Pathological anatomy in Georgia: current reality and future prospects

Georgia´s first pathological anatomy service was established in the Department of Pathological Anatomy of Tbilisi State Medical Institute in 1922. The major activities were autopsy and histological examination of surgical specimens. Autopsy was done in most cases aiming for quality control and improvement of patient health care. Cytopathology was separated from pathological anatomy and cytological diagnostic services were carried out by biologists in clinical laboratories. Since the 80´s, the volume of biopsies has increased in diagnostic pathology and intraoperative express diagnosis was introduced. Surgical and biopsy specimens were routinely embedded in celloidin which was the major obstacle to the use of special stains and archiving the blocks. The frequency of autopsies declined after a new autopsy law was introduced in the 90´s which did not allow autopsy without the consent of patient´ s relatives. Autopsy is still being performed mostly by forensic pathologists to identify elements of the crime.

Papanicolaou staining was implemented in 2000. A significant number of cytopathologists and cytotechnologists have been trained and educational seminars have been organized in the Department of Pathological Anatomy, Tbilisi State Medical University. These activities led to the Georgian National Screening Program of Cervical and Breast Lesions which has been successfully working for the last three years under the patronage of Ms Sandra Roelofs, Georgia´s First Lady. Immunohistochemistry was first used for research in 1983, and for diagnostic purposes in 2000 which required celloidin to be replaced with paraffin. Most pathology laboratories now use paraffin embedding and four laboratories also offer immunohistochemistry.

There are nearly 60 licensed general pathologists in Georgia. There is no subspecialization, and most of them are above 60. Recruitment of young doctors in pathology has been a challenge not only due to the low salary but also limited educational resources. There is no continuing medical education system in pathology making the professional development difficult. In 2008, First Lady of Georgia supported Dutch and Georgian pathologists to propose a project for establishing the Georgian Federal Center of Pathology. Due to the recent political developments, this project was put on hold but not yet cancelled.
The department has a strong commitment to teaching medical students as well as research activities. Two research projects funded by Georgian National Science Foundation (GNSF) are in progress:

1. Breast carcinoma and BRCA1 in Caucasian (Georgian) women, GNSF/ST07/6-223;
2. Detection of metastatic potential of circulating tumor cells (CTC) in patients with invasive ductal carcinoma of the breast, GNSF/ST08/6-461.

Although there is a lack of diagnostic textbooks available in Georgian, a number of textbooks have been published and intended for medical students, postgraduate fellows and residents.

1. G. Burkadze. Immunomorphology. 2001.
2. G. Burkadze. Gynecologic Cytopathology. 2002.
3. G. Burkadze, G. Turashvili. The basis of genera pathology. 2005.
4. G. Burkadze.G.Turashvili. Pathologyoforgan systems. 2006.
5. G. Burkadze. Breast FN A cytopathology. 2008.
6. G. Burkadze, G. Turashvili. General pathology for dentists. 2008.
7. B. Kochlamazashvili, G. Burkadze. Dental pathology. 2010.
8. N. Museridze, G. Burkadze. A human papillomavirus (HPV) and cervical pathology. 2010.