Benign Mimics of Malignant Breast Pathology
Mayo Clinic Laboratories
[{'start': '5.520', 'end': '8.340', 'text': '- This is Lab Medicine\nRounds, a curated podcast'}, {'start': '8.340', 'end': '11.700', 'text': 'for physicians, laboratory\nprofessionals and students.'}, {'start': '11.700', 'end': '13.320', 'text': "I'm your host, Justin Kreuter,"}, {'start': '13.320', 'end': '16.410', 'text': 'a transfusion medicine\npathologist, assistant professor'}, {'start': '16.410', 'end': '19.530', 'text': 'of Laboratory Medicine\npathology at Mayo Clinic.'}, {'start': '19.530', 'end': '22.680', 'text': "Today we're rounding with\nDr. Erinn Downs, professor"}, {'start': '22.680', 'end': '24.810', 'text': 'of laboratory medicine and pathology'}, {'start': '24.810', 'end': '28.500', 'text': 'and anatomic pathology at Mayo\nClinic in Arizona to guide us'}, {'start': '28.500', 'end': '31.320', 'text': 'through the world of benign mimics'}, {'start': '31.320', 'end': '33.810', 'text': 'of malignant breast pathology.'}, {'start': '33.810', 'end': '36.150', 'text': 'Thanks for joining us today, Dr. Downs.'}, {'start': '36.150', 'end': '37.530', 'text': '- Thanks so much for the invitation to'}, {'start': '38.715', 'end': '39.715', 'text': '- Be here.'}, {'start': '39.715', 'end': '42.660', 'text': 'So I, I wanna maybe kick\noff our conversation with,'}, {'start': '42.660', 'end': '44.550', 'text': 'you know, why is it important'}, {'start': '44.550', 'end': '49.080', 'text': 'to appreciate mimics in breast pathology?'}, {'start': '50.280', 'end': '52.230', 'text': '- Sure. So, you know, a lot'}, {'start': '52.230', 'end': '55.080', 'text': "of times we're making a\ndiagnosis based on a coordinated"}, {'start': '55.080', 'end': '58.260', 'text': 'biopsy, and this is oftentimes the,'}, {'start': '58.260', 'end': '61.710', 'text': 'the patients lead off\ninto how they are going'}, {'start': '61.710', 'end': '63.660', 'text': 'to be treated in the future.'}, {'start': '63.660', 'end': '66.150', 'text': "So if we're talking about\nsomething that's benign,"}, {'start': '66.150', 'end': '67.860', 'text': 'this may mean, you know,'}, {'start': '67.860', 'end': '71.280', 'text': 'that their follow-up may\njust be watchful waiting'}, {'start': '71.280', 'end': '73.650', 'text': 'or, you know, additional imaging.'}, {'start': '73.650', 'end': '77.220', 'text': "If it's something that's\nmalignant, it may mean, you know,"}, {'start': '77.220', 'end': '79.380', 'text': "they're gonna go to the operating room"}, {'start': '79.380', 'end': '83.070', 'text': 'and have a, you know, a big procedure.'}, {'start': '83.070', 'end': '86.280', 'text': 'They may need chemotherapy\nor even radiation.'}, {'start': '86.280', 'end': '88.020', 'text': 'So we really wanna make sure'}, {'start': '88.020', 'end': '93.020', 'text': 'that we are appropriately\nclassifying these lesions'}, {'start': '93.360', 'end': '97.140', 'text': 'so that future treatment can really'}, {'start': '97.140', 'end': '98.580', 'text': 'be appropriate.'}, {'start': '99.420', 'end': '100.860', 'text': '- Right. So it sounds like there are a lot'}, {'start': '100.860', 'end': '103.020', 'text': 'of different directions\nthat things can go,'}, {'start': '103.020', 'end': '105.900', 'text': "and I'm impressed to think about these."}, {'start': '105.900', 'end': '108.450', 'text': "You were saying, you know,\nit's, it's a needle biopsy,"}, {'start': '108.450', 'end': '111.720', 'text': "so it's really kind of a minimal\ntissue that you're getting"}, {'start': '111.720', 'end': '116.720', 'text': 'to kind of evaluate the\npathology in, in a needle.'}, {'start': '116.910', 'end': '118.230', 'text': '- Correct? It is.'}, {'start': '118.230', 'end': '120.780', 'text': "So I think it's important\nto remember that, you know,"}, {'start': '120.780', 'end': '125.545', 'text': "we're dealing with a, a small\nsample of a larger lesion."}, {'start': '125.545', 'end': '130.030', 'text': 'A a lot of times though these\nare fairly representative of,'}, {'start': '130.030', 'end': '132.750', 'text': 'of what is is going on.'