Baptist Health Pathologist is Among First Physicians in Nation to Earn New Certification | Health
Pathologist Dayan Sandler, MD, has spent much of the last 18 years of her career evaluating breast core biopsies for cancer, viewing as many as 15 breast biopsy specimens a day.
Dr. Sandler’s philosophy is simple: The more breast cancer you see, the better you are at evaluating it.
Still, when the College of American Pathologists (CAP) offered a new certification course in Breast Predictive Factors Testing – the process of testing tissue to predict how best to treat it – Dr. Sandler signed up for one of the very first classes. Subsequently, she recently became among the nation’s first pathologists to receive the new CAP certification.
“This is raising the bar for the work that pathologists do,” says Dr. Sandler, who serves as laboratory medical director for Baptist Health, for Baptist Medical Center Downtown, Wolfson Children’s Hospital, and Baptist Medical Center Nassau.
In 2007, the College of American Pathologists and the American Society of Clinical Oncology reported that a significant percentage of U.S. testing for markers that predict hormone therapy’s effectiveness may be inaccurate.
Dr. Sandler says every step in the testing process, from collecting and preparing a biopsy specimen to evaluating and communicating the results, is important in preventing errors. She took CAP’s new three-day certification course in November 2010 and then completed several assignments to test her theoretical and practical knowledge of testing methods, interpretation, pitfalls and safeguards.
She said the course confirmed for her that Baptist Health’s Breast Prognostic Marker Laboratory already has in place many overlapping safeguards to ensure correct results for each patient.
“I evaluate one patient at a time, with the idea that every result is very important for the treatment decisions for each and every patient,” Dr. Sandler says.
Patients and their physicians rely heavily on pathology reports when deciding if and how to treat a patient for breast cancer.
A pathologist can determine:
- The type of cancer
- Whether it is invasive
- How aggressively it is growing
- How close the cancer is to the margin of the tissue removed by the surgeon
- The likelihood that the cancer will respond to hormone therapy
- Whether the cancer has spread to the lymph nodes
The new certification program is designed to promote appropriate treatment by ensuring accurate evaluation and interpretation of breast cancer predictive factors, including estrogen and progesterone receptors and Her2neu evaluation. These test results are important in determining which therapies will be considered.
Pathologists who obtain the certification are providing patients with the assurance that their test results are accurate, so patients can feel more confident that their physician’s treatment decisions also will be accurate.
More than a decade ago, Dr. Sandler also was one of the first pathologists to use image analysis. This technology, located at Baptist Downtown, aids in the accuracy of breast prognostic factor testing because it can more accurately distinguish different shades on the slides and read them more consistently than the human eye alone.
“Image analysis is better at distinguishing the shades and it also has trained my eye to better identify the most accurate results, because of the continuous feedback it provides me,” Dr. Sandler says.
Beyond laboratory work, Dr. Sandler also provides a breast consultation service for patients. She answers patients’ questions about their pathology findings, ranging from how lab specimens were prepared to how they were interpreted. Her breast consultation service is available to every Baptist Health breast patient and includes review of outside pathology slides and confirmation of an initial diagnosis.
Dr. Sandler says she is frequently asked, “Does every patient need a second opinion?”
If patients will be treated at a different hospital than the one where their original biopsy was performed, Dr. Sandler advises them to request that the pathologist at the treating hospital review their pathology slides.
Dr. Sandler’s goal is to provide accurate results the first time, every time, so a second opinion isn’t necessary.
“I have a drawer full of cards from patients saying, ‘After I talked to you, I knew what to do,’” she said.