicine at the Children’s Hospital of Peterborough Cit y Hospital, as well as the Head Philadelphia, Stephen has served as of Department and lead for gastrointestinal Director of Central Laboratory Services pathology. She is also one of only two women Silvana Di Palma in addition to his role as a faculty to serve as President of the Royal College of member in the Division of PathologyPatholoogy PatholPathologistsogists in the UK. SuSuzyzy is a true social Silvana is a Consultant, Lead Researcher, Informatics. His workk focusesfocuses on mmediaedia ambassador for ppathologyathology and appears and Lead Educational Supervisor at the machine learning for cancercer diadiagnosis,gnoosis, onon this year’syear’s PowePowerr List thanks Royal Surrey County Hospital. She has long an emerging and highlyly promisingpromising to herher tiretirelessless aadvocacyd work had an interest in cutting-edge research and field that will becomei nvaluabinvaluablelee in in on televisiontelevision andan radio. Her innovation, but she also inspires her co-workers the years to come. He’s also a lleadereaader bestbeesst advice?advd ice? “Get“G to know and instills passion into the next generation of in service, active within tthehe AmerAmericanican youryour cocolleagues!lleag Social doctors. Because she believes that molecular Association for Clinicalal ChemiChemistrystry events,eventss, sponsoredsps onnso sporting biology is the future of pathology, Silvana and on the scientific committeemittee foforr t hthee activities,activities, anda charity instigated a collaboration between two labs Mass Spectrometry: Applicationsplications to cacakeke ssalesalles all help to in her institution, which resulted in the first the Clinical Lab conference.nce. bringbbring peopeople together, robust HER2 in situ hybridization test for flflattenatten hhierarchies,ie and breast cancer patients in the UK. She says, improveimprov working “Confidence in myself, a supportive friend, relationshipsrer llatio and inspirational academics were integral to andand mmomorale.” my successful professional career.” Timothy Craig Allen

Timothy is Professor and Chair of the University of Mississippi Medical Center. His work and advocacy for bringing pathology out of the shadows and for building patient-pathologist communication pathways is extremely encouraging for all in the profession. “If I could change one thing about the field, it would be our attitude,” Timothy says. “We must become more proactive and Syed T. Hoda assertive as physicians, involving ourselves in our hospitals, our communities, and Syed is Director of Bone and Soft Tissue our patients’ lives.” Timothy’s dedication Pathology at New York University (NYU) and to promoting pathologists as critical patient Director of Surgical Pathology at the NYU advocates in all aspects of healthcare makes Langone Orthopedic Hospital. His trailblazing him a true leader and role model for others. approach to new technologies, such as the use of educational apps and the development of remote frozen section systems, sees him appear on this year’s Power List. “I would like my pathologist Valerie Fitzhugh colleagues to be bold, thoughtful, and creative in helping patients and physicians deal with human Valerie is Associate Professor of Pathology and disease – and these are the same qualities we Laboratory Medicine at Rutgers New Jersey should use in teaching the next generation of Medical School. A strong advocate for women doctors to inspire them for the future,” says Syed. in medicine, Valerie is trailblazing with her passionate quest to achieveieve equality in the lablab,, which she promotes inn thethe classroomclassroom andand on social media. Nominatorsors praise hherer active rorolele in sharing her own experiencesperiences to insinspirepire ththehe next generation of pathologiststhologists anandd apapplaudplaud her generous encouragementgement and supportsuppop rtr ofof others. Her favorite ppartart of the jjob?oob? “They“Theye might not know I exist,, butbut to kknownoow ththatat I aamm truly helping patients ggetet the rrightigghtt ttreatmentreeaatmentn gives me incredible joy.”y.”