}, {'start': '132.750', 'end': '135.660', 'text': 'So, you know, there are times when we are,'}, {'start': '135.660', 'end': '138.150', 'text': 'I would say the majority of\nthe time, we are actually able'}, {'start': '138.150', 'end': '139.770', 'text': 'to render a diagnosis'}, {'start': '139.770', 'end': '143.580', 'text': 'and then, you know,\ntreatment goes forward.'}, {'start': '143.580', 'end': '145.770', 'text': 'There are times though, when'}, {'start': '145.770', 'end': '149.670', 'text': "it's probably best serving the patient"}, {'start': '150.570', 'end': '155.520', 'text': 'to leave a, a diagnosis\nas somewhat ambiguous'}, {'start': '155.520', 'end': '158.550', 'text': 'and admit that some of\nthese lesions we just need'}, {'start': '158.550', 'end': '160.470', 'text': 'to look at more tissue.'}, {'start': '160.470', 'end': '163.470', 'text': 'So, you know, we, we try\nreally hard to, to get'}, {'start': '163.470', 'end': '165.660', 'text': 'to a diagnosis, but I think, you know,'}, {'start': '165.660', 'end': '167.220', 'text': "there's also some uncertainty"}, {'start': '167.220', 'end': '170.700', 'text': 'and uncertainty is something\nthat you have to, I think,'}, {'start': '170.700', 'end': '172.560', 'text': 'get comfortable with pathology.'}, {'start': '173.430', 'end': '175.020', 'text': "- I think that's something\nI'd like to highlight"}, {'start': '175.020', 'end': '176.430', 'text': 'for our student listeners'}, {'start': '176.430', 'end': '178.350', 'text': 'because sometimes we have people apply'}, {'start': '178.350', 'end': '180.580', 'text': 'for residency in pathology'}, {'start': '180.580', 'end': '184.420', 'text': "and sometimes it's with the\nperception that things are black"}, {'start': '184.420', 'end': '185.800', 'text': 'and white in pathology.'}, {'start': '185.800', 'end': '187.660', 'text': "And I think you're highlighting that, hey,"}, {'start': '187.660', 'end': '189.580', 'text': 'this is clinical medicine too.'}, {'start': '190.450', 'end': '191.950', 'text': 'There are challenges.'}, {'start': '191.950', 'end': '196.360', 'text': 'So maybe can you kinda share\na couple of examples of'}, {'start': '196.360', 'end': '200.110', 'text': 'where you can have mimics\nmaybe in either direction in'}, {'start': '200.110', 'end': '202.630', 'text': 'breath path breast pathology?'}, {'start': '202.630', 'end': '206.080', 'text': '- Sure. So there are a\ncouple of lesions that I kind'}, {'start': '206.080', 'end': '209.170', 'text': 'of hold in my mind to be aware of.'}, {'start': '209.170', 'end': '213.130', 'text': 'And you know, something like\norganizing fat necrosis,'}, {'start': '213.130', 'end': '215.050', 'text': 'totally benign process'}, {'start': '215.050', 'end': '217.120', 'text': 'that we see frequently\nin the breast can happen'}, {'start': '217.120', 'end': '220.660', 'text': 'after an injury can happen,\nan happen after prior surgery'}, {'start': '220.660', 'end': '222.100', 'text': 'or prior biopsy.'}, {'start': '222.100', 'end': '224.140', 'text': 'So we see organizing fat necrosis, right?'}, {'start': '224.140', 'end': '225.520', 'text': "Fat's benign lesion."}, {'start': '225.520', 'end': '226.840', 'text': 'The mimic of that'}, {'start': '226.840', 'end': '230.620', 'text': 'that is malignant is something\ncalled an invasive carcinoma'}, {'start': '230.620', 'end': '232.660', 'text': 'with his osteocyte features.'}, {'start': '232.660', 'end': '234.850', 'text': 'Fat necrosis has a lot of his osteocytes,'}, {'start': '234.850', 'end': '237.400', 'text': 'as the name implies, invasive carcinoma'}, {'start': '237.400', 'end': '240.790', 'text': 'with his osteocyte features\nlooks like his osteocytes.'}, {'start': '240.790', 'end': '244.540', 'text': 'And they can be really bland\nand, and really tricky.'}, {'start': '244.540', 'end': '249.340', 'text': 'So, you know, I, I think\nsomething I learned'}, {'start': '249.340', 'end': '252.400', 'text': 'during residency was kind\nof this whole concept'}, {'start': '252.400', 'end': '255.160', 'text': 'of a triple test in, in breast pathology'}, {'start': '255.160', 'end': '260.110', 'text': 'where the imaging has to\nmatch the, the clinical'}, {'start': '260.110', 'end': '263.020', 'text': 'and it also has to match\nthe, the pathology.'