Pathologists: Medicine’s private investigators

  • Published
  • By Merrie Schilter-Lowe
  • 60th Air Mobility Wing Public Affairs

TRAVIS AIR FORCE BASE, Calif. – As one of six pathologists at David Grant USAF Medical Center, Lt. Col. (Dr.) Joseph McDermott, 60th Medical Group at Travis Air Force Base, California, spends a great deal of time peering into microscopes.  

“I always dreamed of a career that involved looking through a microscope,” said McDermott.  “My grandfather was a botany professor.” 

Pathologists are board-certified medical doctors or doctors of osteopathy who analyze blood, tissue, cells and body fluids to determine the cause, origin and nature of disease or death.  They also monitor testing to answer questions a provider may have about a specimen. 

Military laboratories are accredited by the College of American Pathologists so military pathologists are required to be laboratory medical directors, said McDermott who is the director of the laboratories at Edwards AFB, California, and Beale AFB, California.

Pathologists also must be very good investigators since patient treatment and recovery depends on their accuracy.

“About 80 percent of a diagnosis is made in the lab,” said McDermott. 

A radiologist may see a lump in breast tissue, but only a pathologist can determine if it’s a cyst or tumor, he said.   

Pathology is an exact science, and the doctors at DGMC are well-trained for it. A four-year   undergraduate degree that includes prerequisites for medical school,  four years of medical school, four years of residency training and one to three years of fellowship training in a subspecialty area are all required to be a certified pathologist.

Enlisted technicians also require rigorous training. 

“For this job, you need to have decent high school grades in algebra, chemistry and English,” said Senior Airman Maria Grantham, 60th MDG histology technician.  “Then you have to graduate from (technical) school, which is nine months.”

Technicians spend another 15 months under close supervision in on-the-job training.

“I knew that pathologists were involved with autopsies and cancers when I enlisted, but I didn’t realize how much is involved in this job,” said Grantham, who is one of four histology technicians at DGMC.  “I’ve been in the Air Force 2 1/2 years and I am definitely happy I put this on my list (of career choices).”

As a histology technician, Grantham prepares specimens for the pathologists, which includes staining, cutting and sealing specimens under glass for protection. 

“We look at anything that is removed from a patient such as a mole or a mass,” she said. 

The pathology laboratory is divided into two sections: anatomic and clinical.  Anatomic pathology is concerned with the analysis of cell, tissue, and organ specimens, and forensics.  The clinical side includes chemistry, the blood bank and blood transfusion services, hematology and microbiology. 

Although most pathologists perform autopsies, DGMC has contracted out this function.

“Most pathology jobs are in anatomic pathology, but most of us here are trained on both sides and get certified in both,” said Col. (Dr.) James Sanderson, 60th MDG medical director of pathology and the clinical laboratory.

As medical director, Sanderson not only tests and analyzes specimens, he also is responsible for all regulatory issues and performs quality checks for other pathologists on difficult cases.    

“When I’m the pathologist on duty, I examine frozen sections, which are inter-operative consultations,” said Sanderson.  “We interpret blood smears brought to us from the clinical lab for review and we do cytology.”

Cytology is the study of cells.

“We look at cells in body fluids,” said Elizabeth Hendrickson, 60th MDG histology and cytology laboratory technician, who has worked in the DGMC pathology laboratory for 20 years. 

Hendrickson manages a mobile pathology processing station that she takes on site to procedures.

“I go to (ear, nose and throat) if the doctor is removing fluids from the thyroid or a lump from someone’s neck,” said Hendrickson.  “I’ll go to radiology or the operating room for a lung biopsy. I take the fluid, place it on a slide and stain it.  Then the pathologist comes in and looks at the cells under the microscope. ”

Hendrickson said she processes fluids quickly so the pathologist can determine on site if there are enough cells in it to make a diagnosis and if the cells are actually from the targeted body part, such as the glands, a tumor or kidney.     

Some cases require rapid diagnosis, such as when the patient is in surgery. 

“We have a special machine that can process the specimen in about 20 minutes,” said Sanderson.  “The intent is that when the surgeon finishes the procedure, the patient doesn’t have to return to the OR for a biopsy.”

Normally, when specimens come to the laboratory, a technician sorts them, enters the information into the laboratory database, affixes a barcoded label to the container with patient information and the required tests and then processes it.     

Processing may include mixing specimens to ensure that all the components are evenly distributed or spinning them in a centrifuge to separate the serum and plasma layer from the red cells.  Once this step is completed, the technician will forward the specimen to either pathology or the clinical laboratory for testing.

The pathologist will weigh and measure the specimen and perform a visual inspection, describing the color, texture and any imperfections–a process called grossing.  Their observations are recorded as part of the pathology report that will be sent to the requesting provider. 

The specimen is then stained, examined under a microscope and placed in a small plastic cassette. 

“Cassettes are processed through a series of chemicals, which can take six to 12 hours,” said Master Sgt. Asante Duncan, 60th MDG pathology section chief.  

Specimens must be cut extremely thin before mounting on a slide, which means they must be frozen or embedded in paraffin wax.  Then the specimen is cut into thin ribbons, placed on a slide and stained. 

“The process can take six to eight hours,” said Duncan.  “The slide is covered with a thin layer of glass and sent to the pathologist.”

If a specimen is malignant, the pathologist will examine dozens of slides under the microscope to determine the type of cancer and how aggressive it is. 

“Some tumors are easily identifiable, but there are some that are so unusual or rare, we send them to an outside lab and the Joint Pathology Center in (Washington) D.C.,” said Sanderson. 

The JPC is the federal government’s premier pathology reference center, providing subspecialty training, consultation and sole veterinary pathology training for all military sources.  The JPC also operates the Department of Defense’s cancer registry system.

Pathologists usually have some idea of what to look for when they receive the specimen.

”Sometimes we get the clinical history with the specimen,” said Sanderson.    

DGMC also processes specimens from other military installations, including Nellis AFB, Nevada, McDill AFB, Florida, and Kadena Air Base, Japan.

Most specimens take two days to process and analyze, but a complex case could take up to 10 days.

“A lot goes on behind the scenes in this facility,” said Sanderson.  “We’re kind of invisible, but what happens in this facility couldn’t happen unless we’re here doing our jobs.”