Yael Heher Yuchun Ding

Yael is Assistant Professor of Pathology at Harvard A trained computer scientistientist ffromroom NeNewcastlewcastlt e Medical School and Director of Quality and University, Ding works alongsidealongside ppathologistsathologgists to Patient Safety in the Department of Pathology develop practical solutionsons in digital ppathology.athhology. at Beth Israel Deaconess Medical Center. He is the creator of X-WOW!,WOW!, whiwhichchh hhee sesett up Pathologists play a critical role in patient safety to improve access to microscopycroscopy eequipmentquipment foforr – and the importance of Yael’s trailblazing work pathologists who work inin remote areas. OnOn hishis Wendy L. Frankel in developing that role cannot be understated. “I ambitions, Yuchun says,s, “One ddayay I suddenlysuddenly love that successful pathology quality and safety realized a cruel fact – my efforts are useless to Wendy is Kurtz Chair and Distinguished initiatives empower frontline lab employees while those who can’t afford hethe equipmentequipment toto produproducece Professor of Pathology and Chair of the helping senior staff understand and improve whole-slide images for analysis. That’s why I Department of Pathology at The Ohio State the lab’s performance,” Yael says. Thanks to created X-WOW! in my own time; I want to University Wexner Medical Center. Wendy her dedication, the role of the pathologist in focus on making digital pathology easier to currently serves as the President of USCAP patient safety, error communication, and patient access for those who have been forgotten.” and is a leader in gastrointestinal pathology. disclosure is more defined than ever. She played a key role in the Columbus-area HNPCC study to determine the prevalence of Lynch syndrome among all newly diagnosed colorectal and endometrial cancer patients. The results of this study have changed the standard of care for colorectal cancer patients around the world. Her best advice? “Follow your interests, but have the flexibility to take opportunities and modify your plans.” THOUGHTFUL AUTOMATION FOR A NEW LEVEL OF WORKFLOW EFFICIENCY.

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44-46 Giving Cancer the Brush-Off Early diagnosis is vital in esophageal cancer. A new technique, WATS3D, can improve detection of pre-cancers and identify patients who need increased surveillance or treatment. 44 NextGenNNeextxtGeG n

and surveillance technologies are flawed – a Tell us about the wide Giving Cancer dangerous situation for patients at risk for sampling approach… esophageal cancer. It’s called wide-area transepithelial the Brush-Off sampling with 3D computer-assisted What’s the current gold standard for analysis (WATS3D). From the name, WATS3D – a new brush- identifying BE and ED? you can probably determine that the test based biopsy technique, The current gold standard for screening and consists of two major components aimed at combined with computer- surveillance of BE and associated neoplastic decreasing the common problems associated assisted analysis – can lesions is forceps biopsy of patients with with the Seattle biopsy protocol. improve detection rates for known or suspected BE. The Seattle WATS3D uses a proprietary brush pre-cancerous conditions in protocol requires biopsies from all four composed of longer and harder needles patients with quadrants of Barrett’s mucosa – every than conventional soft-brush cytology Barett’s esophagus centimeter for patients who have dysplasia; brushes. Soft brushes typically acquire every two centimeters for those who superficial exfoliated cells from the top By Robert Odze don’t – as well as any visible lesions. The portion of the mucosa, but dysplasia diagnosis is based on histologic evaluation and early cancer often reside in the deep Esophageal cancer may not be among of mucosal biopsies. mucosal crypts. If one doesn’t want to miss the most common forms of cancer, but However, this method is fraught with those areas, one needs to acquire tissue from it’s certainly one of the most fatal. Only problems. Foremost of these is that it deeper in the mucosa. The WATS3D brush about one in five people diagnosed with results in a high degree of sampling is useful because it acquires full-thickness esophageal cancer will survive five years error because the biopsies cover only a mucosal fragments – that is, tissue all the (1), and over two-thirds are diagnosed with small fraction of the Barrett’s mucosa (in way down to the muscularis mucosa. And late-stage disease (2). The key precursor to some cases, less than 5 percent). Several because it’s a brush that sweeps across the esophageal cancer is Barrett’s esophagus studies have shown that up to one-third mucosal surface and acquires a lot of tissue, (BE), a metaplastic change that is often of BE patients present with high-grade it greatly decreases sampling error. We’ve followed by transition to dysplasia. Patients lesions and even cancer within one year seen significant increases in detection rates who exhibit signs of BE or esophageal of endoscopic screening or surveillance (3). for both goblet cells (required for fulfillment dysplasia (ED) must undergo increased This indicates that sampling error resulting of the BE criteria) and dysplasia using the surveillance or ablation so that cancer can in false negatives is a huge problem with WATS3D diagnostic platform. be preempted. However, current screening the