}, {'start': '263.020', 'end': '267.915', 'text': 'So if, if one of those is\nnot adding up, beware and,'}, {'start': '267.915', 'end': '272.500', 'text': "and really think about, geez,\nit's really fat necrosis"}, {'start': '272.500', 'end': '274.750', 'text': 'and does this patient have a\nreason to have fat necrosis?'}, {'start': '274.750', 'end': '277.330', 'text': 'Or maybe should I put a\ncytokeratin stain on this'}, {'start': '277.330', 'end': '279.460', 'text': "and make sure I'm not missing something?"}, {'start': '280.330', 'end': '282.250', 'text': 'But so sneaky here.'}, {'start': '282.250', 'end': '285.250', 'text': '- For our listeners\nthat may not be familiar'}, {'start': '285.250', 'end': '288.490', 'text': 'and kind of have experienced\nbreast signup, pathology,'}, {'start': '288.490', 'end': '290.470', 'text': 'can you elaborate about that, that idea'}, {'start': '290.470', 'end': '294.400', 'text': 'of this triple test\nabout, you know, how often'}, {'start': '294.400', 'end': '297.490', 'text': 'or, you know, how do you,'}, {'start': '299.380', 'end': '302.230', 'text': 'how does that conversation happen between'}, {'start': '302.230', 'end': '305.860', 'text': 'what the imaging looks like,\nwhat the pathology is showing,'}, {'start': '305.860', 'end': '307.900', 'text': 'what the clinical, how is, how is'}, {'start': '307.900', 'end': '311.800', 'text': 'that navigated in clinical\nmedicine as an example?'}, {'start': '312.820', 'end': '315.820', 'text': '- So I can think of\nexamples when maybe the,'}, {'start': '315.820', 'end': '317.290', 'text': 'the imaging says,'}, {'start': '317.290', 'end': '320.350', 'text': "I've got these really\nworrisome microcalcifications"}, {'start': '320.350', 'end': '324.580', 'text': 'and you are, you know,\ncutting into a tissue block'}, {'start': '324.580', 'end': '327.400', 'text': 'and you see, you know,'}, {'start': '327.400', 'end': '330.280', 'text': "well there's a couple\nmicrocalcifications there,"}, {'start': '330.280', 'end': '332.980', 'text': "but I'm not, I don't have\nany real epithelial changes"}, {'start': '332.980', 'end': '335.290', 'text': 'associated with these microcalcifications.'}, {'start': '335.290', 'end': '337.150', 'text': "It's really important to go and look"}, {'start': '337.150', 'end': '339.910', 'text': 'and correspond with, you\nknow, the specimen image.'}, {'start': '339.910', 'end': '342.070', 'text': 'So when the radiologist takes this biopsy'}, {'start': '342.070', 'end': '344.590', 'text': 'for microcalcifications, they\nactually image those cores'}, {'start': '344.590', 'end': '346.840', 'text': 'that they take and you can get an idea of'}, {'start': '346.840', 'end': '349.210', 'text': 'how many microcalcifications are there.'}, {'start': '349.210', 'end': '350.980', 'text': 'And then when you look\nunder the scope, you need'}, {'start': '350.980', 'end': '354.160', 'text': "to make sure that what\nyou're seeing matches"}, {'start': '354.160', 'end': '355.210', 'text': 'what, what was there.'}, {'start': '355.210', 'end': '356.680', 'text': 'So, you know, if,'}, {'start': '356.680', 'end': '359.660', 'text': "if you're not seeing many\nmicrocalcifications in comparison"}, {'start': '359.660', 'end': '362.690', 'text': 'to the specimen image, it\nwould really behoove you to'}, {'start': '362.690', 'end': '364.850', 'text': 'go deeper into that\nblock that tissue block'}, {'start': '364.850', 'end': '365.900', 'text': 'and look at more levels'}, {'start': '365.900', 'end': '368.300', 'text': "and really make sure\nyou've accounted for that."}, {'start': '368.300', 'end': '372.170', 'text': "So that's an example of, of\nusing, you know, data that's,"}, {'start': '372.170', 'end': '376.070', 'text': "that's in epic that we, we\nknow about the, the imaging"}, {'start': '376.070', 'end': '379.100', 'text': "to guide what we're doing."