Journal of Pathology and Translational Medicine

Review

The Use of Fine-Needle Aspiration (FNA) Cytology in Patients with Thyroid Nodules in Asia: A Brief Overview of Studies from the Working Group of Asian Thyroid FNA Cytology: Chan Kwon Jung, SoonWon Hong, Andrey Bychkov, Kennichi Kakudo; J Pathol Transl Med. 2017;51(6):571-578. Published online October 27, 2017; DOI: https://doi.org/10.4132/jptm.2017.10.19

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Ultrasound-guided fine-needle aspiration (FNA) cytology is the most widely used screening and diagnostic method for thyroid nodules. Although Western guidelines for managing thyroid nodules and the Bethesda System for Reporting Thyroid Cytopathology are widely available throughout Asia, the clinical practices in Asia vary from those of Western countries. Accordingly, the Working Group of Asian Thyroid FNA Cytology encouraged group members to publish their works jointly with the same topic. The articles in this special issue focused on the history of thyroid FNA, FNA performers and interpreters, training programs of cytopathologists and cytotechnicians, staining methods, the reporting system of thyroid FNA, quality assurance programs, ancillary testing, and literature review of their own country’s products. Herein, we provide a brief overview of thyroid FNA practices in China, India, Japan, Korea, the Philippines, Taiwan, and Thailand.

Citations

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Original Articles

Memorials of Alois Alzheimer (June 14, 1864~December 19, 1915) and Historical Background of Alzheimer's Disease.: Ki Hwa Yang; Korean J Pathol. 1996;30(1):1-6.

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Abstract PDF: December 19, 1995 is the 80th anniversary of Alois Alzheimer's death. Recently, dementing illness including Alzheimer's disease has become the center of public interest in Korea. However, there are not much information about him or historical background of Alzheimer's disease. It is even misunderstanding. It seems to be meaningful to introduce the lifetime of the Alois Alzheimer and the historical background of Alzheimer's disease, especially in the anniversary of his death.

Perspective of The Korean Society of Pathologists.: Je G Chi; Korean J Pathol. 1997;31(10):902-908.

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Abstract: Only since the introduction of western medicine by Japanese officials and American missionaries in the late 1890's, has the Pathology in its modern concept been considered a major part of basic science in medical schools in Korea, after its role as a hospital service had long been ignored. Limited service of tissue diagnosis on surgical material was the only service performed. Professor Inamoto was the first Japanese pathologist to come to Korea and set up a Pathology Department at the Chosun Chongdogbu Hospital in 1913, and Dr. Mills appears to be the first American hospital pathologist who worked at Severance Hospital in 1913 practicing bacteriology and parasitology as well as lecturing pathology at the medical school. Korea was annexed by Japan from 1910 to 1945. The Korean Society of Pathologists (The former Chosun Society of Pathology) was founded on October 1, 1946, during the turmoil after the end of the Second World War and liberation from Japanese occupation. Only a handful of pathologists gathered for the delivery of the Society. The purpose of the Society was to study, research and exchange information and knowledge in the field of Pathology among its members. Since 1947 the Society had held regular annual academic meetings. In 1950 the Korean War occurred and the Korean Society of Pathologists (KSP) had to restart after the war. The still existing Monthly Slide Conference started in 1959, and the Pathology specialist system was adopted in 1963. There had been a considerable confusion during the adoption period of the pathology specialist system in this country, mainly because of the confused concept of the term "clinical pathology". In its start three categories, i.e., anatomic pathology, clinical pathology, and combined anatomic and clinical pathology were opened. However, the combined training program was eliminated in 1975, which eventually resulted in the separation of clinical pathologists from the KSP to found a new society of Clinical Pathology in 1980 against the advice of the KSP. The first official Journal of the Society, The Korean Journal of Pathology was launched in 1967, marking the 20th anniversary of the Society. It started as a biannual Journal and became a quarterly in 1977. In 1991 the Journal became a bimonthly periodical, and since 1996 the Society issues 12 volumes a year. From 1976, academic activity of the Society was expanded by opening its Spring Meeting in addition to the conventional annual Fall Meeting. In 1992 the Society adopted board of trustee system, providing a fresh blood transfusion. In 1996, the Society commemorated its 50th Anniversary, and published a record book, "The First Fifty Years of The Korean Society of Pathologists". As of December 1996, the Society has a total membership of 500 and 7 special study groups The Society holds 2 annual meetings, monthly slide conferences, several long and short courses, and workshops every year. Approximately 400 papers have been presented each year at the annual meetings. Approximately 350 anatomic pathologists work at hospitals, and a additional 50 pathologists are engaged in full time research at the Department of Pathology in medical schools and other research institutes. As we turn the first half century of founding the Korean Society of Pathologists we realize that we have to be well prepared for various expected and unexpected situations in the future. Enforcement of research pathology at medical schools appears to be the most urgent and important issue. For this purpose, the concept of basic pathology, research pathology, and hospital pathology (surgical pathology) should be clearly established. We also have to clearly define the differnece between anatomic pathology and clinical pathology in this country. At present, the clinical pathology stands alone without any collaboration with the KSP in terms of training program, specialty qualification and hospital practice. Undergraduate pathology education is another issue that we have to pay special attention. The number of full time research pathologists should be increased, and their active and dominant participation in the Society are needed. As the demand for the knowledge and promotions of special field of pathology increases, establishment of additional study group should be encouraged. And if the requirements are met, founding a new Special Pathology Society could also be encouraged. However, the basic skeleton and executive power of the KSP in training residents, qualifying specialty or subspecialty, and in representing the entire pathology field should be maintained and strictly enforced. Hospital pathology has been a dominant drive of the KSP for the last 35 years since the adoption of specialty system. The term, "Diagnostic Pathology" appears to be a term that can replace "Anatomic Pathology", "Surgical Pathology", or "Tissue Pathology" in this country. In future the demand of diagnostic pathology particularly endoscopy biopsy diagnosis, cytological diagnosis and evaluation of surgical operation would be greatly increased. Therefore, we have to be ready for the requirements of professional diagnostician in various fields of pathology as well as overall general diagnostic pathologist. Subspecialty qualification could be expected around the year 2005, when the membership of the Society is expected to be 700. The Korean Journal of Pathology has yet to be improved. It should contain more basic research articles produced by full-time basic pathology researchers. Papers related to hospital pathology (diagnostic pathology) including cytopathology should pursure not only originality but also its practical importance in our situation in this country. The Korean Journal of Pathology should aim for its acception and inclusion in international indexing system in near future.

