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Inside the Lab Profession, Training and education, Histology, Guidelines and recommendations

The Art of Grossing

It seems almost overly simplistic to say that every tissue diagnosis begins with a gross examination – and yet, many who think about diagnostic medicine picture screens, stains, and sequences, but overlook the study of tissue samples using only their own hands, eyes, ears… and occasionally noses. What exactly is the fine art of grossing? How is it performed? And why are some so eager to move past it when, in fact, the gross examination may be the most important – and indeed the most beautiful – investigation they perform?

Behind the Grossing Guidelines

The Macroscopic Examination Guidelines from concept to delivery

By Jesse McCoy

As a pathologists’ assistant, an evolving “lab hero” (1), I serve as a key provider in the medical laboratory diagnostic continuum. As part of that role, I provide critical diagnostic information through the macroscopic gross examination, evaluation, and dissection of surgical cancer cases. That information provides pathologists with essential diagnostic information that, in turn, yields prognostic criteria to dictate treatment protocols and outcomes.

To align with the highest standards of patient care, the information we provide at the gross bench must be compliant with the criteria established by both the American Joint Committee on Cancer (AJCC) Cancer Staging Manual and the College of American Pathologists (CAP) Cancer Reporting Protocols. Recognizing quality patient care as a primary core value, the American Association of Pathologists’ Assistants (AAPA) spearheaded a project to provide a source document integrating both sets of established criteria for those “involved in the macroscopic handling of surgical cancer cases” (2). The AAPA Macroscopic Examination Guidelines: Utilization of the CAP Cancer Protocols at the Surgical Gross Bench, colloquially known as the “Grossing Guidelines,” is not only a wonderful practice aid and teaching tool, but also a catalyst for many new relationships between the AAPA, AJCC and CAP. The guidelines have strengthened professional relationships among the vast network of contributing volunteer PAs and validated our long-sought-after sense of belonging to the anatomic pathology and laboratory medicine community (3).

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About the Authors

Michael Schubert

While obtaining degrees in biology from the University of Alberta and biochemistry from Penn State College of Medicine, I worked as a freelance science and medical writer. I was able to hone my skills in research, presentation and scientific writing by assembling grants and journal articles, speaking at international conferences, and consulting on topics ranging from medical education to comic book science. As much as I’ve enjoyed designing new bacteria and plausible superheroes, though, I’m more pleased than ever to be at Texere, using my writing and editing skills to create great content for a professional audience.


Cory Nash

Pathologists’ assistant in the Department of Pathology at the University of Chicago, USA.


Jesse McCoy

Pathologists’ Assistant for Hampton Roads Pathology at Chesapeake Regional Medical Center, Chesapeake, Virginia.

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