}, {'start': '379.100', 'end': '381.650', 'text': "You know, sometimes it's\na conversation with the,"}, {'start': '381.650', 'end': '384.170', 'text': 'with the radiologist\ntoo that says, you know,'}, {'start': '384.170', 'end': '387.320', 'text': 'how concerned are you about this lesion?'}, {'start': '387.320', 'end': '390.230', 'text': 'You know, did this lesion maybe dissipate'}, {'start': '390.230', 'end': '392.510', 'text': 'after you took a a core needle of it?'}, {'start': '392.510', 'end': '394.070', 'text': "Maybe that's a cyst."}, {'start': '394.070', 'end': '396.200', 'text': 'You know, that information\nwould be good to know'}, {'start': '396.200', 'end': '399.625', 'text': 'before we really level into a block and,'}, {'start': '399.625', 'end': '402.590', 'text': "and chase something\nthat maybe isn't there."}, {'start': '402.590', 'end': '404.720', 'text': 'Versus, you know, them saying, you, oh,'}, {'start': '404.720', 'end': '408.350', 'text': "I'm really worried about\nthis and we cut levels"}, {'start': '408.350', 'end': '411.020', 'text': "and we're just not seeing\nwhat can account for"}, {'start': '411.020', 'end': '412.460', 'text': 'that MAs lesion.'}, {'start': '412.460', 'end': '415.910', 'text': 'Then I think, you know, then\nthey reconcile that and,'}, {'start': '415.910', 'end': '419.510', 'text': "and say maybe our, our\nbiopsy really didn't sample"}, {'start': '419.510', 'end': '421.220', 'text': 'what we wanted it to.'}, {'start': '421.220', 'end': '423.380', 'text': "- I see. So it's a nice way to verify"}, {'start': '423.380', 'end': '425.120', 'text': 'that we got this needle.'}, {'start': '425.120', 'end': '429.020', 'text': "Is this representative of the\nlesion that we're going for"}, {'start': '429.020', 'end': '431.390', 'text': 'or, you know, maybe we we missed it'}, {'start': '431.390', 'end': '434.240', 'text': 'or we need to take a\ndifferent approach to it.'}, {'start': '434.240', 'end': '435.950', 'text': 'Correct. I see.'}, {'start': '437.000', 'end': '440.210', 'text': 'How does, how do you\nnavigate that in terms'}, {'start': '440.210', 'end': '442.880', 'text': 'of kind of training?'}, {'start': '442.880', 'end': '446.390', 'text': 'Like thinking back to\nyour own training in this'}, {'start': '446.390', 'end': '448.190', 'text': 'and kind of doing this comparison'}, {'start': '448.190', 'end': '452.990', 'text': 'and understanding what can a\nwhat can account for, you know,'}, {'start': '452.990', 'end': '455.300', 'text': 'we have have the lesion.'}, {'start': '455.300', 'end': '456.410', 'text': 'What is that experience?'}, {'start': '456.410', 'end': '459.080', 'text': "I guess what I'm getting\nat is what's the experience"}, {'start': '459.080', 'end': '461.900', 'text': 'of learning how to approach'}, {'start': '461.900', 'end': '465.680', 'text': 'and navigate these kind\nof challenging waters'}, {'start': '465.680', 'end': '466.970', 'text': 'of, of mimics,'}, {'start': '469.850', 'end': '474.170', 'text': "- You know, unfortunately\nsometimes it's just time, time."}, {'start': '474.170', 'end': '476.150', 'text': "It's time at the microscope."}, {'start': '476.150', 'end': '479.150', 'text': 'I can remember when I\nwas a resident, I had,'}, {'start': '479.150', 'end': '481.520', 'text': 'and I was almost near\nthe end of my residency'}, {'start': '481.520', 'end': '483.380', 'text': 'and I was gonna do a breast fellowship'}, {'start': '483.380', 'end': '485.450', 'text': 'and I had an attending tell me, you know,'}, {'start': '485.450', 'end': '486.740', 'text': "you're a pretty good resident,"}, {'start': '486.740', 'end': '489.050', 'text': "but just so you know, you're\nnot gonna be really good"}, {'start': '489.050', 'end': '491.270', 'text': "until you're about five years out."}, {'start': '491.270', 'end': '493.310', 'text': "And I was like, oh, well that's,"}, {'start': '493.310', 'end': '495.710', 'text': "that's really disappointing to hear."