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 ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

specimens, as well as

biopsies A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a disea ...

submitted by surgeons and non-

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

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 medica ...

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 (IHC) is the most common application of immunostaining. It involves the process of selectively identifying antigens (proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to ant ...

or other laboratory tests.

Specimens

There are two major types of specimens submitted for surgical pathology analysis: ''

'' 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 is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...

. 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 waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

, CT scan, or

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

. Core biopsies, which preserve tissue architecture, should not be confused with

fine-needle aspiration Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, aft ...

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. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...

or malignant tumor, and can differentiate between different types and grades of

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

, 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") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain sta ...

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. From Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approximately "a disease of its own kin ...

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 digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

, 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 The frozen section procedure is a pathological laboratory procedure to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The technical name for this procedure is cryosection. The microtome device tha ...

), identifying the presence of unsuspected concurrent diseases, and providing information for postoperative treatment, such as

adjuvant chemotherapy Adjuvant therapy, also known as adjunct therapy, adjuvant care, or augmentation therapy, is a therapy that is given in addition to the primary or initial therapy to maximize its effectiveness. The surgeries and complex treatment regimens used in ...

in the case of cancer. In the determination of surgical margin of a surgical resection, one can use the

bread loafing Bread loafing is a common method of processing surgical specimens for histopathology. The process involves cutting the specimen into 3 or more sections. The cut sections are mounted by embedding in paraffin or frozen medium. The cut edge is then t ...

technique, or CCPDMA. A special type of CCPDMA is named after a general surgeon, or the

Mohs surgery Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat both common and rare types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, ...

method.

Workflow

* Gross examination *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 Orthopedic pathology, also known as bone pathology is a subspecialty of surgical pathology which deals with the diagnosis and feature of many bone diseases, specifically studying the cause and effects of disorders of the musculoskeletal system. I ...

* Cardiac pathology *

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 (A board-certifiable subspecialty in the U.S.) * Endocrine pathology * Gastrointestinal pathology * Genitourinary pathology * Gynecologic pathology * Head and Neck pathology *

Hematopathology Hematopathology or hemopathology (both also spelled haem-, see spelling differences) is the study of diseases and disorders affecting and found in blood cells, their production, and any organs and tissues involved in hematopoiesis, such as bone m ...

(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 Ophthalmic pathology is the subspecialty of surgical pathology and also a subspecialty of ophthalmology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the eyes. Ophthalmic pathologists generally wor ...

* Pediatric pathology (A board-certifiable subspecialty in the U.S. and a recognised specialty in the U.K.) *

Pulmonary pathology Pulmonary pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the lungs and thoracic pleura. Diagnostic specimens are often obtained via broncho ...

* Renal pathology * Soft tissue pathology * Breast pathology

Notes and references

Bibliography

External links