Grossing Technology Today and Tomorrow

Izak B. Dimenstein, MD, PhD, HT (ASCP)


Lab Med. 2020;51(4):337-344. 

In This Article

Digital Pathology

The implementation of digital pathology in morphology studies practice is already in full gear in histology laboratory practice, especially after the Food and Drug Administration's approved use of whole-slide imaging of Phillips IntelliSite Pathology Solution for primary diagnosis. Although digital microscopy still has many hurdles to overcome, the quality of the microscope slide and its suitability for optimal digitation are often not discussed and are taken for granted, but the issue of microscope slide quality is actually the elephant in the room. Grossing technology can contribute to microscope slide quality by standardizing the preanalytical stage of processing.

There are 3 main areas of grossing technology which can be beneficial to standardization of digital microslide images. We can think of these as a 3-leg stool. Figure 2 highlights them, as follows: (1) a certain time range for fixation, (2) a certain thickness of the gross section, and (3) the embedding orientation for optimal microsection.

Figure 2.

Grossing technology contributions to microslide image standardization.

Standardization of fixation is the first and the most plausible step. Experiences with human epidermal growth factor receptor 2 and estrogen and progesterone receptor fixation time ranges, determined by the College of American Pathologists requirement, show that standardization of fixation is useful and achievable. This should be expanded for further standardization of fixation in tissue processing.

The specimen gross section's certain optimal thickness is especially important in microwave power and vacuum-assisted tissue processing given the current tendency to shorten the processing duration. Affinity to stains and avoidance of artifacts depend on adequate tissue processing. The development of instruments and gadgets to achieve a certain thickness of the gross section, as well as perpendicularity, is part of the contribution of grossing technology to further implementation of digital pathology. Image 1 presents a prototype of a device for certain thickness and perpendicularity of the gross section. The "third-hand" principle of immobilization during gross section is in the background of the device.[9–11]

Image 1.

Device for certain thickness and perpendicularity of the gross section.

Embedding orientation of the gross section in the processing cassette can also contribute to the optimal standard thickness of the microtomy section's ribbon. The angle of the blade's or knife's approach to the tissue and the flattened tissue in the embedding mold with a tamper provide the optimal face surface for the microsection.[1,12,13]

Speech recognition technology (eg, Dragon, Voicebrook PRO, and VoiceOver PRO) is now a well-established method of dictation during grossing. PRO's (Pathology Reporting Optimized) Report Builder suggests gross templates for synoptic reporting that enhance productivity at the grossing table. Speech recognition can have a future as a computerized adjustment of intended dictation despite accents, dialects, and violations of standard English. Our laboratory's Voicebrook is "teachable," for example, in learning how to format paragraphs.

Advanced speech recognition programs are relatively expensive. Some individuals are reluctant to use speech recognition for personal reasons. Despite current cost constraints or adjustment problems experienced by groups or individuals, progress cannot be rolled back. Implementation of face recognition software of the grossing person and other progress in artificial intelligence will come.

However, this inevitable progress should not eliminate medical transcription as a specialty or transcriptionists as part of the professional report generation process, although such progress tends to go in this direction. Experienced medical transcriptionists, besides having the immediate task of transcribing reports, are gatekeepers against errors, discrepancies, and inconsistencies. The medical transcriptionist's role will change to that of facilitator of the transcription workflow, separating template dictations from other types and having final control before delivery to the pathologist.[14]