PATHOLOGY IS CONSIDERED to be the ‘doctrine of diseases’. It is a specialisation that deals with laboratory examination, analysis and testing of samples of body tissues and fluids, thereby enabling doctors and clinicians to diagnose the patient accurately and prescribe treatment accordingly.
“In India, it is only now that we are taking off from conventional pathology to the new generation pathology that is practised in the west, which is largely based on personalised medicine,” says Dr G.S.K. Velu, chairman and managing director, Trivitron Group of Companies, which is based in Chennai. “Going forward, pathology will not just be a support function anymore, which is primarily used for diagnosis; it will be applied equally to prognosis as well as treatment.” Also, technology will help widen the range of home testing kits, moving beyond glucose testing to include profile testing like cardiac and lipid profile, he says.
The three big technological leaps in recent years, say experts, have been the focus on personalised medicine, genomics (which includes pharmacogenomics) and molecular diagnostics. “Though these are complicated advancements, their execution will depend on a healthy partnership between clinicians and lab technicians,” says Velu.
To put it simply, it is the digitisation of pathology across its multiple branches—including haematology, histopathology, clinical biochemistry, immunology and microbiology—which aims to simplify the process of lab testing and diagnosis, reduce timelines by a huge margin and give results that are more accurate than ever before.
“In histopathology, the advantage of personalised or precision medicine is turning around the way cancer treatment is approached,” says Dr Imran G.M., consultant histopathologist, Aster CMI Hospital, Bengaluru. Earlier clinicians would practise conventional diagnosis, which involved taking the tumour issue, seeing it under the microscope and making a broad cancer diagnosis. But now, there is sub-categorisation of each cancer based on a person’s genetic makeup, explains Imran. Just like no two persons are the same, no two cancers are the same. Also, the same cancer type behaves differently in different people.
“So we take the tumour tissues and extract the DNA and RNA from it and sequence them to see the type of mutation in the tumour, which is called genetic profiling of the tumour,” explains Imran. “If some specific mutations are identified, the patient can then be given targeted therapies for that particular mutation only.” That is how pharmacogenomics works, he adds.
Moreover, next generation sequencing has made it easier to carry out mutation analysis for multiple genes at a time, rather than just one gene at one time. So, patients are able to get the whole genome profiling within a few days at less cost.
In the area of digital pathology, live digital microscope is the latest example of innovation, through which high-resolution snapshots can be shared live. Also, one can view several images on multi-view screens at the same time. For the patient, this means a substantial reduction in processing time.
“In our hospital, the laboratory has fully automated, state-of-the-art, high throughput analysers in all its departments, which enables us to provide accurate and timely reports to our patients,” says Dr Lakshmi Vaswani, assistant pathologist at Bhatia Hospital, Mumbai. “We have the Sysmex XN 1000 for seven-part differential counts in complete blood examinations, giving a more detailed, comprehensive report. It also has the immature platelet count feature, which is particularly useful for physicians in the monsoon season where an increase in malaria and dengue cases result in low platelet counts. We have the combined biochemistry and immunology analyser and the cobas 6000, which can also perform a large panel of tests.”
Hospitals are also undertaking newer initiatives to ensure patient satisfaction. “Even though we have a blood collection OPD that is open from 7am to 10pm, the main pathology laboratory is functional 24/7,” says Vaswani. “This is particularly useful for patients who need to check blood sugars early in the morning.” Patients are informed about the availability of reports via SMS and email. “We also track the turnaround time of our in-house tests every month, so we can ensure that our patients are receiving reports on time,” she says.
While Dr Camilla Rodrigues, consultant microbiologist and chairperson of the infection control committee of Hinduja hospital in Mumbai, agrees that digital photography has changed the face of pathology, she adds: “Telepathology, which is used for diagnostic and consultation purposes and is already in practice around the world, is also of utmost importance. In our hospital, we are equipped with the latest technology in the area of pathology and histopathology and are leading in the area of research and innovation.”
However, the government needs to crack down on illegal pathology laboratories across the country. In Maharashtra, for instance, there are around 8,000 bogus pathology labs, as per a calling attention notice in the lower house of the state assembly. “These labs cheat almost one lakh patients every day by charging good money for giving incorrect findings. The reports are not countersigned by qualified postgraduate doctors,” reads the notice. During the legislative session, Minister of State for Medical Education Ravindra Chavan assured that the government resolution to take action against illegal pathology labs will be reissued.