Seattle protocol. The second aspect of WATS3D is The second problem is inter-observer computer-assisted analysis. The computer variability regarding establishing a system scans all of the tissue acquired by At a Glance diagnosis of dysplasia in forceps biopsies. the brush, then uses a neural network and • Forceps biopsy screening for Although pathologists have been assessing artificial intelligence (AI) to analyze it. This esophageal pre-cancers has a high biopsies for several decades now, we haven’t analysis includes a battery of morphologic degree of sampling error seen any significant gain in inter-observer assessments on the nuclear characteristics • Inter-observer variability further agreement, whether general or expert, over of the tissue; it also ranks tissue fragments limits the protocol’s ability to detect that period of time. Pathologists still differ according to degree of atypicality; and significant disease quite strongly in interpretation of dysplastic it performs a unique extended depth- • A new technique, WATS3D, lesions, particularly when it concerns of-field (EDF) imaging analysis on the combines wide-area trans-epithelial distinguishing regenerating epithelium cell aggregates. Ultimately, it synthesizes sampling with 3D computer- from low-grade dysplasia – a common images of the most atypical tissue assisted analysis problem – and secondarily differentiating fragments and presents them to the • WATS3D reduces sampling error, low-grade from high-grade dysplasia. pathologist on a computer screen to be improves detection of goblet cells These are critical decisions because non- used when the pathologist signs out the and dysplasia with assistance dysplastic, low-grade dysplastic, and specimen at the microscope. from computer-generated images, high-grade dysplastic BE may be treated In EDF imaging, tissue fragments – and highlights the most atypical differently, so an accurate diagnosis is typically between 150 and 200 microns areas of tissue important for patient care. thick on a WATS3D smear – are scanned at 5 μm intervals all the way through the to see crypts almost in their natural form. (screening), because most dysplasia and tissue, similar to a CT scan of the human Overall, the learning curve for early cancer that we see in BE is detected body. The system then uses neural network WATS3D is very short. I have a lot of at that point in time (prevalent dysplasia). programming to synthesize all of those experience diagnosing BE via traditional That’s when the chances of finding dysplasia 3D cuts into one crisp, clear, artifact-free means – and, after I went through a are greatest, so that’s when we should be 3D image. That way, the pathologist has teaching process of about 20 cases, I felt using our most powerful detection tool. a unique view of the tissue fragments, very capable of diagnosing the vast majority including whole crypts and their features, of WATS3D cases. By the time I hit 30 Why is it so important to detect these which leads to improvement in diagnosis. cases, I felt extremely comfortable. Despite conditions early? In one recent study, the degree of inter- the novel technique, one evaluates all the At the moment, 95 percent of esophageal observer agreement was much higher for same features in WATS3D specimens that cancers are diagnosed outside the setting WATS3D specimens (all kappa values one sees in traditional forceps biopsies, so of surveillance (5). Even among patients >0.7) than for forceps biopsies alone (4). it’s really nothing new from the histologic in a surveillance program, at least one- point of view. I view it as a crisper, more third develop cancer within a year of an Tell us about your own experience visually accurate and specific method of endoscopic surveillance (3). It’s clear that with WATS3D… evaluating tissue. endoscopic surveillance in its current form WATS3D specimens come in two forms. The recommendation right now is to is not efficient. We recognize from our The first is a formalin-fixed, paraffin- use WATS3D with any patient who experience with cancers in other parts embedded, H&E-stained slide similar to is endoscopically identified as having of the body, such as in the cervix and a normal mucosal biopsy. However, the salmon-colored mucosa in the esophagus the colon, that early (often endoscopic) fragments of tissue are very small – I would and therefore suspected or previously detection of neoplastic precursor lesions consider them “micro”-biopsies. The other known to have BE. Why? Because can drastically reduce the incidence of specimen is the tissue smear I’ve described WATS3D is proven to be more efficacious invasive cancer worldwide. The same is true above. I refer to these two approaches as for both identifying goblet cells (that can for esophageal cancer, which is particularly “histocytology,” because we can see clear help confirm the diagnosis of BE) and for deadly. To make headway in helping histologic features of dysplasia in what identifying neoplastic precursor lesions. In patients with this condition, we must amounts to cytology brush specimens. my opinion, the technique should be used work to detect its precursors and prevent The addition of the computer analysis is not only for surveillance, but also during its development, because once a patient has unique – and it’s fascinating, because you get each patient’s initial index endoscopy esophageal cancer, the fatality rate is high.

