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Ask Me Anything: Dr. Raul Gonzalez

  • 1.  Ask Me Anything: Dr. Raul Gonzalez

    ASCP Ambassador
    Posted 11-17-2024 22:28

    Hello pathology residents & fellows,

    Welcome to the second Resident Council "AMA" (Ask Me Anything) session! For this whole week (11/18-11/22), we are honored to have our celebrity pathologist guest Dr. Raul Gonzalez hosting an AMA on this Pathologists-In-Training Community. Dr. Gonzalez is a GI pathologist and the Anatomic Pathology Research Director at Emory University. He is here to answer all of your questions about GI pathology, or any related topics you are curious about.

    Ask away!



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    Savanah Gisriel, MD, MPH
    Assistant Professor
    UW-Madison
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  • 2.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-18-2024 07:50
    Edited by Raul Gonzalez 11-18-2024 08:08

    Hello everyone, happy to be here! Please feel free to ask me any questions about GI pathology. I am on service this week, so it may take me some time to respond, but I promise I will reply to every question.

    Raul S. Gonzalez, MD
    Professor of Pathology & Laboratory Medicine
    Director of the Gastrointestinal Pathology Service
    Co-Director of Anatomic Pathology Research



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    Raul Gonzalez Staff Pathologist
    Decatur GA
    (770)773-4768
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  • 3.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-18-2024 15:58

    Hi Dr. Gonzalez, it's so nice to have you!

    What do you think is the most under-researched topic in GI pathology? And on the same topic, can you share insights on emerging trends or research in Gl pathology?

    Thank you



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    Katerina Kearns
    Pennsauken NJ
    (508)221-3904
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  • 4.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-19-2024 09:27

    Hi Katerina, great question. It's hard to call anything truly "under-researched" given how much research activity is going on. Maybe anal neoplasia is also a little under-researched, but that's because many GI folks don't enjoy dealing with that site! I do think there are several things we still don't quite understand as anatomic pathologists, though this could perhaps be due to disease processes without a histomorphologic correlate. One example here is mast cell disorders. Another could be certain pediatric GI disorders, though I do not handle pediatric material personally.

    As for emerging trends -- the immune milieu of several neoplastic and non-neoplastic disorders is a hot topic. People are always looking for new biomarkers. Molecular pathology has been the focus of a ton of research effort and money, though it has not translated into huge changes in clinical management. Hopefully that will change soon, too.



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    Raul S. Gonzalez Professor of Pathology, Emory University
    Decatur GA
    (770)773-4768
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  • 5.  RE: Ask Me Anything: Dr. Raul Gonzalez

    ASCP Ambassador
    Posted 11-18-2024 21:52
    Edited by Yembur Ahmad 11-18-2024 21:52

    Hi Dr. Gonzalez, thank you for joining us on here!

    How do you see the future of GI pathology practice changing with new technologies like AI and digital pathology?



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    Yembur Ahmad, MD
    ASCP Resident Council Immediate Past Chair
    Los Angeles, CA
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  • 6.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-19-2024 09:35

    Hi Yembur, I see those changes unfolding every day. Emory has digital signout for all luminal GI biopsies, and I suspect liver samples and resections are not far behind. As with any new technology, it's a tradeoff. I can get through some cases more quickly (such as obvious tubular adenomas), but challenging or subtle cases take a little longer, and a few things are harder to visualize (such as H. pylori). Overall, I think it's a net benefit, though of course it took a lot of time and money to get digital pathology implemented here. I am not sure how cost-effective it currently is for some practices.

    Our digital pathology software has some rudimentary AI-like options, such as automated Ki67 analysis (not sure this is truly AI). I hope that in the future, AI will serve as a screening tool (like a cytotech). Maybe I receive a case and the AI flags it as "likely TA" or "likely adenocarcinoma." That could speed things up, especially if it can also draft the report too. It's also possible that AI will be able to detect subtleties that pathologists do not notice, facilitating more challenging diagnoses as well. None of this is ready for implementation yet, though, and it would need to be carefully vetted and handled. I am concerned by any "pathology AI research" that does not include pathologists in the process.



