From the CAP Cytopathology Committee;
Jordan Paul Reynolds, MD, Derek B. Allison, MD, Editors
Varsha Manucha, MD
Martin J. Magers, MD
January 2025—The traditional image of a pathologist is often that of a scientist working in a laboratory, handling chemical solutions, or peering through a microscope. Over the past decade, pathologists, including those specializing in cytopathology, have increasingly moved beyond those confines, taking on more prominent roles in patient-facing care. This article explores the various ways cytopathologists are expanding their roles, engaging directly with patients and physicians and positioning themselves at the forefront of the management team.
Fine-needle aspiration. Fine-needle aspiration is a minimally invasive, cost-effective method that enables rapid diagnosis of lesions that might otherwise be challenging to access. Clinicians and radiologists perform FNAs frequently, but studies have demonstrated that tissue adequacy and diagnostic accuracy are highest when a pathologist performs the procedure.
Traditionally, pathologists performed FNAs using palpation guidance for superficial, palpable lesions. However, there is a growing trend toward cytopathologists performing ultrasound-guided FNAs. Cytopathologists acquire the skill set during training and fellowships or through hands-on courses offered by organizations such as the CAP, American Society of Cytopathology, and American Society for Clinical Pathology.
The pathologist’s role in FNA encompasses gathering patient history, performing focused physical exams, evaluating patient risk factors, conducting the FNA, and providing on-site adequacy evaluations. Their comprehensive involvement ensures safety, adequate sample collection, higher diagnostic rates, and prompt preliminary diagnoses, enabling rapid patient management. In settings such as one-stop clinics, where clinical, radiological, and morphological examinations are integrated, the direct participation of cytopathologists enhances patient care and reinforces their position as indispensable members of the health care team. FNA is an opportunity for practice development, fostering greater patient-pathologist interactions and expanding the use of pathology services.
Pathology consultation clinics. Traditionally, the training of pathologists has been centered on microscopic diagnosis aided by immunohistochemistry and molecular tests. It is precisely this training that uniquely positions the pathologist to explain to patients the why and how of a diagnosis. The patient-pathologist consultation program is designed to educate patients about the pathology of their disease, equipping, enabling, and empowering them to make informed decisions about their health and treatment. This concept holds even greater significance today in the era of personalized medicine, which requires patient engagement in decision-making, facilitated by a better understanding of the disease process.
In pathology consultation clinics, pathologists meet with patients in an outpatient setting to review pathology findings using clear, nontechnical language. This approach helps patients understand their conditions, alleviates anxiety, and improves treatment compliance. Furthermore, the direct interaction with the pathologist serves to dispel misinformation that the patient may have encountered through social media and internet searches. A multisite quality improvement study showed that patients reported personalized clinical encounters with pathologists improved their understanding of their health condition and their satisfaction with their care experience. These interactions can be highly rewarding for pathologists, serving as a reminder of their motivation to become physicians.
The concept of a pathology consultation clinic, the first of which was implemented in 2017 in Massachusetts, has gained attention and received endorsements from national societies like the CAP and ASCP. Cytopathologists, owing to their direct involvement in FNA procedures, are uniquely positioned to offer similar consultations. By being present during clinical FNAs to provide rapid on-site evaluations, cytopathologists not only enhance diagnostic accuracy but also can offer consultations to their clinical colleagues, thereby strengthening interdisciplinary communication and improving patient care.