www.thepathologist.com 46 NextGen Goblet Cells have plenty of data to suggest otherwise. Many patients can develop dysplasia and An ongoing controversy cancer in esophageal columnar mucosa in the deﬁnition of without goblet cells – something that Barrett’s esophagus has been proven in scientific cloning and We know that cancer develops through a lineage experiments (1). metaplasia–dysplasia–cancer pathway. We In the US, the major governing bodies in It’s true, though, that most patients know that when a patient transitions from gastroenterology all require two criteria who do develop dysplasia and cancer metaplasia to dysplasia, regardless of how to establish the diagnosis of BE. One is do have goblet cells – even though small or isolated the lesions, they have endoscopic recognition of salmon-colored they aren’t strictly required. And most already acquired the necessary mutations to mucosa in the esophagus, for the most part gastroenterologists who see endoscopic be considered at high risk for progression to greater than 1 cm in length; the second is evidence of salmon-colored mucosa in cancer. There’s no reason we wouldn’t want confirmation of the presence of goblet cells the esophagus, even if the biopsies fail to to eliminate it at that stage, so it makes in biopsies from those areas of salmon- reveal goblet cells, still put those patients biological and ethical sense to try to find colored mucosa. In many other parts of the into a surveillance program, because and eliminate pre-cancer before it develops world, BE can be diagnosed by endoscopic there’s always a risk that the lack of goblet into invasive cancer. evidence of salmon-colored mucosa alone cell identification was due to sampling (in other words, those governing bodies error. The sensitivity and specificity of What are the next steps for WATS3D? do not require pathologic identification biopsies to detect goblet cells, particularly WATS3D is ready for routine clinical use. of goblet cells to establish a diagnosis). in patients with shorter segments of BE, There have been five prospective trials (some So why were goblet cells incorporated is very low. randomized) and an inter-observer study into the diagnostic criteria in the US? that have all shown a greatly increased It’s partly based on the belief that Reference detection rate of BE and ED by WATS3D only patients who have goblet cells 1. R Odze, “Histology of Barrett’s metaplasia: do when used as an adjunct to mucosal biopsies. in esophageal mucosa are at risk of goblet cells matter?”, Dig Dis Sci, 63, 2042 Those studies have been performed in both neoplastic progression. However, we now (2018). PMID: 29998421. high-risk academic centers and low-risk general community populations with uniformly positive results. As a result, I believe that if you or I had BE, we would be better off having forceps biopsies plus long-term outcome studies in patients References WATS3D, rather than forceps biopsies without dysplasia haven’t revealed any 1. ASCO, “Esophageal cancer: statistics” (2019). alone, because the data unequivocally show efficacious non-histological biomarkers, so Available at: https://bit.ly/2JjlKpU. Accessed May that this combination approach has a greater that’s where I think we’re headed next. We 13, 2019. chance of detecting pre-cancer, which is need the ability to predict which patients 2. Cancer Research UK, “Oesophageal cancer the goal of surveillance. Now that we have without neoplastic precursor lesions are at incidence” (2014). Available at: a safe and effective ablation treatment for risk of developing them. Luckily, because https://bit.ly/2JgmKeh. Accessed May 13, 2019. pre-cancer (which was formerly treated by WATS3D tissue fragments are virtually all 3. K Visrodia et al., “Magnitude of missed esophageal esophagectomy), WATS3D is ready for epithelial (with very little lamina propria and adenocarcinoma after Barrett’s esophagus prime time. soft tissue), they are primed for molecular diagnosis: a systematic review and meta-analysis”, Of course, our knowledge will continue biomarker studies. I think, in the future, Gastroenterology, 150, 599 (2016). PMID: to grow. There are studies currently we’ll see WATS3D brush specimens used 26619962. underway to evaluate WATS3D in various not only for morphological evaluation, but 4. PR Vennalaganti et al., “Inter-observer agreement patient groups, such as post-ablation, short- also in concert with biomarker panels. among pathologists using wide-area transepithelial segment BE, low- and high-risk European Regardless of where the next few years sampling with computer-assisted analysis in and North American patients – so we’ll take us, I think the data are already so patients with Barrett’s esophagus”, Am J have even more information in a few years’ compelling that WATS3D should already Gastroenterol, 110, 1257 (2015). PMID: time than we do now. The field of BE is be considered standard of care – and I hope 25916227. also moving toward biomarker-based the rest of the world soon agrees. 5. NJ Shaheen et al., “ACG clinical guideline: evaluation of patients with non-dysplastic diagnosis and management of Barrett’s esophagus”, BE to determine which patients are at risk Robert Odze is Professor of Pathology at Am J Gastroenterol, 111, 30 (2016). PMID: for progression and which aren’t, so that Harvard Medical School and Chief of 26526079. we can modify our existing surveillance Gastrointestinal Pathology at Brigham and programs accordingly. So far, randomized, Women’s Hospital, Boston, USA. Official society partner of The Pathologist

