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Dr. Robert Guarino, Director of Breast Pathology Services at Staten Island University Hospital-Northwell Health, explains how his service fits into the hospital’s multidisciplinary breast care team.
A Service, Not a Solo Job
New York, USA, Oct 16, 2026, ZEX PR WIRE — Dr. Robert Guarino has directed Breast Pathology Services at Staten Island University Hospital-Northwell Health since July 2012. The title sounds like it describes one person reading slides. It does not.
“Breast pathology only works as a service when it’s built into a team,” Guarino says. “A diagnosis has to reach a surgeon, an imaging specialist, and an oncologist fast, and it has to be right the first time.”
That service sits inside the Florina Rusi-Marke Comprehensive Breast Center at Staten Island University Hospital. Guarino works alongside colleagues in breast surgery, breast imaging, breast medical oncology, radiation oncology, nurse navigation, and genetic counseling. Pathology is one piece of a structure built so a patient does not have to coordinate her own care between departments.
What the Pathology Side Actually Covers
Guarino’s role covers the diagnostic work that follows a biopsy or surgical specimen: reading tissue under the microscope, identifying tumor type and grade, and reporting the markers that guide treatment decisions. None of that happens in isolation.
“The surgeon needs margins. The oncologist needs receptor status. The imaging team needs to know if what they saw on a scan matches what’s in the tissue,” he says. “My report has to answer all of those questions, not just one.”
He describes the center’s structure as a rotation of expertise around a single patient rather than a single department making a call. “I was recruited into this role specifically because the surgical and imaging directors wanted breast pathology handled by someone who does only breast pathology,” Guarino says. “That specialization is the point of the whole model.”
Fourteen Years in the Same Seat
Guarino has held the same position for fourteen years. He sees that continuity as part of what makes the service work.
“Long-term colleagues read each other’s shorthand,” he says. “A breast surgeon who has worked with the same pathologist for over a decade already knows how I phrase an ambiguous finding, and I know what detail they need spelled out versus what they can infer. That saves time, and time matters when someone is waiting on a result.”
He adds that the nurse navigators and genetic counselor on the team round out the picture for patients who need more than a diagnosis. “Some patients need genetic counseling before they even decide on surgery. Some need a navigator just to keep track of five appointments in two weeks. Pathology is in the middle of all of it, but it isn’t the whole of it.”
Teaching the Service, Not Just Practicing It
Guarino is also an assistant professor at SUNY Downstate Medical School in Brooklyn, where he teaches second-year medical students, and he trains resident physicians at the hospital.
“Teaching makes me explain the service out loud, not just do it,” he says. “When a resident asks why I called a finding atypical instead of malignant, I have to walk through my reasoning in words. That keeps me honest about my own process.”
He says the teaching side and the clinical side feed each other. “Students ask questions clinicians stop asking after a few years. Residents catch me using shorthand I should define better in a report. Both make the service more useful to the next patient.”
Staying Current on Purpose
Guarino reads breast pathology journals and textbook updates regularly and attends continuing medical education seminars most years. He frames this as part of what the service requires, not a separate commitment.
“Breast pathology changes. Markers get refined, classification systems get updated,” he says. “If I’m not reading the current literature, my reports fall behind what the oncologists downstream are expecting to see.”
He points to his own training as the foundation for that habit. Guarino completed fellowship training in oncologic and breast pathology at The Mount Sinai Hospital in Manhattan, where he credits two mentors, Dr. Jonathan Lara and Dr. Ira Bleiweiss, both trained at Memorial Sloan Kettering Cancer Center, with shaping how he approaches the work.
“They taught me that a pathology report is a tool for someone else’s decision, not an end in itself,” Guarino says. “Everything about how I run this service comes back to that.”
About Dr. Robert Guarino
Dr. Robert Guarino is Director of Breast Pathology Services at Staten Island University Hospital-Northwell Health in New York, where he has worked since 2012 within the Florina Rusi-Marke Comprehensive Breast Center. He is also an assistant professor at SUNY Downstate Medical School in Brooklyn and is a Fellow of the American College of Pathology, boarded in Anatomic and Clinical Pathology. He lives between New York and New Jersey.
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