}, {'start': '495.710', 'end': '497.090', 'text': 'I look back now'}, {'start': '497.090', 'end': '501.080', 'text': 'and I understand what\nhe was was getting at'}, {'start': '501.080', 'end': '503.120', 'text': 'that it is time in the saddle'}, {'start': '503.120', 'end': '506.990', 'text': 'and it is time dealing\nwith different situations'}, {'start': '506.990', 'end': '508.520', 'text': 'that that arise.'}, {'start': '508.520', 'end': '512.740', 'text': 'And the, the longer you do\nthis, the, you know, just the,'}, {'start': '512.740', 'end': '517.430', 'text': 'the more you are cognizant of,\nof the different things that,'}, {'start': '517.430', 'end': '519.470', 'text': "that you're gonna run across."}, {'start': '519.470', 'end': '523.460', 'text': 'So, you know, in training\nyou, you hear a lot about them'}, {'start': '523.460', 'end': '527.150', 'text': "and then I think it's maybe not\nuntil you are actually faced"}, {'start': '527.150', 'end': '530.060', 'text': 'with working one of\nthese lesions up that it,'}, {'start': '530.060', 'end': '532.640', 'text': 'everything starts to fall into place and,'}, {'start': '532.640', 'end': '536.160', 'text': 'and you begin to learn to\nwork through these a bit more.'}, {'start': '536.160', 'end': '539.790', 'text': "- Hmm. So I, I've heard\npeople sometimes talk about,"}, {'start': '539.790', 'end': '541.500', 'text': "we don't learn from experience,"}, {'start': '541.500', 'end': '545.395', 'text': 'but the idea we learn from\nreflecting on experience.'}, {'start': '545.395', 'end': '547.290', 'text': "And so I'm curious kind of, you know,"}, {'start': '547.290', 'end': '550.290', 'text': "what's what's your approach of kind of"}, {'start': '550.290', 'end': '553.350', 'text': 'capturing the learning\nwhen you come across one'}, {'start': '553.350', 'end': '557.100', 'text': 'of these mimics and and\nafter you navigate it?'}, {'start': '557.100', 'end': '559.530', 'text': "Are there certain ways you're,\nyou're kind of reflecting"}, {'start': '559.530', 'end': '563.160', 'text': 'and thinking about the case, for example,'}, {'start': '563.160', 'end': '567.300', 'text': 'maybe appreciating, was there\nsome nuanced piece of this'}, {'start': '567.300', 'end': '570.330', 'text': 'that made this one different than others?'}, {'start': '570.330', 'end': '571.830', 'text': 'How, how do you go about that?'}, {'start': '573.570', 'end': '577.380', 'text': "- So I'm always appreciative\nof having clinical history."}, {'start': '578.400', 'end': '580.590', 'text': 'I think clinical history and,'}, {'start': '580.590', 'end': '584.310', 'text': 'and knowing what has gone\non with the patient is,'}, {'start': '584.310', 'end': '585.810', 'text': 'is really important.'}, {'start': '585.810', 'end': '588.540', 'text': 'And that can really'}, {'start': '588.540', 'end': '593.310', 'text': 'save you from potentially\ngoing down, down, you know,'}, {'start': '593.310', 'end': '595.140', 'text': 'the wrong road.'}, {'start': '595.140', 'end': '597.810', 'text': 'You know, in, in breast\npathology sometimes we deal'}, {'start': '597.810', 'end': '599.760', 'text': 'with metastatic lesions to the breast'}, {'start': '599.760', 'end': '602.400', 'text': "and if you don't know that\nthis patient had a history"}, {'start': '602.400', 'end': '604.170', 'text': 'of an ovarian s serious carcinoma,'}, {'start': '604.170', 'end': '605.910', 'text': 'then you may misinterpret something'}, {'start': '605.910', 'end': '609.030', 'text': 'that looks like micro\npapillary carcinoma as'}, {'start': '609.030', 'end': '610.110', 'text': 'as a breast primary.'}, {'start': '610.110', 'end': '612.360', 'text': "So it's knowing clinical history"}, {'start': '612.360', 'end': '615.420', 'text': 'and having a heightened\nsense for, you know,'}, {'start': '615.420', 'end': '616.830', 'text': 'this looks micro papillary,'}, {'start': '616.830', 'end': '619.680', 'text': "maybe I don't have any\ninformation on the patient."}, {'start': '619.680', 'end': '621.750', 'text': 'Maybe I should do a\ncouple of immuno stains'}, {'start': '621.750', 'end': '624.420', 'text': "and just make sure that what\nI'm really dealing with is,"}, {'start': '624.420', 'end': '626.400', 'text': 'is a breast primary.'