Departments

The Breast Pathology program specializes in interpreting and evaluating core needle breast biopsies, incisional and excisional biopsies, lumpectomy or partial and total mastectomy specimens, sentinel lymph nodes, axillary dissections, prophylactic and oncoplastic reduction mammoplasty, and neoadjuvant breast cases. The faculty is board-certified in anatomic pathology and many of the pathologists also have subspecialty expertise in breast pathology. We provide state-of-the-art diagnostic services focused on precise diagnoses of both benign and malignant breast diseases. In cases with malignant diagnosis, additional ancillary studies for receptors are reported with two- to three-day turnaround times. We work closely with our clinical team to ensure that our patients get accurate and reliable results that are critical to patient care. The first question a breast pathologist seeks to answer when reading a breast biopsy is whether cancer is present. But the information included in the pathology report goes far beyond the “yes” or “no” diagnosis. Even if the biopsy is benign, we need to ensure that the calcifications seen on imaging correlate with calcifications seen on the core biopsy pathology specimen. The earliest stage of breast cancer, called ductal carcinoma in situ (DCIS), is usually detected in this manner. Discordance between pathology and imaging is addressed by means of communication between the radiologist and pathologist in a radiology-pathology conference or by individual communication. A pathology report always has a detailed visual morphologic description of the tumor. The initial biopsy report includes information on whether the cancer is confined within the ducts (in situ carcinoma) or has breached the duct wall and invaded into the adjacent stroma (invasive carcinoma). We provide intraoperative consultation on sentinel lymph nodes in the frozen section suite to detect metastases, which will then help the surgeon in planning patient management. Additional details will be studied and added to the pathological report after mastectomy and sentinel node biopsy to determine whether the cancer has metastasized or spread to any lymph nodes. Tumor size, histologic grade, and lymph node status are prognostic indicators that provide valuable information about the likely clinical outcome. For example, a patient whose tumor is well-differentiated and has negative margins, i.e., has clear margins, has a better prognosis than a patient whose tumor is one that is poorly differentiated and is present at the margin.

Whereas laboratory scientists typically analyze blood or other fluids from patients, anatomic pathologists evaluate tissue specimens, which include cervical scrapings (i.e., PAP smears), biopsies, surgical resections, and whole-body evaluations at autopsy. Anatomic Pathology has three major divisions: Surgical Pathology. This is the examination of tissue removed as a biopsy or as part of a surgical procedure. When a biopsy is done (typically a small sampling of a lesion by incision or by an invasive technique like a core needle biopsy or endoscopy), the pathologist determines what disease process is present, and/or the extent of disease. In all cases, pathologists make their diagnoses by examining thin slices of the lesion under a microscope. Pathologists often also use a variety of specialized molecular techniques to further refine the diagnosis and to predict how the disease may respond to various types of treatment. In this way, the pathologist helps guide any subsequent therapy the patient may need. Cytopathology: This is the examination of very small amounts of tissue removed by scraping a surface, or by aspiration through a fine needle. Obtaining a cytopathology specimen is typically less invasive than obtaining a surgical pathology specimen, so these procedures can be performed in a clinic or a physician’s office. Cytopathologists examine individual cells and small collections of cells to assess for the presence or absence of malignancy. Autopsy Pathology: This is the anatomic examination of a deceased patient to determine what diseases were present and how extensive they were, and to assemble these findings into an explanation for why the patient died. Autopsy examination can answer questions family members may have about the patient’s death, but can also increase understanding of disease for the physicians caring for the patient.

