Improving Communication and Clinicopathological Correlation with the Dermpath Lab

Clinicopathological correlation is the thought process that combines both gross and microscopic information to determine the most probable diagnosis. Being captivated by seeing the clinical image and pathology slide side by side is a common sensation for physicians feeling drawn to dermatology. This marriage of clinical and pathologic findings is also fundamental to resident and continuing medical education for dermatologists.

Clinicopathological correlation helps to confirm clinical suspicions and to provide more information in more obscure clinical cases. A nine-year study of nearly 4,000 skin biopsy specimens reported that 23.2 percent of the pathological diagnoses were inconsistent with the clinical diagnoses, suggesting room for diagnostic accuracy improvement. 

Studies suggest that improved clinical and pathologic correlation can help bridge that gap. By reviewing your own biopsy slides, providing accurate clinical information to your pathologist, and correlating together on challenging cases, your dermatology practice can continue to give patients the quality care they deserve.

Back to Your Roots: Reviewing Biopsy Slides

While only one out of five dermatologists reportedly read their own slides, most dermatologists prefer to review their slides. Dermatologists also receive significant training in dermatopathology during residency, more than twice that of their general pathology colleagues, and dermatology journals include more articles on dermatopathology. While avoiding the liability of reading their slides, many dermatologists enjoy keeping up their skills, confirming their clinical findings, or obtaining additional information needed to secure a diagnosis.

However, the traditional dermatopathology workflow may prevent dermatologists from reading or reviewing their own slides. Less than 25 percent of dermatologists have an in-house lab; if sending to an outside lab, it can take up to two weeks to turn around slides and even results. By using a lab that utilizes a digital pathology workflow, like PathologyWatch, dermatologists have quicker and easier access to review their own pathology slides or those of their colleagues, providing helpful information when planning surgical excisions or Mohs procedures, for example. 

Don’t Rule Out the Dermatopathology Requisition

Research studies emphasize the importance of clinical information in making accurate pathologic diagnoses, particularly in dermatopathology. In a recent Dialogues in Dermatology podcast, an important study was reviewed, indicating that dermatopathologic diagnostic accuracy is 53 percent when no clinical information is provided; accuracy improves to 78 percent when information is provided. Another study emphasized the importance of continued correlation in difficult cases, noting that repeat biopsy with additional CPC improved the concordance of clinical and pathologic diagnoses further. 

Providing dermoscopic images and essential diagnostic criteria for melanoma—like size, partial or complete biopsy, and evolution of a lesion—can also influence the pathologic diagnosis, likely resulting in improved patient outcomes. Dermatologists are particularly well-trained in providing helpful information on their requisition forms.

Tips on communicating effectively with the lab include having clinicians (rather than medical assistants) complete (or dictate) findings on the requisition, providing a helpful list of differential diagnoses, and giving other relevant clinical information and photographs. 

The Power of a Simple Phone Call

Lastly, in challenging cases, or simply where vital information was left out, a quick text or phone call with an experienced dermatopathologist can be invaluable in clinching the diagnosis. 

Sometimes you may find that important clinical information, such as a genetic disease or patient age, is left off the requisition, potentially skewing a pathologic diagnosis. This critical information needs to be passed on to the consultant, just as key clinical information from a patient may help in assuring your clinical diagnosis. 

If a dermatologist reads their own slides, consulting with a network of expert dermatopathologists like PathologyWatch on difficult cases can improve diagnostic accuracy.

While physicians are often pressed for time in the clinic, taking time to review pathology slides, providing accurate information to your dermatopathology lab, and interacting with consultants directly to make important clinicopathological correlations will ultimately result in time savings and better patient outcomes by making an accurate diagnosis. 

Can You Identify an Epidermal Inclusion Cyst?

Images shown are not intended to be used for the diagnosis or treatment of a disease or condition.

An epidermal inclusion cyst is the most common cutaneous cyst, often called a sebaceous cyst, which is actually a misnomer. The center of epidermoid cysts almost always contains keratin and not sebum. This keratin often has a “cheesy” appearance. They also do not originate from sebaceous glands; therefore, epidermal inclusion cysts are not truly sebaceous cysts.

In this episode of Digital Dermatopathology Digest, Rajni Mandal, MD, dermatopathologist at PathologyWatch, explains the common characteristics of an epidermal inclusion cyst.