}, {'start': '626.400', 'end': '630.120', 'text': 'A you know, I think another\nthing is use your colleagues.'}, {'start': '631.260', 'end': '634.530', 'text': "A lot of times I'm, you know,"}, {'start': '634.530', 'end': '636.620', 'text': 'I may be going down a\nroad on something and,'}, {'start': '636.620', 'end': '639.120', 'text': "and think I'm, I'm headed\nin the right direction"}, {'start': '639.120', 'end': '642.000', 'text': "and, you know, it's, it's always\ngood to phone a friend and,"}, {'start': '642.000', 'end': '643.560', 'text': 'and show a case around'}, {'start': '643.560', 'end': '647.400', 'text': 'and make sure that you know,\nthese different sets of eyes'}, {'start': '647.400', 'end': '649.080', 'text': 'and this different knowledge base.'}, {'start': '649.080', 'end': '653.340', 'text': "That's, that's there it\nis, it is thinking, yeah,"}, {'start': '653.340', 'end': '654.360', 'text': "you're on the right page"}, {'start': '654.360', 'end': '657.180', 'text': 'or man, we, you gotta do you really need'}, {'start': '657.180', 'end': '659.940', 'text': 'to do some other things with this case.'}, {'start': '659.940', 'end': '662.430', 'text': '- I think for the maybe\nclinicians that are listening'}, {'start': '662.430', 'end': '664.650', 'text': 'to this podcast, like to highlight your,'}, {'start': '664.650', 'end': '667.860', 'text': 'your point out about knowing the clinical'}, {'start': '667.860', 'end': '669.090', 'text': 'history is really important.'}, {'start': '669.090', 'end': '671.670', 'text': 'I think sometimes people feel like,'}, {'start': '671.670', 'end': '673.500', 'text': "well we shouldn't tell put,"}, {'start': '673.500', 'end': '675.390', 'text': "tell the pathologist what's going on"}, {'start': '675.390', 'end': '677.940', 'text': "or what we're suspect suspicious of"}, {'start': '677.940', 'end': '682.200', 'text': 'because we want to have\nlike an unbiased read.'}, {'start': '682.200', 'end': '685.320', 'text': 'Right. But, but what would\nyou say to them just to kind'}, {'start': '685.320', 'end': '688.140', 'text': 'of underline and highlight\nyour point on the clinical'}, {'start': '688.140', 'end': '690.060', 'text': 'information is helpful?'}, {'start': '690.060', 'end': '693.870', 'text': '- Yeah. You know, pathology\nis not practiced in a vacuum'}, {'start': '693.870', 'end': '698.430', 'text': 'and it, it, it, you know, that\ninformation is so important'}, {'start': '699.960', 'end': '702.240', 'text': 'to, to know that the history'}, {'start': '702.240', 'end': '707.010', 'text': 'and it, it, do you run a\nrisk that it biases you?'}, {'start': '707.010', 'end': '710.580', 'text': 'Sure you do, but you also\nowe it to the patient'}, {'start': '710.580', 'end': '714.340', 'text': 'and to yourself to\nincorporate that information,'}, {'start': '714.340', 'end': '716.200', 'text': 'not let it bias you,'}, {'start': '716.200', 'end': '719.770', 'text': "and then prove to\nyourself what's happening"}, {'start': '719.770', 'end': '720.970', 'text': "and what's going on."}, {'start': '720.970', 'end': '725.380', 'text': 'And, you know, using the,\nthe, the medical history'}, {'start': '725.380', 'end': '729.610', 'text': 'to help you, not bias you to,\nbut to bolster your diagnosis,'}, {'start': '730.510', 'end': '732.550', 'text': '- You know, along those lines, I wonder,'}, {'start': '732.550', 'end': '736.000', 'text': 'thinking about another segment\nof our audience, maybe the'}, {'start': '736.000', 'end': '737.590', 'text': 'young professionals, you know,'}, {'start': '737.590', 'end': '740.860', 'text': 'in those first five years out in practice,'}, {'start': '742.810', 'end': '746.530', 'text': 'what are your thoughts\non, you mentioned showing,'}, {'start': '746.530', 'end': '748.540', 'text': 'showing the case to colleagues'}, {'start': '748.540', 'end': '752.410', 'text': 'and you know, what are\nsome best practices on'}, {'start': '752.410', 'end': '756.400', 'text': 'how you go about showing\na case to a colleague?'