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Why did you pursue digital and If hospitals and medical institutions theater and literature; I even have a computational pathology? buy and deploy this kind of technology, Diploma in Speech and Drama from My initial plan was to study medicine, they need to know where the return on Trinity College London. I indulge my but my application was unsuccessful. their investment will come from. For interest in literature through my eight- Biomedical science seemed like the next that to happen, AI technology needs its year-old son, who can quote the entire best thing and it was a subject I could own Current Procedural Terminology opening monologue from Henry V! get excited about, so I began my degree (CPT) codes for billing. Once the Although there’s no magic recipe to in biomedical engineering in Bombay, technology justifies its own CPT maintaining a healthy work-life balance India. During my studies, I was exposed codes, I believe we’ll see a significant – and, sometimes, something has to give to medical imaging and realized that inflection point. – I exercise every week to ensure I don’t the integration of computer science go insane! and imaging was a sweet spot for me. What are you most excited about when I pursue so many different avenues I began to develop pattern recognition it comes to computational pathology? to continue to build visibility and algorithms, not to find cancer, but to The proteomics, genomics, metabolomics, excitement in this space. Back in find people in videos and to recognize and transcriptomics of a tumor are 2007, when a few of us started the first certain movements. fundamentally reflected in traditional digital pathology meeting, we held it During my PhD, I really started to H&E slides. I am extremely excited in a classroom because only 14 people zero in on the computational analysis by this because it’s the lowest common attended. It’s fantastic that, in just 12 of medical images, starting with denominator; you can take breast years, we’ve gone from a very small niche radiography. I was fortunate enough to cancer tissue from patients in Liberia, to having several large annual meetings. meet two pathologists: Mike Feldman Birmingham, Sydney, and Cleveland, But we haven’t forgotten the pain that and John Tomaszewski. One day, and they will all produce the same slide came with early failures. It has made us Mike said to me, “Imagine if you could stained with the same two things – resilient; I think we recognize that we digitize this little slide and start to hematoxylin and eosin. We can now must continue to champion the idea to interrogate it computationally; think digitize those slides, upload the images sustain and grow interest. about the opportunities.” I picked it to the cloud, and analyze them from up and replied, “This little thing? That anywhere in the world. That global What are the proudest moments of should be trivial!” I didn’t realize that impact will be a great leveler for low- and your career so far? one small slide would produce gigabytes middle-income countries that can’t afford I am most proud of things that relate of data! That was just the beginning – expensive molecular diagnostic tests. to the visibility of the field as a whole, shortly thereafter, we published the first rather than to personal recognition. For paper on digital pathology. How do you balance your leadership example, in 2017, I was honored with the positions, research areas, and Institute of Electrical and Electronics How close are we to using algorithms personal interests? Engineers (IEEE) Engineering in in routine clinical practice? “There is a tide in the affairs of men. Medicine and Biology Society (EMBS) In the US, my sense is that many artificial Which taken at the flood, leads on to Technical Achievement Award. This intelligence (AI) and machine learning fortune; omitted, all the voyage of their was the first time it was awarded for algorithms will now receive 510(k) life is bound in shallows and in miseries. contributions to digital pathology, so I designation from the FDA, rather than On such a full sea are we now afloat, felt as though I was carrying the flag for the traditional premarket approval. and we must take the current when it the whole community. And that’s a big deal; we’ll see many serves, or lose our ventures.” This quote For me, the real accomplishment more submissions and much faster from Shakespeare’s play Julius Caesar will be when these technologies are turnaround times, leading to new reflects my career journey so far. I didn’t actually used to modulate treatments algorithms’ being approved within two deliberately seek out all of the fields I for patients – that’s the ultimate goal. to three months. However, despite currently work in, but when opportunities My present focus is on increasing the getting approval from the FDA, we presented themselves, I started moving visibility of digital and computational must achieve certain inflection points into different disease areas and “took the pathology, laying the platform to to see wide-scale deployment. current when it served.” transition these technologies to the Fundamentally, it’s about monetization. It also demonstrates my love for clinic on a large scale.

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