What is diagnostic neuropathology?
Diagnostic neuropathology is a small specialty dealing with diseases of the nervous system. It covers a wide range of disease processes such as neoplasia, neurodegeneration, inflammatory and infective processes and trauma. There is also huge diversity in the age range of patients, for example in the diagnosis of congenital malformations in fetal brains through to the assessment of neurodegenerative disease in the elderly.
A typical week in neuropathology can include the assessment of surgical specimens such as brain biopsies and tumour resections, cytological examination of cerebrospinal fluid, examination of peripheral nerve and skeletal muscle biopsies, and various ophthalmic specimens such as corneal resections and conjunctival biopsies. The contribution of molecular pathology is huge and always increasing, particularly in the diagnosis of CNS tumours.
There is also a significant post-mortem component. Neuropathological post-mortems are performed where the suspected cause of death is in the nervous system, or where further assessment of a neurological disease is required. We also examine formalin-fixed brains that are referred by our colleagues in histopathology, for example in cases of suspected SUDEP, and brains that are referred by colleagues in paediatric pathology, for example cases of congenital malformation and sudden unexpected death in infancy.
How does the training scheme work?
The current diagnostic neuropathology curriculum was introduced in 2012 when it was made a separate specialty. Training is therefore only available in dedicated training centres. Currently in 2017 there are fewer than 15 trainees in diagnostic neuropathology in the UK, and there are around 60 consultants. Recruitment in England is nationalised and runs once or twice per year; the number of jobs advertised varies depending on the number of vacant training posts. There are two main routes of entry into the four-year training programme, at the end of which you need to pass the part 2 FRCPath exam in neuropathology.
The first route is through general histopathology, where you are eligible to apply after passing the part 1 FRCPath exam. There is a requirement to gain relevant clinical knowledge, for example in neurology and neurosurgery, and this comprises 50% of the first two years.
The second route of entry is from neurology or neurosurgery after completion of ST3 in these specialties. Trainees from this route complete a year of general histopathology at the beginning of the four-year programme, and sit the FRCPath part 1 exam.
What are the advantages of the career?
- The diversity of anatomical sites, disease processes and diagnostic techniques, across the entire age range, makes it interesting and rewarding.
- The complex neurological diseases, for example those affecting skeletal muscle, require close clinical correlation and this allows us to build good relationships with clinical teams.
- Research into neuroscience is constantly being integrated into our diagnostic practices, and it is easy to combine academic work with diagnostic neuropathology.
- There are opportunities to specialise further, for example to focus on neuromuscular pathology, neurodegenerative diseases, paediatric neuropathology or forensic neuropathology.
Are there any disadvantages?
- The main disadvantage is the limited number of centres that have neuropathology units, which may restrict you geographically during your training and as a consultant. There is a list of neuropathology units available on the British Neuropathology Society’s website (http://www.bns.org.uk/uk-neuropathology-departments/).
How can I find out more about the specialty?
If you are already a histopathology trainee, you should have the opportunity to complete an attachment in neuropathology. If you are working in a clinical specialty you can contact a neuropathology unit to request a taster week, where you will see examples of the work of a neuropathologist. If you are a medical student there may be a relevant student selected unit for you to select, otherwise you could contact your local neuropathology department and ask to spend some time with them. Participating in relevant audits, attending conferences and writing up case reports is another useful way to gain experience. There is further information available on the British Neuropathological Society’s website (http://www.bns.org.uk/) which includes the dates of upcoming meetings, and on the RCPath’s website where the training curriculum is available (https://www.rcpath.org/trainees/training/training-by-specialty/diagnostic-neuropathology.html).
Dr Mark Fabian
ST5 in Diagnostic Neuropathology
Southampton General Hospital