“An epidermal inclusion cyst has an epidermis-like lining with a granular layer,” explains Mandal—as opposed to a nongranular layer, seen in a pilar cyst or steatocystoma. “Sometimes there is a connection with the overlying epidermis known as a punctum.” 

Mandal goes on to mention features, the lack of which can help distinguish epidermal inclusion cysts from other common cysts, including dermoid, pilar, and vellus cysts.

Ruling Out a Dermoid Cyst

A dermoid cyst has cell walls that contain hair follicles, sweat glands, and other multiple adnexal skin structures. By contrast, an epidermal inclusion cyst lacks adnexal structures.

Ruling Out a Pilar Cyst

What makes a pilar cyst unique is that it arises from the epithelium between the sebaceous gland and the arrector pili muscle. They are lined by stratified squamous epithelium without a granular cell layer, similar to what is seen in the outer root sheath of the hair follicle, and filled with keratin.

Often presenting themselves as a round, dome-like bump, a pilar cyst is typically firm to the touch but not painful for the patient, while an epidermal inclusion cyst may become inflamed and painful to the touch. 

Ruling Out a Vellus Hair Cyst

If small hairs appear in the vellum, with small red or brown bumps and a smooth dome shape, and often occur over the sternum, it is likely a vellus hair cyst.

Whether you’re in residency, studying for board exams, or a practicing dermatologist looking to stay sharp, the Digital Dermatopathology Digest video series is your informational and convenient source for dermatopathology review. Find the full series here.

PathologyWatch Raises $2M in Extension Funds to Bolster Pathology AI Research

Funding led by Neue Fund and BioVentures Investors to extend pathology AI research and allow strategic life science and AI investors into the round.

SALT LAKE CITY, December 16, 2020—PathologyWatch has announced $2M in extension funding from Neue Fund, BioVentures GmbH, Lateral Capital, BeniVC and Sky Ventures. PathologyWatch will direct the capital towards digital dermatopathology development and scaling the laboratory system to extend pathology AI research and to allow additional strategic life science and AI investors into the round. 

Following $5M series A funding, the $2M extension brings the total capital PathologyWatch has raised to $7M series A. The company has raised over $10M total capital to date. The extension funds will bolster operations to facilitate larger clients and continue progress in developing innovative technology, including the extension of artificial intelligence research for various cancer lines.

“It’s thrilling to see our year-over-year volume triple,” said Dan Lambert, Pathlogywatch CEO and cofounder. “With that increase comes the demand to improve algorithms, build out operational volume, increase lab capacity and augment staffing to ensure our clients achieve optimal patient outcomes.”

PathologyWatch specializes in providing dermatology clinics with fully interfaced EMR reporting and 24/7 access to digital slides. In addition to more efficient workflows and faster turnaround times, clients have direct access to leading dermatopathologists.

“In the digital dermatopathology universe, PathologyWatch stands apart with cutting-edge technology and services designed to improve the human experience,” noted Cofield Mundi of Neue Fund. “Our confidence couldn’t be higher in their ingenuity and devotion to advancing the digital dermatopathology landscape.”

About PathologyWatch

PathologyWatch is the groundbreaking leader of digital dermatopathology services. Through these services, dermatology clinics, hospitals and laboratories can improve operational efficiency by speeding up workflow and enhancing patient outcomes by utilizing the PathologyWatch expert professional team and partner laboratory services. This can facilitate best-in-class reads and, in some cases, enable additional revenue to the practice by in-housing pathology. With an intuitive and easy-to-implement digital pathology solution that includes access to top-tier dermatopathologists and a streamlined clinical workflow that interfaces directly into the EMR, PathologyWatch brilliantly combines state-of-the-art technology and clinical decision-making to deliver unprecedented patient care.

View the original release.

PathologyWatch Announces Key Hire to Bolster Digital Dermatopathology Practice

Darren Whittemore, DO, joins the PathologyWatch team to support the delivery of optimal patient outcomes.

SALT LAKE CITY—DECEMBER 8, 2020—PathologyWatch, a full-service digital dermatopathology solution, is pleased to welcome Dr. Darren Whittemore, DO, to the growing PathologyWatch family. A qualified and respected dermatopathologist, Whittemore will be instrumental in establishing processes to ensure dermatology clinics receive the highest level of digital pathology services.  