}, {'start': '757.780', 'end': '760.150', 'text': "What's a way that you\ncan do that that kind"}, {'start': '760.150', 'end': '763.600', 'text': 'of respects their time, kind\nof highlights, you know,'}, {'start': '763.600', 'end': '767.320', 'text': 'what issue that you see\nor question that you have?'}, {'start': '767.320', 'end': '770.350', 'text': 'What does that look like when\nyou ask a colleague for help?'}, {'start': '771.310', 'end': '775.870', 'text': "- Sure. I, I think, you\nknow, I'm, I'm lucky I have"}, {'start': '775.870', 'end': '778.150', 'text': 'wonderful colleagues that\ntheir doors are always open'}, {'start': '778.150', 'end': '779.860', 'text': 'and I can just walk in their office'}, {'start': '779.860', 'end': '783.160', 'text': 'and say, Hey, can you look\nat this case that always,'}, {'start': '783.160', 'end': '787.150', 'text': "you know, not everybody's gonna\nbe in that same situation."}, {'start': '787.150', 'end': '791.050', 'text': "And I think it's important\nto also know that, you know,"}, {'start': '791.050', 'end': '792.280', 'text': 'a lot of people are busy.'}, {'start': '792.280', 'end': '795.460', 'text': "So if it's reaching out"}, {'start': '795.460', 'end': '797.740', 'text': "and saying, Hey, I I have\na case I'm struggling with,"}, {'start': '797.740', 'end': '799.690', 'text': 'can we make a time to sit down together'}, {'start': '799.690', 'end': '802.270', 'text': 'and look at this, you\nknow, being respectful of,'}, {'start': '802.270', 'end': '806.380', 'text': "of someone's time, being\nprepared with here's, you know,"}, {'start': '806.380', 'end': '808.935', 'text': "here are the pertinent\nslides, you know, don't,"}, {'start': '808.935', 'end': '811.300', 'text': "don't follow up with\nthe two trays of slides"}, {'start': '811.300', 'end': '814.870', 'text': 'and say, please help me find\na microinvasion in this,'}, {'start': '814.870', 'end': '818.500', 'text': 'you know, 50 trays of ductal carcinomas.'}, {'start': '818.500', 'end': '822.160', 'text': 'I do, you know, have,\nhave a good idea going in'}, {'start': '822.160', 'end': '823.990', 'text': 'what your questions are'}, {'start': '823.990', 'end': '827.230', 'text': 'and show them the, the\npertinent information'}, {'start': '827.230', 'end': '828.370', 'text': 'or the pertinent slides,'}, {'start': '828.370', 'end': '831.250', 'text': 'but also come with the\npertinent information and, and,'}, {'start': '831.250', 'end': '834.250', 'text': "and the history that, that's\nrelevant to the case too."}, {'start': '835.510', 'end': '838.005', 'text': "- Oh, it's wonderful. Wise\nwords for the audience."}, {'start': '839.170', 'end': '843.790', 'text': "Maybe as a final question, I'm\ncurious on, you know, these"}, {'start': '843.790', 'end': '846.100', 'text': 'as diagnostic challenges.'}, {'start': '846.100', 'end': '849.220', 'text': 'Is this a situation where\nthese mimics are kind'}, {'start': '849.220', 'end': '851.950', 'text': 'of a static thing and we just\nneed to kind of train to them'}, {'start': '851.950', 'end': '855.760', 'text': "and they're gonna persist in\nbeing a diagnostic challenge?"}, {'start': '855.760', 'end': '860.200', 'text': 'Or do you see, you know, future,'}, {'start': '860.200', 'end': '861.880', 'text': "I don't know if it's immunostains"}, {'start': '861.880', 'end': '866.560', 'text': "or if it's AI technologies\nthat may change, you know,"}, {'start': '866.560', 'end': '869.260', 'text': 'what we see as a, a mimic?'}, {'start': '869.260', 'end': '871.960', 'text': '- Sure. I, I think that, you know,'}, {'start': '871.960', 'end': '874.960', 'text': "just looking back since\nI've started, I can think"}, {'start': '874.960', 'end': '876.790', 'text': 'of examples of, of cases'}, {'start': '876.790', 'end': '879.910', 'text': "that I would've signed out very\ndescriptively at one point."}, {'start': '879.910', 'end': '883.000', 'text': 'Like well grade spindle\ncell neoplasm, right?'