Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists

Anatomical pathology

Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...

. Surgical pathology involves the gross and microscopic examination of surgical

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 specimens, as well as biopsies

Biopsy

A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

 submitted by non-surgeon

Surgeon

In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...

s such as general internists

Internal medicine

Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...

, medical subspecialists

Internal medicine

Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...

, dermatologists, 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

Histology

Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

 (i.e., microscopic) examination of the tissue, and may involve evaluations of molecular properties of the tissue by immunohistochemistry

Immunohistochemistry

Immunohistochemistry or IHC refers to the process of detecting antigens in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues. IHC takes its name from the roots "immuno," in reference to antibodies used in the procedure, and...

 or other laboratory tests.

Specimens

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

Biopsy

A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

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

Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...

. 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

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

, CT scan, or magnetic resonance imaging

Magnetic resonance imaging

Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

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

Cytopathology

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...

 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 or malignant

Cancer

Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 tumor, and can differentiate between different types and grades of cancer

Cancer

Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

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

Prognosis

Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...

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

Inflammation

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

, infectious

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

, or idiopathic

Idiopathic

Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...

 diseases of the skin

Skin

-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 and gastrointestinal tract

Gastrointestinal tract

The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....

, 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

Staging

Staging may refer to:* Staging , a chef works briefly and without pay in another chef's kitchen to learn to new techniques and cuisines* Staging , the use of multiple engines and propellant to launch a rocket...

 the extent of malignant disease, establishing whether or not the entire diseased area was removed (a process called "determination of the surgical margin

Surgical margin

Surgical margin, also known as tumor free margin, free margin, normal skin margin, and normal tissue margin, usually refers to the visible normal tissue or skin margin that is removed with the surgical excision of a tumor, growth, or malignancy.-Definition:Surgical margin in a surgery reports...

 often using frozen section), identifying the presence of unsuspected concurrent diseases, and providing information for postoperative treatment, such as adjuvant chemotherapy

Adjuvant chemotherapy

Adjuvant therapy, also called adjuvant care, is treatment that is given in addition to the primary, main or initial treatment. The surgeries and complex treatment regimens used in cancer therapy have led the term to be used mainly to describe adjuvant cancer treatments...

 in the case of cancer.

In the determination of surgical margin

Surgical margin

Surgical margin, also known as tumor free margin, free margin, normal skin margin, and normal tissue margin, usually refers to the visible normal tissue or skin margin that is removed with the surgical excision of a tumor, growth, or malignancy.-Definition:Surgical margin in a surgery reports...

 of a surgical resection, one can use the bread loafing

Bread loafing

Bread loafing is a common method of processing surgical specimen 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 thinly sliced with a microtome or a cryostat...

 technique, or CCPDMA

CCPDMA

CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment". It is the preferred method for the removal of certain cancers, especially skin cancers.A classical example of CCPDMA is Mohs surgery...

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

Mohs surgery

Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. It is one of the many methods of obtaining complete margin control during removal of a skin cancer using frozen section...

 method.

Surgical pathology workflow

• Gross examination
  Gross examination
  Gross examination or "grossing" is the process by which pathology specimens are inspected with the bare eye to obtain diagnostic information, while being processed for further microscopic examination....
  
  

• Frozen section

• Fixation & Embedding

• Histopathologic examination
  Histopathology
  Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
  
  

• 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 exerience 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
  Bone pathology
  Bone pathology, also known as orthopedic pathology is a subspecialty of surgical pathology which deals with the diagnosis and feature of many bone diseases. It uses gross and microscopic findings along with the findings of in vivo radiological studies, and occasionally, specimen radiographs to...
  
  
• Cardiac pathology
• Cytopathology
  Cytopathology
  Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
  
   (A board-certifiable subspecialty in the U.S.)
• Dermatopathology
  Dermatopathology
  Dermatopathology is a subspecialty of both dermatology and surgical pathology that focuses on the study of cutaneous diseases at a microscopic level. It also encompasses analyses of the potential causes of skin diseases at a cellular level. Dermatopathologists work in close association with...
  