Pathology in Korea during the Period 1945~1957.: Je G Chi; Korean J Pathol. 1995;29(3):352-360.

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Abstract PDF: The pathology in Korea was introduced by Japanese and American missionaries in early 1920. Since that time, pathology teaching, service and research in Korea had been under strong influence of Japan. There was no indendent disciplines of Korean Pathology until the time of Liberation from Japan in 1945. Pathology activity during early period of Korean Pathology, 1945 to 1957, was reviewed in this paper, based on the literature available. The first half of this period (1945 to Korean War), was a transition period from the Pathology. Only 8 papers related to pathology were Japanese-German Pathology to Korean published during this time in Korean literature. However, papers that were orally presented at annual meetings were 12 in 1947, 23 in 1948 and 13 in 1949, respectively. The Korean Society of Pathologists was founded in 1947. And the annual meeting was started from 1947 under the auspiece of Korean Medical Association. The annual meeting could not be held in the year of 1950, when the Korean war started. Virtually no public academic activity was present during 1950 to 1952. The second half of this period(Korean war to 1957) represented reconstruction of Pathology. In fact it was a restart of the Korean Pathology in Korea. During this period less than 10 papers were published in the Korean medical journals. Oral presentation titles at the annual meetings were 6 in 1953, 18 in 1954, 14 in 1955, 15 in 1956 and 31 in 1957, respectively. In summary, the period of the first 12 years since the liberation from Japan, 1945 to 1957, appears to be the dark age of Korean Pathology. No significant academic activity could be found during this period. The slow start of Korean Pathology during the first half of this period was further delayed by the Korean War. Despite all these facts, spirit and effort of early Korean pathologists should be highly appreciated. It seems that the Korean Pathology actually restarted after the Korean war under the influence of American Pathology. It seems only after 1958 that the Korean Pathology took a firm position for promotion.

The Establishment of Hospital Pathology in Korea.: Je G Chi; Korean J Pathol. 1994;28(2):109-117.

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Abstract PDF: A brief historical review of the Pathology Service in the western hospital system in Korea is made. Only since the introduction of western medicine by Japanese officials and American missionaries in the late 1890 has Pathology been considered a major part of basic science in medical schools, and its role as a hospital "Service had previously long been ignored. A limited service of tissue diagnosis of surgical material and autopsy had been performed. Professor Inamato was the first Japanese pathologist to come to Korea and set up a Pathology Department at the Chosun Chongdogbu Hospital in 1913. And Dr Mills appears to be the first American hospital pathologist who worked at Severance Hospital in 1913 doing bacteriology and parasitology as well as lecturing on patology at the medical school. After the Korean war most university hospitals adopted the Central Laboratory system which is equivalent to Pathology Service in the American hospital system. The need for hospital pathologists, therefore increased greatly. To meet this need the Korean Society of Pathologists that was founded in 1946, established a pathology specialty system in 1963, and began to produce hospital pathologists in both anatomic and clinical pathology. Unfortunately in the midst of changing a hospital laboratory system the term Clinical Pathology was erroneously used by some pathologists to measn Hospital Pathology as a whole. They claimed and advocated that Surgical Pathology should also be a part of Clinical Pathology. They made no distinction between anatomic pathology and clinical pathology. Although their claims proved to be erroneous later, the discord between anatomic pathologists and clinical pathologists resulted in a complete separation of the anatomic pathology(AP) and clinical pathology(CP) programs in residency training and in the specialty board system. As of now there is no access to train combined AP and CP specialists who are greatly needed for a great majority of hospitals in Korea. Presently there are almost equal number of anatomic pathology and clinical pathology specialists. M.D. clinical pathologists in Korea have no knowledge of tissue pathology examination, and conversely anatomic pathologists have no access to a clinical laboratory during their training periods. Furthermore there are only a handful specialists in the clinical pathology field. There is an increased chance to have clinical microbiologists, clinical biochemists and other experts in clinical pathology fields, who are not M.D.s but Ph.D.s, in the near future, because M.D. microbiologists and biochemists working at Departments of Microbilogy or Biochemistry at medical schools are doing research of their own. Therefore general clinical pathologists with a con-temporary training background as in Korea would have difficulty in finding a ro as a physician and not as an administrator or supervisor of a clinical laboratory. It is hoped that a balanced system involving Pathology(anatomic pathology) and Laboratory Medicine(clinical pathology) in modern Korean hospitals will be established in the coming years.