Board certified in anatomic and clinical pathology and dermatopathology, Whittemore was fellowship-trained at the University of Texas Health Science Center after completing his residency at the combined US Air Force Wilford Hall Medical Center/Brooke Army Medical Center program.

“Dermatopathologists play a critical role in a patient’s recommended treatment,” said Dan Lambert, CEO and cofounder of PathologyWatch. “With expertise and attention to detail, Dr. Whittemore utilizes innovative advances in digital pathology to deliver the highest quality of care and efficiency to patients.”

Whittemore brings extensive subspecialty experience and proven abilities in diagnosing alopecia cases to PathologyWatch. Also, he embraces new technologies and the growing role they play in understanding the pathogenesis of diseases. 

“With advantages that include enhanced clinicopathologic correlation, improved turnaround time and paperless, electronic workflows, digital dermatopathology represents the future of the dermatology industry,” Whittemore said. “Joining PathologyWatch places me in the heart of this burgeoning technology with individuals who are committed to helping dermatology clinics deliver industry-leading care to their patients.”

For more information on PathologyWatch, please visit pathologywatch.com.

About PathologyWatch
PathologyWatch is the groundbreaking leader of digital dermatopathology services. Through these services, dermatology clinics, hospitals and laboratories can improve operational efficiency by speeding up workflow and enhancing patient outcomes by utilizing the PathologyWatch expert professional team and partner laboratory services. This can facilitate best-in-class reads and, in some cases, enable additional revenue to the practice by in-housing pathology. With an intuitive and easy-to-implement digital pathology solution that includes access to top-tier dermatopathologists and a streamlined clinical workflow that interfaces directly into the EMR, PathologyWatch brilliantly combines state-of-the-art technology and clinical decision-making to deliver unprecedented patient care.

View the original release.

PathologyWatch Makes Your Dermpath Workflow Easy as Pie

The healthcare industry is busier than ever. While patients are grateful for quality dermatology care, staying competitive in the marketplace can be challenging for those just starting out or looking to expand their practice.

Here are three ways PathologyWatch can streamline your dermpath workflow to be easy as pie:

Ensure Tantalizing Turnaround Times on Lab Results

Patient satisfaction and health outcomes can be impacted by long turnaround times, mainly when a patient’s condition requires a quick response to starting treatment. If this is a new practice, a great way to reduce overhead expenses without compromising accuracy or quality patient care is to partner with a digital pathology service provider.

There are at least two benefits of this partnership. First, studies show that using a lab with experience in digital pathology to read slides improves your chances of receiving a result within 48 hours. The most important asset you can share with your patients after their examination or procedure is information. When you have a solid partnership with an experienced lab, tracking the status of samples and obtaining results quickly is meaningful to patients.

Second, since slides are digitized, they can be shared among experts. Best of all, your patients will display an attitude of gratitude as they view their results and discuss treatment options with a better understanding of their case.

Serve Up an EMR Interface

Studies show that three out of five dermatologists have already adopted EMR technology, a logical choice for a busy dermatology office. “When a dermatology practice sees 40–50 patients per day, relying on paper to manage the workflow can create inefficiencies and impact the time to deliver results to patients,” explains April Larson, MD.

But not all EMR technology performs the same or cooperates with other systems. “To move beyond the challenges of paper, dermatopathology lab services like PathlogyWatch can build an HL7 interface directly to the dermatology clinic’s EMR to optimize margins of error and turnaround times, preserving precious staff and provider time,” adds Larson.

PathologyWatch utilizes an HL7 interface, enabling the lab to quickly send reports directly to your EMR of choice. In some instances, it populates a patient’s diagnosis and treatment details. This means all of the patient’s information is centralized and easily accessible. “The adoption of technology can save the staff from menial, time-consuming tasks and allow them to participate more in patient care, which increases both staff and patient satisfaction,” says Larson.

Provide Support a la Mode

Every system has hiccups and challenges. Find a lab with friendly staff members who are responsive to patient billing issues, technical problems, or just general questions. This makes it easy and comfortable when your staff unavoidably need to reach out for help with patient care in the dermatopathology arena. This is especially important because your team often takes the heat from unhappy patients, so it helps when your ancillary partners are eager to help and relieve those burdens.

Running a dermatology practice is an incredibly rewarding experience. By finding supportive partners, updating medical records processes that streamline work, and partnering with innovative services that offer both accurate and speedy results for patients, your dermpath workflow will be the icing on the “pie.”