   (A board-certifiable subspecialty in the U.S.)
• Endocrine pathology
  Endocrine pathology
  Endocrine pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of organs of the endocrine system, including the thyroid, parathyroids, exocrine pancreas, and adrenal glands....
  
  
• Gastrointestinal pathology
  Gastrointestinal pathology
  Gastrointestinal pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the digestive tract and accessory organs, such as the pancreas and liver....
  
  
• Genitourinary pathology
• Gynecologic pathology
  Gynecologic Pathology
  Gynecologic pathology is the medical pathology subspecialty dealing with the study and diagnosis of disease involving the female genital tract. A physician who practices gynecologic pathology is a gynecologic pathologist...
  
  
• Head and Neck Pathology
  Head and neck pathology
  Head and Neck pathology is the subspecialty of surgical pathology and dentistry which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the neck, scalp, face, ears, paranasal sinuses, nasal cavity, oral cavity, salivary glands, pharynx, and larynx...
  
  
• Hematopathology
  Hematopathology
  Hematopathology is the branch of pathology which studies diseases of hematopoietic cells . In the United States, hematopathology is a board certified subspecialty practiced by those physicians who have completed general pathology residency and additional fellowship training in...
  
   (A board-certifiable subspecialty in the U.S.)
• Neuropathology
  Neuropathology
  Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology, and neurosurgery...
  
   (A board-certifiable subspecialty in the U.S. and a recognised specialty in the U.K.)
• Ophthalmic pathology
  Ophthalmic pathology
  Ophthalmic pathology is the subspecialty of surgical pathology and also a subspecialty ophthalmology of which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the eyes. Ophthalmic pathologists generally work closely with ophthalmologists....
  
  
• Pediatric pathology
  Pediatric pathology
  Pediatric pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of children. Pediatric pathologists generally work closely with pediatricians....
  
   (A board-certifiable subspecialty in the U.S. and a recognised specialty in the U.K.)
• Pulmonary pathology
  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 bronchoscopic transbronchial biopsy, CT-guided percutaneous...
  
  
• Renal pathology
  Renal pathology
  Renal pathology is a subspecialty of anatomic pathology that deals with the diagnosis and characterization of medical diseases of the kidneys. In the academic setting, renal pathologists work closely with nephrologists and transplant surgeons, who typically obtain diagnostic specimens via...
  
  
• Soft tissue pathology
  Soft tissue pathology
  Soft tissue pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of the soft tissues, such as muscle, adipose tissue, tendons, fascia, and connective tissues...
  
  

See also

• Anatomical pathology
  Anatomical pathology
  Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
  
  
• Digital pathology
  Digital Pathology
  Digital Pathology is an image-based information environment enabled by computer technology that allows for the management of information generated from a digital slide...
  
   and Telepathology
  Telepathology
  Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research. Performance of telepathology requires that a pathologist...
  
  
• List of pathologists
• History of pathology
  History of pathology
  The history of pathology can be traced to the earliest application of the scientific method to the field of medicine, a development which occurred in the Middle East during the Islamic Golden Age and in Western Europe during the Italian Renaissance....
  
  

External links

• "Conversations with Pathologists", a website based on a book project by Sue Armstrong, sponsored by Genentech
  Genentech
  Genentech Inc., or Genetic Engineering Technology, Inc., is a biotechnology corporation, founded in 1976 by venture capitalist Robert A. Swanson and biochemist Dr. Herbert Boyer. Trailing the founding of Cetus by five years, it was an important step in the evolution of the biotechnology industry...
  
   and The Pathological Society of Great Britain and Ireland
  Pathological society
  The Pathological Society of Great Britain and Ireland is a professional organisation whose mission is stated as 'understanding disease'.- Membership and Profile :...
  
  
• Johns Hopkins Surgical Pathology Weekly Unknown Case Conference
• PathologyPics.com: An interactive histology database for the Practicing Anatomic Pathologist as well as Pathology Trainees.
• The Arthur Purdy Stout Society of Surgical Pathology
• Rosai and Ackerman's Surgical Pathology, 10th Edition,