Grossing Technology Today and Tomorrow

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


Lab Med. 2020;51(4):337-344. 

In This Article

Gross Digital Pathology

Almost all grossing stations use a camera that provides high-quality images. Gross photography integrated into the institutional laboratory information systems can go beyond the employment for specimen identification and general digital photographs.

Modern grossing technology needs to be thought of as a comprehensive procedural approach to the application of gross digital pathology in the surgical pathology laboratory by reflecting the stages of specimen processing from accession to the specimen's placement into the embedding cassette. The preanalytical stage includes capturing images of requisition forms, containers, and barcoded labels on the containers. This stage should be mandatory as a standard of care to prevent a specimen's misidentification. The sampling stage provides optional general grossing photography, with possible annotated measurements. Images of the specimen's exploration process, which show how the section on the microscope slide is found and taken, can also be useful for a pathologist's diagnosis. The stage of using selected close-up images of specimens or sections, which directly correspond to the microscope slide, is an advancement in gross digital pathology by providing pathologists with an additional tool for making a diagnosis.[1]

Close-up images directly corresponding to the microscope slide open opportunities to solve issues with specimen orientations or resection margins. Gross digital pathology becomes a working diagnostic tool to confirm or reject grossing submissions. On some occasions, the request for a deeper cut can be justified. According to the section's gross close-up image, situations could occur in which the pathologist might ask to reembed the section upside down, take an additional section, or even reconsider the pathology diagnosis (Figure 3).

Figure 3.

Selection for close-up section's images.

Implementation of the close-up image advancement in gross digital pathology requires the development of a mini-grossing board for capturing diagnostically oriented images of a grossing section. One of the significant hurdles in implementing advancements in gross digital pathology is limited memory storage capacity at this stage of the laboratory information system.