The Art of Grossing
Gross examination underpins all diagnoses based on tissue samples – but is this vital skill given the credit it deserves?
Michael Schubert, Cory Nash, Jesse McCoy | | Hot Topic
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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