Some services can analyze and evaluate urologic specimens better than others. Here are a few pointers that could help you decide where to send your patients’ specimens.
What do you know about the pathologists analyzing your patients’ specimens? Are you sure the person signing off on the report is qualified to do so? How many other slides has the pathologist looked at that day? That year? Does the lab pay its pathologists using a system that encourages productivity beyond the point of proficiency and into the realm where quantity is more important than quality?
If it has been awhile since you’ve considered these questions, perhaps it’s time to reassess how and where you execute the clinical pathology needs of your patients. Urologists who are unsure about which qualities to seek in a lab may find all the answers they need in the firm stance of M. Nasar Qureshi, MD, PhD, a uropathologist who heads QDx Pathology Services in Cranford, N.J., a full-service laboratory that also sets up in-house pathology laboratories.
“Few pathology laboratories have uropathology expertise,” he warns. “A lot of labs have gotten on the bandwagon of uropathology because that’s what the marketplace holds, but most of them do not have uropathologists. I would really urge the urologist to be very clear on the credentials of the pathologist signing out the case.”
Now that so many more men undergo prostate screening at a relatively young age, often when cancer is in a very early stage—the need for a uropathologist’s eye is more critical than ever, according to Dr. Qureshi. “It’s one thing to find cancer in half the prostate of an 80-year-old man. The trick is not in finding wall-to-wall cancer but in looking at a 52-year-old patient and recognizing the three atypical glands, which may turn out to be cancer when pursued.”
Just do the math, Dr. Qureshi says. “The progression rate of prostate cancer from start to full-fledged disease is eight to 10 years. This man’s disease is getting picked up at an extremely early stage where maybe 1% of his prostate is cancerous. He’s looking at a 99% chance of cure. But if the pathologist misses it, he’s coming back in five years with a full-fledged cancer, and perhaps a $5 million lawsuit against you.”
Dr. Qureshi says that this illustrates how the onus on the pathologist has increased as the changes in criteria for prostate screening have led to earlier detection. “Clinicians are looking for definitive guidance, and that is where you need a specialized uropathologist,” he explains.
Unlike many larger labs that pay their pathologists based on a high number of slides to be read each day, Dr. Qureshi takes a much different approach with his staff—one that he believes is crucial for quality assurance purposes. “I’ll stop a pathologist who does more than 80 prostate slides per day, because I know there comes a saturation point where they’re going to be swayed and get tired or just start saying, ‘This must be benign.’ If you’re going to do 150 slides a day, I’m sorry, but you’re going to miss cancer.”