The Men Behind the Microscopes: Pathologists play a vital role in cancer diagnosis and research

June 25, 2016
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Dr. John Jalas (left) and Dr. David Krasne assist Institute researchers.
They work mostly out of sight, in the quiet of a laboratory—surrounded by microscopes, test tubes, glass slides and computers. Some patients never meet a pathologist and most are hard-pressed to explain what a pathologist does.

But the cancer pathologists on staff at the John Wayne Cancer Institute are not behind-the-scenes guys. David L. Krasne, MD, and John R. Jalas, MD, PhD, are Saint John’s Health Center pathologists who provide critical support for cancer diagnosis and research at the Institute, along with other members of the Saint John’s pathology unit.

“In surgical oncology, we are only as good as our pathologists are,” says Anton J. Bilchik, MD, PhD, professor of surgery and the Institute’s chief of medicine. “We depend on them to help develop therapeutic strategies. We’re very fortunate to have pathologists who are talented, accessible and work in a very collaborative way.”

“We’re the disease sleuths—the diagnosticians. The subsequent treatment and prognosis is based on the pathology report. So we have to get the right answers.” – Dr. John Jalas

However, both Dr. Krasne and Dr. Jalas say they too are the lucky ones. Dr. Krasne, a professor of pathology at the Institute and medical director of the pathology department and clinical laboratory at Saint John’s, worked with Institute researchers in the 1990s to help develop the sentinel node biopsy techniques for breast cancer staging, techniques now used as standard care around the world.

“The reason we collaborate well with the Institute is because most of us on the pathology team have an academic background,” says Dr. Krasne, who joined the Institute in 1990. “Everyone is from one of the top pathology training programs in the country.”

Dr. Jalas, who joined the Health Center more than five years ago after completing a fellowship in surgical pathology at the University of California, San Francisco, was searching for a place where he could perform clinical services and research.

“It’s a very unique set-up here,” says Dr. Jalas, who is an assistant professor of pathology at the Institute. “It’s wonderful for someone like me because of my research background.”

In their work at the Health Center, Dr. Krasne and Dr. Jalas are part of a group of pathologists who examine blood and tissue samples for a variety of both cancerous and noncancerous conditions. “We’re the disease sleuths—the diagnosticians. The subsequent treatment and prognosis is based on the pathology report. So we have to get the right answers,” Dr. Jalas says.
In his years at the helm, Dr. Krasne has created a department that prides itself in accurate work and strong relationships.

“What most people do not realize is what a big difference it can make regarding who the pathologist is on a case,” he says. Pathologists have to work diligently and become skilled across a broad range of conditions to ensure errors are not made, he says. “In that regard a critical criterion for our pathology department is we’re all very strong generalists.”

But the staff also possesses focused expertise in many areas including neuropathology, diseases of the blood and lymph nodes, breast, gastrointestinal system, urologic oncology, gynecologic pathology, cutaneous and melanocytic tumors of the skin, cytologic diagnosis and others. “We work as a team. Our aggregate knowledge and experience is applied to every patient,” Dr. Krasne says.

In their roles at the Institute, Dr. Krasne and Dr. Jalas support the research team by providing tissue samples for studies and participating in various research projects. Dr. Jalas is currently working with Dr. Bilchik on immunoprofiling of colon cancer and the cancer staging system.

“Basically we’re trying to look at how the body is reacting to the cancer,” he says. “Based on that, we can work to predict how patients will do. Maybe some patients who get chemotherapy don’t need it. That’s very exciting research.”

Dr. Krasne is currently collaborating with surgical oncology fellow Kelly T. Huynh, MD, on research to determine if a certain type of melanoma may not require a sentinel node biopsy to see if the cancer has spread beyond the primary tumor.

Both Dr. Jalas and Dr. Krasne, and the entire pathology team at Saint John’s also teach the surgical oncology fellows. The fellows are urged to look beyond the cancer pathology report. “The principle we instill in them is that they need to know who the pathologist is and have a familiarity with their work; it has to be someone they can talk to and trust,” Dr. Krasne says.

Today cancer diagnosis and treatment is increasingly based on assessing the genetic underpinnings of the tumor. Gene sequencing technology can tell oncologists things about a tumor that can’t be seen with a microscope.

“Part of what we do hasn’t changed in 150 years: processing tissue, making slides and looking at it with a microscope,” Dr. Jalas notes. “But now we’re moving to next-generation sequencing. With sequencing information, we’ll be able to say this particular cancer will respond best to this particular drug.”

Yet neither Dr. Krasne nor Dr. Jalas expects to have their expertise replaced any time soon. “There is still immense value from the information you get from looking at something under a microscope, and most diseases and cancers are still defined by their microscopic appearance,” says Dr. Krasne.