3 Questions with Jonathan Chen, MHS, PA(ASCP)

During his last semester of college, Jonathan Chen, MHS, PA(ASCP), took a cancer biology course. While he was fascinated by the content, he knew he didn’t want to go into research. It was as he was exploring his options that he shadowed a pathologists’ assistant at the NIH, observed his first autopsy, and came across what excited him the most: the surgical pathology laboratory. 

“I had no idea that this part of laboratory medicine existed,” Mr. Chen says. “I was completely fascinated watching the PA gross in a wide variety of specimens like thyroids, prostates, colons, and kidneys, and covering frozen sections when the surgeons would walk in with a specimen that needed an intraoperative consultation.” Drawn to the fast-paced nature of surgical pathology, he knew this was where he was meant to be. 

Here, Mr. Chen shares more about what motivates him, his favorite test to perform, and more in this issue of 3 Questions (and a bonus!). 

Have you had any mentors or role models who have influenced your career choice? If so, how have they impacted your journey? 

Before attending pathologists’ assistant (PA) school, I worked as a grossing technician at a small private pathology laboratory, and I would say the entire team at Integrated Cellular & Molecular Diagnostics played a huge role in paving my way to becoming a PA. It was at this lab that I got my first introduction to laboratory medicine, and I was able to see the entire pathology process from start to finish: from grossing biopsies to observing the histotechs embed and cut paraffin blocks, to looking at the slides with the pathologists during sign-out. This is where I learned basic grossing skills from the pathologists and laboratory director and also learned how to work on a team with the other histotechs and pathologists. I’m forever grateful to the staff for hiring me right after graduation from college and giving me this opportunity.

What is your favorite test to perform and why?

My favorite test to perform is the gross examination of head and neck and bone/soft tissue cancer specimens because there’s so much specimen type diversity within these two subspecialties. For head and neck pathology, there are a wide variety of organs and structures within this small complex anatomic space, ranging from simple resections like thyroids, salivary glands, and tonsils, to more complex resections like laryngectomy, mandibulectomy, and orbital exenterations. Bone/soft tissue pathology is also similar, where we can get the typical long bone resection for osteosarcoma, but also get hemipelvectomies for chondrosarcomas, various retroperitoneal sarcomas with multi-organ en bloc resections, and all the soft tissue sarcomas in the different compartments of the body. I really enjoy the diversity of specimens within these two subspecialties, and I also enjoy the challenge of identifying all the necessary anatomic structures, assessing margins, identifying invasion into components, and finally the technical challenge of sectioning the bone specimens on the bone saw. 

What motivates you in your role, knowing that your results influence a patient’s diagnosis and treatment? 

What motivates me is knowing that my job as a pathologists’ assistant can have very important (sometimes high stakes) implications for the patient’s diagnosis and treatment. Our job is super important because there are even some errors that our pathologists can’t fix but has implications on patient outcome down the road. A common example of this is submitting an “en face” margin when the tumor is close, and it should have been submitted as a perpendicular margin instead, and now the “en face” margin is microscopically positive. Does this mean that this margin is actually positive or is this is a false positive margin?  Not only can this cause a huge headache for the pathologist, but this can have a significant impact on the patient’s prognosis and follow-up treatment. There’s a saying in the PA circle, “treat every specimen as if it were your own (or your family member’s or friend’s specimen)”, and I always keep this in mind when approaching every specimen that comes across my board – that this is someone’s specimen and how I gross it can have important implications for the patient down the road. That’s what motivates me to do right by the patient for every specimen.

How do you approach difficult cases where the results could have a life-changing impact on a patient? 

The majority of the difficult specimens that I encounter are specimens that are received disrupted and unoriented, and I’m unable to understand the specimen orientation even after reviewing the imaging and the operative note. This is when I will call the surgeon to come down to the gross room to review the specimen with me. This is important to do because the surgeon knows best how the specimen is oriented, knows which defects are true defects vs artefactual, and knows which margins are truly grossly positive. We never want to assume anything or guess how the specimen should be oriented, because this has high-stakes implications for the patient down the road for follow-up treatment. This is why working closely and collaborating with our surgeons is so important for patient care.