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Evolving Grossing Techniques in Surgical Pathology

Yeh, I-Tien MD

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doi: 10.1097/PCR.0000000000000389
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Understanding pathology begins at the gross bench. More often than not, the microscopic diagnosis follows the gross appearance. As a resident, I was naive enough to think that if I learned how to properly gross specimens, that would be sufficient to carry me through my career as a pathologist. I understood that medicine was constantly changing and that we would need to adjust our diagnostic categories as knowledge increased and treatment changed. But surely sectioning tissue would remain the same, right? Of course, the short answer is no. Evolving surgeries and therapies require new approaches to tissue examination, both gross and microscopic. Each article in this issue takes on the evolving methods of gross examination of complex specimens in response to newer medical knowledge and treatment.

In my own practice, the pathologists still do the grossing; it is becoming less and less common to do so in the United States, as pathology assistants have largely taken over this job because it is often thought that the pathologist's time is too valuable to spend cutting tissues. However, all of us still must supervise what happens at the gross bench, and we still see specimens for intraoperative consultation. If a specimen is correctly grossed, then the correct diagnosis may be rendered. The opposite is also true: if a specimen is incorrectly grossed, the incorrect diagnosis may be rendered.

In this issue, we address some of the common specimens received in our pathology laboratories, including breast, lung, gynecologic organs, head and neck, and pancreas. Dr Nazarullah and her associates summarize the current best practice of grossing breast specimens. We were fortunate to have had an Arthur Purdy Stout Society Companion meeting to the United States and Canadian Academy of Pathology in 2018 addressing the grossing of specimens, and Drs Myers and Sadow and their colleagues present their reviews drawing from their presentations at this conference, lung and head and neck, respectively. We also take a specialized look at the gastrointestinal and gynecologic tracts. Drs Williams and Affolter present a new method of pancreatoduodenectomy specimens. Dr. Kulumani Mahadevan and collaborators address topics in the grossing of pelvic adnexal organs. And to round out the issue, we have a review of the principles of gross photography because “a picture is worth a thousand words”!

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