Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves gross and microscopic examination of

surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

specimens, as well as biopsies submitted by surgeons and non-

surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

s such as general internists, medical subspecialists,

dermatologist Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medi ...

s, and interventional radiologists. The practice of surgical pathology allows for definitive diagnosis of disease (or lack thereof) in any case where tissue is surgically removed from a patient. This is usually performed by a combination of gross (i.e., macroscopic) and histologic (i.e., microscopic) examination of the tissue, and may involve evaluations of molecular properties of the tissue by

immunohistochemistry Immunohistochemistry is a form of immunostaining. It involves the process of selectively identifying antigens in cells and tissue, by exploiting the principle of Antibody, antibodies binding specifically to antigens in biological tissues. Alber ...

or other laboratory tests.

Specimens

There are two major types of specimens submitted for surgical pathology analysis: '' biopsies'' and ''surgical resections.'' A ''biopsy'' is a small piece of tissue removed primarily for the purposes of surgical pathology analysis, most often in order to render a definitive

diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

. Types of biopsies include ''core biopsies'', which are obtained through the use of large-bore needles, sometimes under the guidance of radiological techniques such as

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

, or

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...

. Core biopsies, which preserve tissue architecture, should not be confused with fine-needle aspiration specimens, which are analyzed using

cytopathology Cytopathology (from Greek , ''kytos'', "a hollow"; , ''pathos'', "fate, harm"; and , ''-logia'') is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in ...

techniques. ''Incisional biopsies'' are obtained through diagnostic surgical procedures that remove part of a suspicious lesion, whereas ''excisional biopsies'' remove the entire lesion and are similar to therapeutic ''surgical resections.'' Excisional biopsies of skin lesions and gastrointestinal polyps are very common. The pathologist's interpretation of a biopsy is critical to establishing the diagnosis of a

benign Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...

malignant Malignancy () is the tendency of a medical condition to become progressively worse; the term is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malig ...

tumor, and can differentiate between different types and grades of

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

, as well as determining the activity of specific molecular pathways in the tumor. This information is important for estimating the patient's

prognosis Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing"; : prognoses) is a medical term for predicting the likelihood or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) ...

and for choosing the best treatment to administer. Biopsies are also used to diagnose diseases other than cancer, including inflammatory, infectious, or

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...

diseases of the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

and

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...

, to name only a few. ''Surgical resection'' specimens are obtained by the therapeutic surgical removal of an entire diseased area or organ (and occasionally multiple organs). These procedures are often intended as definitive surgical treatment of a disease in which the diagnosis is already known or strongly suspected. However, pathological analysis of these specimens is critically important in confirming the previous diagnosis, staging the extent of malignant disease, establishing whether or not the entire diseased area was removed (a process called "determination of the surgical margin", often using frozen section), identifying the presence of unsuspected concurrent diseases, and providing information for postoperative treatment, such as adjuvant chemotherapy in the case of cancer. In the determination of surgical margin of a surgical resection, one can use the bread loafing technique, or CCPDMA. A special type of CCPDMA is named after a general surgeon, or the Mohs surgery method.

Workflow

Gross examination Gross processing, "grossing" or "gross pathology" is the process by which pathology specimens undergo examination with the bare eye to obtain diagnosis, diagnostic information, as well as cutting and tissue sampling in order to prepare material fo ...

*Frozen section *Fixation & Embedding * Histopathologic examination *Ancillary testing *The surgical pathology report *Direct consultation

Subspecialties

Many pathologists seek fellowship-level training, or otherwise pursue expertise in a focused area of surgical pathology. Subspecialization is particularly prevalent in the academic setting, where pathologists may specialise in an area of diagnostic surgical pathology that is relevant to their research, but is becoming increasingly prevalent in private practice as well. Subspecialization has a number of benefits, such as allowing for increased experience and skill at interpreting challenging cases, as well as development of a closer working relationship between the pathologist and clinicians within a subspecialty area. Commonly recognized subspecialties of surgical pathology include the following: * Bone pathology *

Cardiac pathology Cardiac pathology is the subspecialty of pathology which deals with diseases and disorders that affect the heart. It encompasses a broad range of conditions, including structural, functional, and biochemical abnormalities that impair the pumping ...

Cytopathology Cytopathology (from Greek , ''kytos'', "a hollow"; , ''pathos'', "fate, harm"; and , ''-logia'') is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by George Nicolas Papanicolaou in ...

(A board-certifiable subspecialty in the U.S.) *

Dermatopathology Dermatopathology (from Greek , ''derma'' 'skin' + , ''pathos'' 'fate, harm' + , ''-logia'' 'study of') is a joint subspecialty of dermatology and pathology or surgical pathology that focuses on the study of cutaneous diseases at a microscopic an ...

(A board-certifiable subspecialty in the U.S.) * Endocrine pathology * Gastrointestinal pathology * Genitourinary pathology * Gynecologic pathology * Head and Neck pathology * Hematopathology (A board-certifiable subspecialty in the U.S.) * Neuropathology (A board-certifiable subspecialty in the U.S. and a recognised specialty in the U.K.) * Ophthalmic pathology * Pediatric pathology (A board-certifiable subspecialty in the U.S. and a recognised specialty in the U.K.) * Pulmonary pathology * Renal pathology * Soft tissue pathology * Breast pathology

Notes and references

Bibliography

External links