}, {'start': '883.000', 'end': '884.950', 'text': 'And listed what the differential was,'}, {'start': '884.950', 'end': '887.020', 'text': 'could be a fibromatosis,'}, {'start': '887.020', 'end': '888.550', 'text': "the immuno stains don't really support it,"}, {'start': '888.550', 'end': '890.900', 'text': "but maybe it's a low\ngrade fibromatosis like"}, {'start': '890.900', 'end': '892.160', 'text': 'metaplastic carcinoma.'}, {'start': '892.160', 'end': '895.400', 'text': 'Big difference in in those two diagnoses.'}, {'start': '895.400', 'end': '899.960', 'text': 'You know, and, and the,\nthe, just with that'}, {'start': '899.960', 'end': '902.000', 'text': 'as a specific example,\nthe, the thinking about'}, {'start': '902.000', 'end': '905.300', 'text': 'that has changed and you\ncan actually look for the,'}, {'start': '905.300', 'end': '909.350', 'text': 'the typical molecular alteration in'}, {'start': '909.350', 'end': '910.550', 'text': 'fibromatosis'}, {'start': '910.550', 'end': '915.380', 'text': 'and use that to help\nyou make that diagnosis.'}, {'start': '916.250', 'end': '919.010', 'text': 'And then you are much more specific in'}, {'start': '919.010', 'end': '922.940', 'text': 'what you are calling this\nlow grade stem cell neoplasm.'}, {'start': '922.940', 'end': '927.170', 'text': 'And I, I think you are\ndoing a much better service'}, {'start': '927.170', 'end': '930.980', 'text': 'to the clinicians and frankly\nto the patient as well'}, {'start': '930.980', 'end': '932.570', 'text': 'because certainly the, the treatment of'}, {'start': '932.570', 'end': '936.080', 'text': 'that lesion in particular\nhas changed over time.'}, {'start': '936.080', 'end': '938.330', 'text': 'So much like our, our diagnoses in'}, {'start': '938.330', 'end': '940.790', 'text': 'that realm have changed somewhat over time'}, {'start': '940.790', 'end': '944.060', 'text': 'because we, you know, we have\nmolecular data, so so has the,'}, {'start': '944.060', 'end': '945.140', 'text': 'the treatment of them.'}, {'start': '945.140', 'end': '948.590', 'text': 'So I, I think molecular\nplays a big role, you know,'}, {'start': '948.590', 'end': '950.720', 'text': 'certainly immunohistochemistry as,'}, {'start': '950.720', 'end': '953.600', 'text': 'as new stains come on\nboard plays a big role.'}, {'start': '953.600', 'end': '956.480', 'text': 'And I would imagine you\nmentioned ai, I would imagine'}, {'start': '956.480', 'end': '957.860', 'text': 'and in the future Sure.'}, {'start': '957.860', 'end': '960.380', 'text': 'I think AI will probably\nplay a role as well.'}, {'start': '960.380', 'end': '962.480', 'text': "I think we're a ways from it,"}, {'start': '962.480', 'end': '965.090', 'text': "but I think it's, I think\nwe're not getting away from it."}, {'start': '966.410', 'end': '968.810', 'text': '- Oh, wonderful. World in pathology.'}, {'start': '968.810', 'end': '970.190', 'text': "- Correct.\n- We, we've been routing"}, {'start': '970.190', 'end': '973.580', 'text': 'with Dr. Downs talking\nabout benign mimics,'}, {'start': '973.580', 'end': '975.170', 'text': 'malignant breast pathology,'}, {'start': '975.170', 'end': '976.970', 'text': 'and I really appreciate you taking the'}, {'start': '976.970', 'end': '979.700', 'text': 'time to talk with us\ntoday. Dr. Downs, thank'}, {'start': '979.700', 'end': '981.770', 'text': '- You for so much for letting me be here.'}, {'start': '981.770', 'end': '984.080', 'text': '- To all of our listeners,\nthank you for joining us today.'}, {'start': '984.080', 'end': '985.880', 'text': 'We invite you to share your thoughts'}, {'start': '985.880', 'end': '987.980', 'text': 'and suggestions via email'}, {'start': '987.980', 'end': '991.460', 'text': 'to MCL education@mayo.edu.'}, {'start': '991.460', 'end': '994.340', 'text': "If you've enjoyed this\npodcast, please subscribe"}, {'start': '994.340', 'end': '996.740', 'text': 'and until our next rounds\ntogether, we encourage you'}, {'start': '996.740', 'end': '998.630', 'text': 'to connect lab medicine'}, {'start': '998.630', 'end': '1001.990', 'text': 'and the clinical practice through\neducational conversations.'}]