Armed Forces Institute of Pathology

The Armed Forces Institute of Pathology (AFIP) was a U.S. government institution concerned with diagnostic consultation, education, and research in the medical specialty of pathology.

Overview
It was founded in 1862 as the Army Medical Museum in Washington, D.C., on the grounds of the Walter Reed Army Medical Center. It primarily provided second opinion diagnostic consultations on pathologic specimens such as biopsies from military, veteran, and civilian medical, dental, and veterinary sources. The unique character of the AFIP rested in the expertise of its civilian and military staff of diagnostic pathologists whose daily work consisted of the study of cases that are difficult to diagnose owing to their rarity or their variation from the ordinary. The accumulation of such cases has resulted in a rich repository of lesions, numbering over three million, that have been the basis of major pathological studies.

Examples are the published reports on the clinical, pathological, and molecular characteristics of the relatively newly recognized gastrointestinal stromal tumors.

Another special feature of the AFIP was the interaction between its departments in analyzing complex cases. The AFIP's diagnostic departments were based on organ sites—e.g., dermatological, hepatic, gastrointestinal, genitourinary, pulmonary, soft tissue, bone, hematological, neurological, endocrine, and gynecological pathology. In addition, there were specialty departments dealing with infectious and parasitic diseases, molecular studies and environmental pathology. As all of these specialties were located in one institution, rapid collaborative examination of a case was facilitated and interdepartmental collaborative research was the rule rather than the exception. In 2009 the Environmental Protection Agency shut down many of the labs, especially those dealing with anthrax, due to improper storage practices.

Unique to the AFIP was the Department of Radiologic Pathology, which pursued the interface between diagnostic radiology and anatomic pathology. This department was responsible for a course attended by virtually all North American radiologists in their training. A by-product was an unmatched repository of medical cases having extensive radiological images and pathological slides, a great source for studies in this field.

The educational mission of the Institute consisted of formal courses providing continuing medical education (CME) credits for postgraduate medical personnel. A number of these courses had microscope slide study sets for individual examination by the participants as well as authoritative lectures by the AFIP and visiting staff. Fellowships were available as were one-month visits to individual departments.

AFIP and international standardization
The AFIP played a critical role in the standardization of pathologic diagnosis of tumors. This was mainly the result of the participation of AFIP staff as panel members and reference center heads in the International Histological Classification of Tumors (IHCT) series of the World Health Organization (WHO). WHO reference and collaborating centers were established at the AFIP in a number of subjects aimed at international standardization of tumor nomenclature, classification, and diagnostic criteria. AFIP staff contributed the largest number of IHCT panel members than any other institution. AFIP staff played key roles in the Tumor Node Metastasis (TNM) project of the Union for International Cancer Control (UICC). The AFIP Atlases of Tumor Pathology, published by the American Registry of Pathology were, and still are, monumental contributions to standards in diagnosis throughout the world.

Disestablishment
The Base Realignment and Closure proposal for 2005 included a realignment of the WRAMC campus that had as one element the disestablishment of AFIP with relocation of its "military relevant functions" to the NNMC, Bethesda, Maryland; Dover AFB, Delaware; and Fort Sam Houston, Texas.

The implications of the BRAC and reaction to it by the pathology world resulted in congressional legislation in the National Defense Authorization Act of 2008 (NDAA 2008)[section 722] establishing a Joint Pathology Center (JPC). This recognized the significant contributions of the AFIP and mandated the JPC to assume many of AFIP's responsibilities in consultation, education, and research, as well as the modernization of its unique tissue repository. AFIP shut its doors on September 15, 2011. Tom Baker helped to found the Joint Pathology Center and is currently the medical director of the Joint Pathology Center. Aaron Auerbach, Hematopathologist and Gastrointestinal Pathologist is one of the subspecialists to help establish the Joint Pathology Center

Continuation as American Institute of Radiologic Pathology
Recognizing the educational value of the radiology-pathology correlation course and corresponding vast database of cases, the American College of Radiology has been instrumental in creating the American Institute of Radiologic Pathology (AIRP) to allow continuation of the radiology-pathology course. The first course of the AIRP began January 2011.