Surgical Pathology - Uses, Protocol, and Procedure

What Is Surgical Pathology?

Surgical pathology involves the examination of tissue samples taken from living patients during surgical procedures to diagnose a medical condition and determine a treatment plan. Surgical pathologists are specialists who analyze these tissue samples and offer their expert opinion on various organ systems and medical fields. They play a critical role in providing diagnostic information and second opinions. For example, analysis of the removed tissue by a surgical pathologist for breast cancer can help the surgeon decide whether additional lymph nodes under the arm need to be removed.

The tissue samples are scrutinized in surgical pathology through visual inspection and microscopic analysis. The field has advanced to incorporate molecular diagnostic methods, such as analyzing DNA and RNA in the blood. This technology offers various benefits, such as the capability to do the following -

• The capability to differentiate between benign and malignant white blood cells.

• Find out genetic alterations in its earlier stages that could lead to cancer.

• To find out the presence of infectious agents in tissue samples.

When Is Surgical Pathology Required?

Surgical pathology is typically performed when the pathologist needs to examine a tissue sample from the patient during a surgical procedure to diagnose or rule out a specific condition. Some common indications for surgical pathology include:

1. Cancer Diagnosis and Staging: To determine the type and extent of cancerous growth and whether it has spread to other parts of the body.

2. Infectious Disease Diagnosis: To diagnose and determine the severity of infectious diseases, such as tuberculosis or fungal infection.

3. Chronic Disease Evaluation: To evaluate conditions such as Crohn's disease or ulcerative colitis, which affect the digestive system.

4. Preoperative Evaluation: To determine the nature of a mass or abnormal growth and plan an appropriate surgical approach.

5. Postoperative Evaluation: To determine a surgical procedure's effectiveness and monitor disease and the possibility of recurrence.

What Is a Surgical Pathology Report?

• The surgical pathology report is an important tool for both the patient and the treating physician, as it provides important information about the type and extent of the disease. The terms invasive and malignant are commonly used in pathology reports to describe the behavior of the tissue sample and its potential for causing harm.

• For example, an "in situ" diagnosis indicates that the abnormal cells are confined to the site where they originated and have not spread to surrounding tissues. On the other hand, "invasive" indicates that cancer has spread beyond the original site and into surrounding tissues. A malignant diagnosis means that the cells are cancerous, while a benign diagnosis means that the cells are non-cancerous.

• The margin refers to the edge of the tissue sample and is important in determining whether all cancer has been removed during surgery. Positive margins indicate that cancer is present at the edge of the tissue sample, while negative margins mean no cancer.

• Overall, the pathology report plays a crucial role in guiding treatment decisions and determining the prognosis for the patient.

What Does a Surgical Pathology Report Include?

A surgical pathology report is a medical document that summarizes the result of a pathological examination of tissue removed during surgery. A surgical pathology report typically includes the following information:

• Patient Demographics: This section includes the patient's name, age, and other relevant demographic information.

• Clinical History: This section provides information about the patient's medical history, including any relevant medical conditions and the reason for the surgery.

• Specimen Description: This section describes tissue removed during surgery, including its size, shape, and any gross (visible to the naked eye) features.

• Microscopic Description: This section describes the microscopic appearance of the tissue, including the presence of any abnormal cells or tissues.

• Diagnosis: This section provides the pathologist's interpretation of the results, including the final diagnosis of the condition affecting the tissue.

• Recommendations: This section may include recommendations for additional testing or treatment based on the results of the pathology examination.

The patient's healthcare provider uses the information in a surgical pathology report to determine the appropriate course of treatment and monitor the patient's progress.

What Are the Uses of Surgical Pathology?

• Suspected Cancer: Surgical pathology is indicated in cases where cancer is suspected based on symptoms or imaging studies.

• Tissue Removal: Surgical pathology is indicated when tissue needs to be removed for diagnostic purposes, such as in the case of a biopsy.

• Evaluation of Therapeutic Response: Surgical pathology may be indicated to evaluate tissue's response to therapy, such as in the case of surgical resection of a tumor.

How to Measure Quality in Surgical Pathology?

1. In surgical pathology, accuracy, timeliness, and report completeness are considered critical components of quality. While cost is often a factor in determining quality, it has less importance in the current medical system with third-party payers.

2. A quality assurance and improvement (QA and I) plan should focus on these three elements to ensure quality in surgical pathology.

3. Generally, a quality assurance and improvement (QA and I) plan involve monitoring five elements of the test cycle, including pre-analytic, analytic, and post-analytical phases. This comprehensive approach is taken because errors can occur at any point in the process, leading to inaccurate diagnoses.

4. Monitoring the entire test cycle also helps ensure that the various components of the process work together effectively to produce a high-quality final product.

5. Most monitors within the three phases are focused on accuracy, with relatively few on the diagnosis.

6. On the other hand, report completeness is primarily addressed through post-analytic phase monitors, though many aspects of completeness stem from the analytic phase of the test cycle.

Conclusion:

Surgical pathology is a subspecialty of pathology that involves the examination of tissue removed during surgery to diagnose and understand the underlying disease or condition. The primary goal of surgical pathology is to make a definitive diagnosis based on the examination of tissue samples, which can help guide treatment decisions and inform prognosis. Surgical pathology is an important tool for understanding and diagnosing disease and is a critical component of patient care in various medical specialties.