Pathologist’s assistant (PathA) and his/her role in the surgical pathology department: a systematic review and a narrative synthesis

The Critical Role of Breast Specimen Gross Evaluation for Optimal Personalized Cancer Care

Gross examination is the foundation for the pathologic evaluation of all surgical specimens. The rapid identification of cancers is essential for intraoperative assessment and preservation of biomolecules for molecular assays. Key components of the gross examination include the accurate identification of the lesions of interest, correlation with clinical and radiologic findings, assessment of lesion number and size, relationship to surgical margins, documenting the extent of disease spread to the skin and chest wall, and the identification of axillary lymph nodes. Although the importance of gross evaluation is undeniable, current challenges include the difficulty of teaching grossing well and its possible perceived undervaluation compared with microscopic and molecular studies. In the future, new rapid imaging techniques without the need for tissue processing may provide an ideal melding of gross and microscopic pathologic evaluation.

Slide Over: Advances in Slide-Free Optical Microscopy as Drivers of Diagnostic Pathology

Conventional analysis using clinical histopathology is based on bright-field microscopy of thinly sliced tissue specimens. Although bright-field microscopy is a simple and robust method of examining microscope slides, the preparation of the slides needed is a lengthy and labor-intensive process. Slide-free histopathology, however, uses direct imaging of intact, minimally processed tissue samples using advanced optical-imaging systems, bypassing the extended workflow now required for the preparation of tissue sections. This article explains the technical basis of slide-free microscopy, reviews common slide-free optical microscopy techniques, and discusses the opportunities and challenges involved in clinical implementation.

Pathologists' assistants, an essential healthcare workforce: the experience of a surgical pathology department in Italy

AIMS

The progressive increase of both the workload and the complexity of laboratory procedures, along with shortage of staff, has made evident the need to increase the efficiency in the pathology departments. To support the pathologists, a new technical professional role, the pathologists' assistant (PA), has been introduced.

METHODS

We decided to carry out a retrospective analysis on PAs' performance. This was compared with that of junior/senior pathologists in the amount and type of surgical specimens examined, the number of lymph node retrieved in colorectal resections, the number of cases needing a second grossing procedure and the average time spent in grossing. As the COVID-19 pandemic period in fact resulted in a dramatic reduction of histological cases in our department, we divided PA activities into two periods, according to the COVID-19 pandemic.

RESULTS

'Simple' specimens made up the majority (92%) of the specimens examined by PAs in pre-COVID-19 period while 'complex' specimens, often neoplastic, represented the minor part (7%). However, 'simple' specimens dropped to 81% and 'complex' specimens rose to 18% in the COVID-19 period, when PAs had the chance to test themselves with more complicated surgical samples, under the supervision of a pathologist. Lymph node retrieval rate and average time spent in grossing are in line with literature data and confirm that PAs performance is comparable with pathologists' one, in selected settings.

CONCLUSION

In our experience, PA has represented a fundamental time-saving resource for the pathologists, who can devote time almost exclusively to diagnostic reporting.

The History of Pathologists' Assistants: A Tale of 2 Educational Mavericks

Context.—

The use of medical technologists to assist with clinical pathology workload has been common since the 1930s. In stark contrast, most aspects of anatomical pathology have traditionally been considered to be medical work that must be performed by pathologists or residents.

Objective.—

To describe the history of the pathologists' assistant profession in North America.

Design.—

Available primary and secondary historical sources were reviewed.

Results.—

The concept of physician assistants, capable of performing delegated medical tasks, was created by Eugene A. Stead Jr, MD, at Duke University in 1965. When this profession began, it was quickly embraced by the American Medical Association, which took ownership related to certification and licensing of practitioners as well as external accreditation of training programs. Because of concerns about pathology manpower in the late 1960s, Thomas D. Kinney, MD, also at Duke University, developed the first training program for pathologists' assistants in 1969. Pathologists' assistants were not immediately accepted by many academic pathologists, especially related to work in the surgical pathology gross room. Organized pathology did not help the new profession develop standards, and so in 1972 pathologists' assistants created their own professional organization, the American Association of Pathologists' Assistants. Although it took several decades, the association was eventually able to forge relationships with the National Accrediting Agency for Clinical Laboratory Sciences for training program accreditation and the American Society for Clinical Pathology for board certification for practitioners. The development of the profession in Canada is also described.

Conclusions.—

The pathologists' assistant profession is now well established in North America.