Macroscopists and Cytotechnicians: The Pathologist’s Counterparts

What is “macroscopy?” It is a diagnostic examination of a sample obtained by surgery or autopsy that uses only the naked eye – what some may know as “gross examination.”

The structural changes diseases cause in organs are diverse. Growth, shrinkage, loss of texture, changes in color, consistency, and content… Despite their differences, we often refer to all such changes as “lesions” – and different lesions can coexist in the same disease. Therefore, an accurate diagnosis can only be obtained by evaluating the lesions one by one and investigating the relationship between them – a task performed not only by pathologists, but also by macroscopy technicians (a job title similar to that of the pathologists’ assistant). Thus, identifying and correlating these lesions leads to macroscopic diagnosis – laying a foundation upon which microscopic evaluation can build.

A day in the life
There is no pathologist in the institution where I currently work – meaning that I spend my entire day attending to macroscopy. I handle the macroscopic examination and sampling of all specimens, then compile my results into a macroscopy report in my own name. The samples I take are prepared by histotechnicians and sent to pathologists in another center.

Once a week, I attend fine needle aspiration cytology in radiology. I quickly paint the fluid taken from the patient with a syringe using the Diff-Quik method. Is there evidence of cell competence? I evaluate the preparation under a microscope and report to the radiologist. This allows us to make the final diagnostic process easier for the pathologist and helps us to avoid taking unnecessary biopsies.

On weekends, I scan the vaginal smears that come on weekdays and write notes to our pathologist, marking the areas I consider suspicious.

I also work with Haldun Umudum, Head of Pathology at Ufuk Üniversitesi, Ankara, Turkey, to conduct frozen sections via digital pathology. I work over 1,000 kilometers away in Kars, so we are pioneering the use of remote frozen sections in Turkey. I perform the macroscopic examination locally, then send my sample preparations to Ankara digitally for further investigation.

When macroscopy technicians and cytotechnicians are well trained, they can provide vital laboratory services – especially in situations where pathologists are not readily available. I feel like I provide a bridge between macroscopy and microscopy, especially when I have the privilege of participating in academic studies. I love my job!

Talking about training
In North America, macroscopy education is given as a two-year program after completion of an undergraduate degree. The country’s first undergraduate program opened at Duke University in 1969 and the American Association of Pathologists’ Assistants (AAPA) was founded in 1972. Since 2005, all pathologists’ assistants must complete a certification examination conducted jointly between the AAPA and the American Society for Clinical Pathology (ASCP). Certification lasts for three years and must then be renewed via participation in a certification maintenance program.

In my country, macroscopy technicians and cytotechnicians are not trained separately; the two-year pathology technician program involves both macroscopy and cytology courses, with additional practical training provided by pathologists. This training is not standardized; it takes place under the initiative of the specialist physician and reflects the cases seen at the institution where the technician works. In fact, there is no defined job description, certification program, or training standard for technicians trained by experts (as opposed to those who complete a certificate). It’s unknown how many such technicians are currently in practice – nor can we be certain of their training or skill levels, which vary based on the decisions and expectations of the pathologists who train them.

But improvements are on the horizon. A standardization committee has begun work on a certification program for macroscopy technicians that will hopefully soon become official in our country. In addition, Turkish pathologists on social media have explained the work of macroscopy technicians and cytotechnicians to others and expressed their support – which has increased interest in this career path and even inspired my colleagues to seek out additional learning.

Although all of my training took place in Turkey, my career has more closely resembled that of an American pathologist’s assistant than that of my Turkish colleagues. I took macroscopy and cytology courses from pathologists at the institution where I work. One of my teachers, Hüseyin Üstün, told me and my classmates that if we wanted American-style training, he would train us meticulously in accordance with these programs. Later, by doing a master’s degree in pathology, I established a connection between macroscopy and microscopy and was able to progress my skills in both macroscopy and cytology. I am currently continuing my academic studies in a doctoral program focused on tumor biology and immunology.

Not everyone who aspires to be a macroscopy and cytotechnician will have access to a formal training program. Those who lack such access should seek advice and direction from their pathologist colleagues. A word of advice: never consider your education complete. Read; research; ask questions. Always strive to learn new things.

Macroscopy mysteries
I’ve found that some pathologists are biased against macroscopy technicians and cytotechnicians – but I think that we ease their workloads. As a well-trained team, we can accomplish great things. As laboratory medicine professionals, we understand that surgical margin evaluation and sampling are vital in resections and in some excisional biopsies – and that error is unacceptable – which is why we strive to develop our skills in macroscopic and cytologic examination so that pathologists can rely on our support.

Many countries have no schools or certification programs at all for macroscopy technician and cytotechnicians. As laboratory workloads increase and disease diagnosis becomes more complex, I think roles like ours will become increasingly necessary to maintain efficiency and diagnostic quality in the lab.

Most people are surprised at the scope of our duties. In fact, when I tell pathologists who are new to my department that I perform macroscopic examinations, I can see their worry. I know they’re unaccustomed to relying on the support of a non-pathologist – but it makes me happy to see those prejudices quickly disappear after working with me. Pathologists need to understand that macroscopy technicians and cytotechnicians are experts in our field. In short, I want them to trust us and give us a chance.

Career advice
I encourage potential candidates to think carefully before choosing this career – because it’s not a job I recommend to those who don’t love the work. You must be constantly open to learning new information. Forget the stereotypes you’ve heard about the laboratory and those who work in it. Work hard to improve yourself – and, if you have questions, don’t be afraid to bring them to your colleagues, whether pathologists or non-pathologist laboratorians. Don’t have a pathologist or senior colleague available for questions? There are many on social media – you can learn a lot by following them!