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    Raul Gonzalez Staff Pathologist
    Decatur GA
    (770)773-4768
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  • 7.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-19-2024 16:48

    Hi Dr. Gonzalez, 

    I was hoping you might be able to share some insight into what your program looks for in research track/PSTP/PSP-type applicants. 

    I'm a G2 MD/PhD student hoping to pursue GI path in a research track program. I find myself debating the utility of honing in on my project and a related clinical project that is not inherently path-focused (and the clincial one is not at all GI focused) vs. taking time away from those to pursue a more traditional path project. 

    Thank you very much for your time.

    Sincerely,

    Mary Grace



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    Mary Grace Murray Student
    Loyola University Chicago
    Maywood IL
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  • 8.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-20-2024 09:26
    Edited by Raul Gonzalez 11-20-2024 09:25

    Hi Mary, I am not really involved with the MD/PhD side of things, but I passed your question along to one of our MD/PhD gastrointestinal pathologists. Here is his reply:

    Our PSTP offers a 3-year AP- or CP-only residency that is combined with a 1-2 year mentored research fellowship that is funded by the Department. In general, applicants come with strong research backgrounds in basic science (like yourself) and have a strong interest in generating independent research programs with mentors when they come to Emory. While some exposure to Pathology is encouraged (so that you can speak to your interest in pursuing this career), subspecialty research or clinical research in pathology is not expected nor needed in the setting of extensive prior basic science research experience. 
    He also suggested that you focus on whatever research approach you feel would be the most focused and productive (in terms of data and papers). You are welcome to reach out to him and discuss further if you like -- I can give you his contact information if you email me.



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    Raul Gonzalez Staff Pathologist
    Decatur GA
    (770)773-4768
    ------------------------------



  • 9.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-22-2024 16:09

    Good afternoon Professor Raúl Gonzalez, my name is Roberto I am a final year medical student in a small city in Bolivia in South America. I started a voluntary rotation in pathology and I want to make a contribution to be a factor of change. I was feeling a bit limited because in my hospital we only have H&E in the laboratory because before I only read research on molecular markers or trials. But before asking I read your some of your papers and I found the one on PD-1 inhibitors and histological patterns in patients really impressive, as well as the one on how to conduct research as a resident. I would like to ask you for some advice on how to recognize or justify that a case report or case series is worth reporting. How I might say that something is worth reporting and what I should highlight it to contribute. I am grateful for your attetion. Thank you professor Raul González 

    Sincerely

    Roberto Jimenez 



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    Roberto Jimenez-Fernandez Student
    Santa Cruz BO
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  • 10.  RE: Ask Me Anything: Dr. Raul Gonzalez

    Posted 11-25-2024 09:56

    Hi Roberto, excellent question! Many of my studies focus on the H&E appearance of diseases and their relationship to clinicopathologic factors. For me, this is both more interested and much cheaper than fancy IHC/molecular studies.

    The first trick is to recognize when you struggle with something and cannot find excellent guidance in the literature about what to do. For instance, I started seeing those examples of GI injury in patients on PD1 inhibitors and realized there was no series in the pathology literature about what these cases looked like. This can extend to unusual case reports as well. If you search the literature and come up short, then it's time to contrbute to the literature yourself!

    Now, sometimes you have a great case or idea but the literature does provide guidance. I have had many "great research ideas" (in my mind) deflate because someone had already studied the same thing, only better. Now, in these situations, you may still think the literature lacks some crucial information (eg, a paper did not discuss the effect of a particular finding on patient prognosis), and that can be the opening you need to still pursue a project yourself.



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    Raul Gonzalez
    Professor of Pathology
    Emory University
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  • 11.  RE: Ask Me Anything: Dr. Raul Gonzalez

    ASCP Ambassador
    Posted 11-22-2024 20:59

    Thank you for your insightful answers and being here this week Dr. Gonzalez! 



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    Sri Kavuri
    University of Texas Medical Branch
    Baltimore MD
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