Original research in pathology: judgment, or evidence-based medicine?

Abstract

Pathology is both a medical specialty and an investigative scientific discipline, concerned with understanding the essential nature of human disease. Ultimately, pathology is accountable as well, as measured by the accuracy of our diagnoses and the resultant patient care outcomes. As such, we must consider the evidence base underlying our practices. Within the realm of Laboratory Medicine, extensive attention has been given to testing accuracy and precision. Critical examination of the evidence base supporting the clinical use of specific laboratory tests or technologies is a separate endeavor, to which specific attention must be given. In the case of anatomic pathology and more specifically surgical pathology, the expertise required to render a diagnosis is derived foremost from experience, both personal and literature-based. In the first instance, knowledge of the linkage between one's own diagnoses and individual patient outcomes is required, to validate the role of one's own interpretations in the clinical course of patients. Experience comes from seeing this linkage first hand, from which hopefully comes wisdom and, ultimately, good clinical judgment. In the second instance, reading the literature and learning from experts is required. Only a minority of the relevant literature is published in pathology journals to which one may subscribe. A substantial portion of major papers relevant to the practice of anatomic pathology are published in collateral clinical specialty journals devoted to specific disease areas or organs. Active effort is therefore required to seek out the literature beyond the domain of pathology journals. In examining the published literature, the essential question then becomes: Does the practice of anatomic pathology fulfill the tenets of 'evidence-based medicine' (EBM)? If the pinnacle of EBM is 'systematic review of randomized clinical trials, with or without meta-analysis', then anatomic pathology falls far short. Our published literature is largely observational in nature, with reports of case series (with or without statistical analysis) constituting the majority of our 'evidence base'. Moreover, anatomic pathology is subject to 'interobserver variation', and potentially to 'error'. Taken further, individual interpretation of tissue samples is not an objective endeavor, and it is not easy to fulfill the role of a 'gold standard'. Both for rendering of an overall interpretation, and for providing the semi-quantitative and quantitative numerical 'scores' which support evidence-based clinical treatment algorithms, the Pathologist has to exercise a high level of interpretive judgment. Nevertheless, the contribution of anatomic pathology to 'EBM' is remarkably strong. To the extent that our judgmental interpretations become data, our tissue interpretations become the arbiters of patient care management decisions. In a more global sense, we support highly successful cancer screening programs, and play critical roles in the multidisciplinary management of complex patients. The true error ...

Predicting impact factor one year in advance

“…In the field of pathology, the most cited papers tend to be published in high-impact disease-or organ-specific journals rather than pathology journals. 23 But IF is not the only factor authors consider. Speed and fairness of the review process are also important, and authors may prefer 'lower impact' journals like Lab Invest that have a quick and fair review process, free of undeservedly harsh reviews and uncertainties that engender delays in processing.…”

Terahertz pulsed spectroscopy of paraffin-embedded brain glioma

“…Unfortunately, experience is required to interpret paraffin-embedded brain samples, which is not an objective standard and is subject to interobserver variation or error. 8 Therefore, an objective, label-free, quantitative analysis technique for paraffin-embedded brain glioma is required. The terahertz (THz) spectroscopic technique, which is a novel medical imaging modality, 9 has received a attention for its benign nature (noninvasive and nonionizing) toward humans and its high sensitivity to biomolecules 10,11 and tissues.…”

Underutilization of Meta-analysis in Diagnostic Pathology

“…4 A specific guideline on conducting meta-analyses, namely, PRISMA (preferred reporting items for systematic reviews and meta-analyses), has been proposed to improve the quality of meta-analyses. 5 The number of published metaanalysis articles has been consistently increasing on a yearly basis owing to their gradually recognized value.…”

“…3 Generally, scientific literature is biased toward positive results, which makes meta-analyses particularly important because of their ability to authenticate and disprove individual studies. 4 A specific guideline on conducting meta-analyses, namely, PRISMA (preferred reporting items for systematic reviews and meta-analyses), has been proposed to improve the quality of meta-analyses. 5 The number of published metaanalysis articles has been consistently increasing on a yearly basis owing to their gradually recognized value.…”