The Pathology Specialty System in Korea: Past, Present and Future Prospects.: Je G Chi; Korean J Pathol. 1992;26(6):537-542.

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Abstract PDF: The specialist system of hospital pathology in Korea has adopted the American system in its start, and divided its categories into anatomical pathology(AP), clinical pathology(CP), and combind anatomic and clinical pathology(AP +CP). Since 1975 the society eliminated the category of combined AP and CP specialist. The first qualifying examination took place in 1963. It started out as a written examination and later changed to have two parts, written and practical. One year of internship and 4 years of anatomic pathology were required for AP specialist. CP required the same period of training in CP to be eligible for the specialist qualifying examination. The training period was shortened to 3 years from 4 years, 1981~1990 and then returned to 4 years in 1991. There has been considerable confusion during the adoption period of the pathologist specialist system in Korea, mainly because of an incorrect concept of the term "clinical pathology" in the modern hospital. Many people understood "clinical pathology" to mean "hospital pathology" as an opposing concept of "basic or experimental pathology" at medical school. The misconception arose from the fact that Pathology Department in a Hospital has not been realized under Japanese hospital system that prevailed Korean hospital system until 1950. In old Japanese style, the laboratory examinations including some histopathological examination had been conduced in corresponding clinical departments. And Pathology Department in medical school was responsible only for autopsy and not for making diagnosis of biopsy or operative specimen necessarily. Therefore, there has been a conflict between traditional Pathologists(most of them anatomic pathologists) at medical school and so-called "clinical pathologists" in the hospital, as the Korean medical delivery system adopted American system particularly after the Korean war. Now in Korean, in the great majority of hospitals, clinical pathology is clearly defined from anatomic pathology, and the two-services are at work in separate programs. However, there are still a few university hospitals, where histopathological examination and reporting are done in the Clinical Pathology Department. It is hoped that a combined AP and CP program can be started again in near future for the pathologists who work in community hospitals or most smaller general hospitals where the pathologists with adequate knowledge on both AP and CP at work supervising clinical laboratory technicians and technologists. However, it is fully realized the specialists in subspecialty field such as neuropathology, dermatopathology, hematopathology, clinical microbiology, clinical chemistry, etc. are also needed. For future prospect both the Korean Society of Pathologists and Korean Society of Clinical Pathologists should collaborate with each other in full scale in spite of painful past experiences.

Monthy Slide Conference of the Korean Society of Pathologists: A Historical Review on it's 30-year Anniversary.: Je G Chi; Korean J Pathol. 1989;23(4):403-409.

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Abstract PDF: A brief historical review of our monthly slide conference (MSC) was made. These conferences were begun by several pathologists in Seoul in 1959 under the name of "Monthly Meeting of Seoul Pathologists" acting on a proposal of Dr. Kristen Arnesen. Dr. Arnesen, a Scandinavian pathologist, was the first head of the Department of Pathology of the National Medical Center (NMC), which had been established in 1958 by the joint efforts of the U.N.Korean Reconstruction Agency, the goverments of the three Scandinavian countries and the goverment of the Republic of Korea. Seoul National University, Yonsei University, National Medical Center and Holy Ghost Medical College (now Catholic Medical College) were the first 4 participants who joined the conference from the beginning, and the conferences were held at Seoul National University or at the NMC. This conference was incorporated into the official academic activity of the Korean Society of Pathologists by 1965. The history of MSC was arbitrarily divided into five developmental stages: the first stage (1959-1960), second stage (1961-1963), third stage (1964-1970), fourth stage (1971-1983) and the fifth stage (1984-1988). The number of participating institutions increased to 11 by the end of 1973, 24 by the end of 1983 and 41 by the end of 1988. The total number of cases discussed at the MSC was 1,805 by the end of 1988. An average 100 members have participated each month in the meeting since 1980, and a total of 65 slide sets have been distributed since 1986. This conference has contributed enormously in training resident pathologists and refining diagnostic skills of specialist pathologists. It has become one of the most interesting and eagerly-awaited meeting of the Korean Society of Pathologists. It is author's hope that this brief overview may convey some inspiration to our young pathologist collegues and instigate increased efforts to refine their diagnostic skills and also to explore the vast and, as yet, unsolved problems in the pathology field in this country.

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