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The Grossing Histotechnologist in Surgical Pathology

Part 1 of this 2-part article explores regulatory requirements.

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No one doubts who signs out the surgical pathology report or who does microtomy and slide staining. When it comes to who does grossing, especially biopsies and small specimens, however, the clarity gets blurred. There is no uniformity in assignment of this work in academic institutions vs. community hospitals, not to mention commercial laboratories. Even in similar institutions the assignment of grossing is different.

Everyone agrees on grossing importance for diagnostic outcome of the case, but grossing is discussed rarely in earnest. Just as an indirect example, Recommendations for Quality Assurance and Improvement in Surgical and Autopsy Pathology by Association of Directors of Anatomic and Surgical Pathology, while presenting the detailed roster of accession and histology monitors for errors prevention, failed to mention grossing issues.1

This article explores the assignment of grossing biopsies and small specimens in surgical pathology practice.

Who Does What?

Who does the biopsies and small specimens grossing? The answer to this question depends on the institution, concrete participants and sometimes cases. For example, although every pathology report includes gross description, it is an aberration if a pathologist does grossing on a regular basis in most laboratories, especially biopsies and small specimens. In academic institutions, grossing is assigned to pathology residents. In institutions with pathologists' assistants and grossing histotechnologists, first year residents start with large specimens and finish the grossing training with biopsies and small specimens on weekends or as emergency substitutes. Residents have many educational sessions, exams and other concurrent responsibilities that may interfere with the interests of the laboratory workflow. For the laboratory, it may be better to excuse them from grossing biopsies only to the limits of their training interests.

 
 A precise diagnostic section of a skin lesion during grossing.

Pathologists' assistants perform grossing, including biopsies and small specimens, in institutions that have them on staff. Pathologists' assistants who graduated from special programs at the level of bachelor's or master degrees have a sufficient level of education for this task. American Association of Pathologists' Assistants (AAPA) introduced American Society for Clinical Pathology (ASCP) certification.

So while others can perform grossing biopsies,  the tendency is to delegate it to histotechnologists. And this discipline includes two positions: histotechnicians (HT) and histotechnologists (HTL). HTL(ASCP) certification requires a bachelor degree and knowledge of immunohistochemistry (IHC), although many HT successfully work in immunohistochemistry.

Grossing Data

In 1999, the National Society for Histotechnology (NSH) Board of Directors noticed that "many laboratories are expecting histology technicians to 'gross-in' small specimens,"2 which became one of the reasons to require AA degree or 60 semester hours of college for HT(ASCP) certification after 2005. To date, no task force has been established to work on grossing issues.3 Grossing topics generate an explosion on postings at HistoNet discussion group, especially the question of eligibility for doing grossing by histology technicians.

 
 Sawing a small bone fragment.


Regulatory Requirements

CAP is the main regulatory body that determines accreditation requirements in surgical pathology. CLIA '88 provides the governmental regulation of laboratories' performance. Compliance with the latter is obligatory. Other accreditation agencies, such as the Joint Commission, are neutral to grossing compliance issues.

The CAP accreditation checklist formerly included a set of questions ANP 11600-11670 about grossing.4 Three main checklist's questions include:

1.      Are all macroscopic tissue examinations performed by a pathologist or pathology resident, or under the supervision of a qualified pathologist?

2.      When an individual other than a pathologist or pathology resident processes a specimen, or assists in grossing examination, is the extent of their activities (including the types of specimens examined) defined in a documented protocol?

3.      Is the performance of non-pathologists who perform gross tissue examinations evaluated by the pathologist on a regular, periodic basis?

Traditionally, CAP distinguished processing (taking measurements and putting biopsies in the cassette with no cutting involved) and grossing (anything that must be cut in) and divides surgical pathology specimens in first and second class. CLIA, on the other hand, considers all grossing to be high complexity testing. However, CAP recently announced a revision to their accreditation checklist eliminating the concept of processing of tissues. The soon-to-be-released revised CAP checklist will no longer separate the activities of grossing and processing, and the standard for personnel performing this work will be the same as those given in CLIA. If a laboratory is in compliance with CLIA, it automatically meets CAP's requirements.

Continued on page 2...


The Grossing Histotechnologist in Surgical Pathology

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Iam a medical technologist ,going for an interview for Anatomical pathology tech.
Any tips on how to prepare for this will be appreciated.

CATHERINE BAMPADDE,  MLTJune 05, 2013
CALGARY



I'm a phlebotomist about to enter my first year of clinicals as a Histotechnician. Is there anything you can tell me that I should be prepared for please any help will do. Thank you

Meyosha Jackson,  Phlebotomist,  St. Francis HospitalJanuary 05, 2013
Wilmington, DE



Here is my situation. I am living in a country that is territory of the U.S, but I won't mention it because I want to protect my privacy. I don't want any of these lab administrators to identify me.

I got offered an interview today at a path lab. They never told me on the phone the type of duties for the job, so I just assumed they just want a histotechnologist who has knowledge of all the general areas (cutting, embedding, staining etc). When I got the interview then they tell me they just want someone who can gross specimens. In my resume I did not put I had any experience grossing specimens, because in reality I don't and I am not going to lie. When I was pursuing my histotechnology degree, I was taught very little about grossing. The professor just told us a general measurement to cut specimens and that is it. Not enough to prepare a histotech on how to gross. In the United States there is a program to specifically learn how to gross and that is the Pathology Assistant program. There is no PA program in the country where I live so sometimes they hire general doctors with no education in pathology to do the more complicated grossing, and the hire some lab tech or train histotechs to do the small grossing just as appendix, colon, vesicles, etc. To me this is wrong.

They are just making pathologists to read slides all days and these are delegating the grossing tasks to others with a position below them and pay them a low salary.

This company is going to interview two other people and I hope they don't offer me this position. I am willing to learn, and get trained,but even though I can get a training, I don't feel comfortable doing this task that is suppose to be for a pathologist.

The Histotechnologist position has lost respect here. I am overqualified now because these path labs hire anyone to do the job. They even train their receptionists how to gross and do histology. These companies have lost their respect for people who really prepared themselves for this career, it is disappointing.

Please respect each profession and let them each perform the tasks they are suppose to do, because we are letting other people to invade our profession, and we are also forced to invade the profession of others, and in the end, we end up with no job.

Anonymous ,  HistotechnologistFebruary 04, 2011



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