The department of pathology and laboratory medicine at the University of Florida College of Medicine – Jacksonville has strived to change the culture of pathology. It has evolved from one consisting of passive interpreters of microscopic images and lab results to one featuring partners in clinical care, research and education.

AN EVOLVING DISCIPLINE

During the past several decades, substantial progress has been made in science and technology, resulting in advances in diagnoses and therapies as well as improvements in patient outcomes. Pathologists have played a central role in this progress. However, the value of pathologists has remained under-recognized among the public and even among colleagues. The traditional image of pathologists and laboratorians serving behind the scenes and only producing pathology reports had to change. They needed to be recognized as those who define the disease, characterize the molecular and genetic basis of pathogenesis, navigate the course of treatment and predict the future.

It was critical to bring pathologists and laboratorians to the forefront of medicine and provide opportunities for integration of this discipline with others. This required expansion of our department by building a state-of-the-art laboratory, increasing the number of faculty and residents and establishing cytopathology, transfusion medicine and breast pathology fellowship programs.

The department features 13 faculty members, eight pathology residents, three fellows and 110 staff members. To create opportunities for each faculty member to interact within the area of his or her choice and to accommodate the needs of others, we introduced subspecialties. We placed each faculty in charge of their particular area of interest, allowing them to work closely with faculty and trainees from other disciplines.

A culture of planning, trust and strong communication ensures faculty members can effectively respond to inquiries from colleagues about patient care and research. In addition, we have integrated our educational activities with other disciplines via several inter- and intradepartmental conferences. We are also involved with various multidisciplinary tumor boards.

Our department is an international house, with faculty, trainees and staff coming from various parts of the world and representing different ethnicities, genders, religions, customs and backgrounds.  Therefore, we ensure the working environment reflects respect for diversity, individuality and transparency and the opportunity for everyone to equally benefit from the available resources.

Visit this link to learn more about our department’s talented and experienced faculty members.

EDUCATION

For many years, pathology residents and fellows in cytopathology, breast pathology and transfusion medicine have enjoyed the department’s supportive environment. Several former residents and fellows are now nationally recognized leaders in the field. The strength of our training programs is in our intention to prepare residents and fellows to serve as serious patient advocates by exercising cost containment in rendering timely and accurate diagnoses.

Our training programs receive continuous accreditation because of outstanding leadership. Anwer Siddiqi, M.D., is director of the pathology residency program, with Agnes Aysola, M.D., serving as assistant director. Aysola is also director of the transfusion medicine fellowship. Meanwhile, I have guided the department’s training efforts for 25 years and currently serve as director of the cytopathology and breast pathology fellowship programs.

RESEARCH

The department’s faculty, residents and fellows have been engaged in clinically oriented research projects, with numerous publications in major scientific journals, as well as presentations at national and international meetings. The focus of research in our department has evolved around the study of morphology and the pattern of biomarker expressions in solid tumors. Progress has been made despite a lack of access to a basic science laboratory and the inability to enroll patients in clinical trials.

In 1984, we established the tumor analysis laboratory and pioneered the concept of studying the status of hormone receptors in fine-needle aspiration biopsies. At that time, the tumor analysis laboratory at what was then University Medical Center was the only one of its kind in the nation and served as a reference lab for others. This laboratory was perhaps our first attempt to introduce the concept of “precision medicine,” a key component of personalized medicine. In light of assessing the status of hormone receptors in aspirates, the laboratory was instrumental in the foundation of a national clinical trial to start presurgical chemotherapy in breast cancer patients.

In addition, the laboratory played a role in defining the cytomorphology of high-risk premalignant breast disease and establishing a cytologic grading system called the Masood Cytology Index. This index was the only surrogate endpoint biomarker that created opportunities for use in National Cancer Institute-funded chemoprevention trials. Defining cytomorphology as a morphologic breast cancer risk predictor resulted in me being named as one of the Top 20 Most Influential Oncology Professors in the World in 2012.

Our department’s future research efforts will focus on the use of next-generation sequencing, a newer technology. We plan to conduct whole genome sequencing of several hundred cancer samples in one of our studies. The focus will be on health disparities among black and white patients, with the aim to find any genetic differences between tumors that provide answers and potentially lead to different therapies.

The newly opened CLIA-certified next-generation sequencing laboratory, under the direction of Brett Baskovich, M.D., will also provide cancer testing, with a 170-gene cancer panel for patients with different malignancies. The laboratory offers a broad range of uses, including cancer therapies, diagnosis of genetic syndromes, pharmacogenetics and microbiology.

On a related note, our field is the only Clinical Laboratory Improvement Amendments-regulated discipline in medicine and is required to comply with guidelines established by several regulatory organizations at the federal and state levels. This requires qualified faculty oversight for each area of pathology and laboratory services.

Our department has much responsibility, embraces its uniqueness and remains eager to expand and enhance its activities at UF Health.