Our expert pathologists are key players in all health care provided by Yale Medicine. By studying bodily fluids and tissues, we help other physicians make diagnoses. We offer highly specialized diagnostic and consultation services in all major specialty and subspecialty areas of pathology. Our subspecialists attend all regular meetings in which a number of doctors from various specialties review and discuss a patient's medical condition and treatment options.They are on call around the clock, ensuring that doctors working in oncology, surgery, transplantation, and other service areas always have access to our expert knowledge. Our internationally recognized physicians offer specialized expertise in breast, cytopathology (cell), dermatologic, endocrine, gastrointestinal and liver, gynecological, head and neck, hematologic (blood), neurologic, ophthalmologic, pediatric, kidney, soft-tissue and bone, transplant, thoracic and urologic pathology, molecular and genomic pathology, and autopsy pathology. Specialized care is offered in the following areas: Accredited PD-LI testing Autopsy Cytopathology Intraoperative frozen section and tumor triaging service Molecular diagnostics and tumor genomics profiling Pediatric pathology Support laboratories: histology, immunohistochemistry, translational pathology, and electron microscopy and quantitative immunofluorescence analysis of multiplexed tumor markers Surgical pathology with subspecialty expertise in gastrointestinal tract and liver; prostate; bladder; kidney; gynecological tract; endocrine system; head, neck, and oropharynx; bone and soft tissue; hematologic and lymphoid system; brain, muscle and eye; pulmonary system; and transplantation

Our most comprehensive diagnostic service, Surgical Pathology includes the subspecialties of more than 40 physicians. Our board-certified pathologists offer complete pathology services for a wide range of cancerous and noncancerous diseases and conditions. We provide diagnostic services in the following specialty areas: Breast Pathology Bone & Soft Tissue Pathology Dermatopathology Endocrine, Head & Neck Pathology Gastrointestinal & Liver Pathology Genitourinary Pathology Gynecological Pathology Hematopathology Medical Renal Pathology and Electron Microscopy Neuropathology Ophthalmic Pathology Pediatric & Placental Pathology Thoracic Pathology

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

The dedicated pediatric hematologists and oncologists of the Yale Pediatric Hematology and Oncology Program provide comprehensive and compassionate care for children with all forms of cancer and blood diseases, including leukemia, malignant tumors and lymphomas, as well as sickle cell disease, hemophilia, coagulation abnormalities, and platelet disorders. Our program utilizes a team approach to care, and is active in research that seeks to advance the diagnosis and treatment of pediatric cancer and blood diseases. Cure rates continue to rise for children with cancer. At Yale, we are determined that more and more children will survive, and that they will thrive. We work to design treatments that cause less discomfort to patients in the short term and fewer serious complications in the long term. Smilow Cancer Hospital and Yale New Haven Children’s Hospital’s care team works with patients and their families to design individual treatment plans. In addition to an oncologist, our multidisciplinary team includes advanced practice providers, registered nurses, social workers, a psychologist, psychiatrist, neuropsychologist, nutritionist, and child life specialists, all who have expertise in the medical, social, emotional and educational needs of children and teens. Understanding that children with cancer and blood disorders need more than medical care, we work with patients and their families to help them meet their social, emotional, educational, and behavioral needs. Our support services include: Routine psychosocial evaluations for newly diagnosed patients and their families. Home visits for the most gravely ill or psychiatrically symptomatic children and their families. A school integration program that includes counseling for families and children about their rights to have special services. We work with school districts to make appropriate accommodations for students returning to school, including providing special education services, if necessary. Psychoeducation and neuropsychological testing for patients at risk for neurocognitive problems. Support groups for siblings and parents. End-of-life support team for children and families. HEROS Survivorship Program The HEROS (Health, Education, Research & Outcomes for Survivors of Childhood Cancer) Survivorship Program at Smilow promotes the lifelong health of pediatric cancer patients after their cancer treatment has ended.It was the first childhood cancer survivorship program in Connecticut to offer comprehensive care for adults and children who had survived pediatric cancer. In our specialty clinic, patients receive detailed cancer treatment summaries and an individualized schedule for future screening for chronic conditions related to their original cancer treatment. Our multidisciplinary team that includes a pediatric oncologist, nurse practitioner, psychologist, registered dietician, and nurse educator are committed to caring for each patient as a whole person and empowering survivors

Covering every aspect of health care for adults, Internal Medicine is the largest department in the Yale School of Medicine, and the largest clinical service at Yale New Haven Hospital. We provide comprehensive and specialized services in all areas in a variety of outpatient settings as well as the Veterans Affairs (VA) Connecticut Health Care System campus in West Haven. Our culture of collaboration and research gives patients access to expert opinions from nearly 1,000 doctors, as well as opportunities to get tomorrow’s health care today through more than 100 clinical trials. Most importantly, we attend to our diverse community of patients with compassionate, thorough care. Specialized care is offered in the following areas: Allergy & clinical immunology Cardiovascular medicine Digestive diseases Endocrinology General internal medicine Geriatrics Hematology Infectious diseases Medical oncology Occupational health & environmental medicine Nephrology Pulmonology, critical care & sleep medicine Rheumatology International reputation for work in understanding function, independence, and quality of life in older persons Key research breakthroughs of the past decade that include the development of a protective Lyme bacillus disease vaccine, exploration of the underlying causes of allergic disease, and the discovery of novel inherited immunological diseases Largest interventional cardiology program in Connecticut Major referral center for patients with type 1 and type 2 diabetes, as well as other metabolic conditions Nationally ranked program in kidney diseases and the largest kidney transplant program in New England, with multidisciplinary care clinics One of the largest peripheral vascular programs in the country, with leadership and participation in multiple new percutaneous device trials Once of only a few motility centers in Connecticut to provide all motility procedures and services Unique medical forensic exams for individuals with claims of torture who are seeking asylum in the U.S.

The Yale Child Study Center is an internationally recognized center of innovation in child and family mental health, dedicated to promoting healthy development and psychological well-being across the lifespan. We care for children and adolescents whose families are concerned about their child’s development and behavior. Common concerns include developmental delays, behaviors or worries that interfere with their child’s life, isolation and fear of school, and defiant and difficult behavior. Our first job is to listen. As we begin to understand the family and child, we will guide our patients through the evaluation, diagnosis, and treatment process. We provide office and home-based interventions as well as telehealth services, and we work with as many people involved in your child’s growth as possible, including parents, teachers and pediatricians. Above all, we care about your child’s development and your family’s well-being. We will use every means available—and maybe even invent some new ones—to help the child and their family. We are committed to working with every family to help them understand and address their child’s and family’s needs. Our interdisciplinary teams use up-to-date science to evaluate and then work with the family to develop a comprehensive treatment recommendations. Our treatment may include (one-on-one or group) therapy, family therapy, and parent-centered approaches and collaboration with schools. When appropriate, our providers will discuss the use of medication, providing detailed information so parents can make an informed decision. Many of our patients improve and thrive without medication, and for others it is a valuable part of their treatment. At the Yale Child Study Center, we are pioneering many treatments including approaches that help parents improve disruptive anger and aggression in children with autism and other developmental disorders. We are also developing new ways to help children overcome anxieties that may limit their daily lives, and treatment approaches designed to lessen the impact of an overwhelming event on the child and family. Finally, we work directly with parents around their own concerns about their roles as parents.

At the Pediatric Genomics Discovery Program (PGDP) at Yale, we offer patients and their families with potential undiagnosed genetic diseases an opportunity to be evaluated by a team of physician-researchers specializing in genetics. Roughly one in 30 babies born in the United States each year has a genetic condition. These conditions can range from abnormal limbs, to a permanently weakened heart, to an overly curved spine. In some cases, a medical team might be able to identify, at a cellular level, the exact cause of a condition. In other cases, however, the cause of a child's disease remains unclear even after extensive evaluation and testing. We are embarking on a study to uncover answers to undiagnosed diseases in children and adults by studying their genetics, and are looking for participants. The short video below explains our study. Click here to sign a consent form and to provide other demographic information. [note to tech: add an External link to Kohezion e-consent form and other demographic information.] What is this study about? We want to study undiagnosed genetic diseases because it will help us understand what these conditions are, what might happen to people with these conditions, and what doctors could potentially do to treat them. How will this study help me? We hope to provide some answers for you or your child’s condition, although we can’t know ahead of time if we will find all the answers. Your participation could help others with similar conditions in the future. What do I need to do to get started? Here is how you can participate: Learn more about the study by reviewing the information on this website. Sign up using our online consent process through this link: [LINK to e-consent form]. We will ask you to provide some background information about you, the best way to contact you, and your consent to participate in our study. Provide us with samples from kits that we will ship directly to your home. Our team’s medical experts will then reach out to you to learn your story and gather any additional medical information we might need. Our team will take it from there. What samples do I need to provide? Most of the time, a saliva sample is all we need. If we ask for further samples, these will most likely be additional saliva. However, in rare cases, we may ask for a blood sample. By enrolling in this study, you are giving us permission to ask for, collect, and use additional samples for study purposes. You can change your mind or decline to provide samples at any time—it is completely up to you. What will the research team do? We will use the samples you provide us to perform a state-of-the-art, comprehensive genetic analysis. With that, we may be able to detect previously undiscovered genetic causes of your child’s genetic disease that are not identified by conventional clinical testing. Is my family eligible to participate? To participate in the study, the affected child, Mom, and Dad will each ne

Clinical Genetics at Yale School of Medicine has a long and distinguished history of advancing the understanding of inherited disorders and providing outstanding care to patients and families with a genetic disorder or suspected of having such a disorder. Informed by transformative basic and translational research, highly trained Yale genetics physicians and support staff provide comprehensive diagnostic evaluations, genetic counseling, and care for children and adults affected by a wide variety of rare and complex inherited and congenital conditions. The full spectrum of state-of-the-art genetics laboratory services, including molecular and cytogenetic diagnostic laboratories, are housed within the Department. Comprehensive and compassionate clinical care of the highest quality is provided by a team of highly experienced physicians who specialize in medical genetics, genetic counselors, nurse practitioners, nutritionists, and laboratory geneticists who value collaboration and respect for individuals and families. Recognizing its stature in the field, the Department has been designated a Center of Excellence for rare diseases by the National Organization of Rare Disorders. It is committed to improving access to and care for patients with rare disorders. Appointments for a genetic evaluation can be scheduled by calling (203) 785-2660 . Your health care provider must make a referral for genetics evaluation via the EPIC electronic medical record, and our schedulers will contact you to schedule an appointment. The mission of Clinical Genetics is: To provide outstanding and compassionate clinical care to patients by applying the most recent diagnostic and therapeutic advances based on cutting-edge basic and translational genetic/genomic research To provide outstanding training for clinical and laboratory geneticists, empowering them to become leaders in the seamless integration of genetics and genomics across the entire field of medicine. To advance the field of genetics and genomics medicine through the innovative research programs housed in our department and university. Patient care General Genetics Clinic for Children and Adults. We provide comprehensive diagnostic evaluations, follow-up, and management for children and adults with a large variety of medical problems, including: Birth defects Chromosomal abnormalities Abnormal results of newborn screening Inborn errors of metabolism Intellectual disability Autistic spectrum disorder Developmental delay Neurocutaneous disorders Childhood and adult genetic syndromes Hereditary cancer syndromes (link to cancer counseling ) Individuals suspected to have a genetic disorder Note: We care for patients and families with many other genetic disorders. Please contact us at (203) 785-2660 if you have questions about whether a patient should be referred for genetic consultation. Specialty clinics Down Syndrome Program Craniofacial Program Neurofibromatosis Program We provide dia

Yale is the regional leader in diagnosing and treating a wide range of sleep problems in infants, toddlers, children, and teens. Sleep problems can be linked to respiratory issues, or may stem from other medical, behavioral, or developmental concerns. We are dedicated to working with each family to locate the source of the child’s sleep issues, and to find a way to better sleep. No matter the cause, we will deliver comprehensive, compassionate care for each child’s sleep challenges in a warm, child-friendly environment. Our staff includes physicians who are board-certified in pediatrics, pediatric pulmonology, and sleep medicine. We are the only center in the state staffed exclusively with board-certified specialists. In addition to diagnosis and treatment of sleep issues, we provide support for patients in need of oxygen and ventilators, and continuous positive airway pressure (CPAP) titration and management. Nonrespiratory sleep complaints we treat include: Insomnia, including difficulties falling asleep and nocturnal awakenings Excessive daytime sleepiness Restless leg syndrome Sleep disturbance, including parasomnias (sleep walking, night terrors, nightmares, and bed wetting) Narcolepsy Respiratory sleep problems include: Obstructive sleep apnea with snoring, noisy breathing, disrupted sleep, or daytime sleepiness and/or attention problems Life-threatening eventsin infancy Respiratory complications of neuromuscular disease, including muscular dystrophy Pre- and post-operative evaluation for scoliosis, spina bifida, cleft palate, and other neurosurgical and craniofacial disorders