Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with
the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and
molecular examination of organs and tissues.
Over the last century, pathology has evolved tremendously: from historical examination
of whole bodies to a more modernized practice, centered on the diagnosis and prognosis of
cancer to guide decision-making in cancer treatment.
Its modern founder was the Italian scientist Giovan Battista Morgagni from Forlì.
Anatomical pathology is one of two branches of pathology, the other being clinical pathology,
the diagnosis of disease through the laboratory analysis of bodily fluids and/or tissues.
Often, pathologists practice both anatomical and clinical pathology, a combination known
as general pathology.
Similar specialties exist in veterinary pathology.
Differences between Anatomic Pathology and Clinical Pathology
Anatomic pathology relates to the processing, examination, and diagnosis of surgical specimens
by a physician trained in pathological diagnosis.
Clinical pathology is the division that processes the test requests more familiar to the general
public; such as blood cell counts, coagulation studies, urinalysis, blood glucose level determinations
and throat cultures.
Its subsections include chemistry, hematology, microbiology, immunology, urinalysis and blood
bank.
Anatomical pathology is itself divided in subspecialties, the main ones being surgical
pathology, neuropathology, hematopathology cytopathology, and forensic pathology.
To be licensed to practice pathology, one has to complete medical school and secure
a license to practice medicine.
An approved residency program and certification is usually required to obtain employment or
hospital privileges.
Skills and procedures The procedures used in anatomic pathology
include: Gross examination - the examination of diseased
tissues with the naked eye.
This is important especially for large tissue fragments, because the disease can often be
visually identified.
It is also at this step that the pathologist selects areas that will be processed for histopathology.
The eye can sometimes be aided with a magnifying glass or a stereo microscope, especially when
examining parasitic organisms.
Histopathology - the microscopic examination of stained tissue sections using histological
techniques.
The standard stains are haematoxylin and eosin, but many others exist.
The use of haematoxylin and eosin-stained slides to provide specific diagnoses based
on morphology is considered to be the core skill of anatomic pathology.
The science of staining tissues sections is called histochemistry.
Immunohistochemistry - the use of antibodies to detect the presence, abundance, and localization
of specific proteins.
This technique is critical to distinguishing between disorders with similar morphology,
as well as characterizing the molecular properties of certain cancers.
In situ hybridization - Specific DNA and RNA molecules can be identified on sections using
this technique.
When the probe is labeled with fluorescent dye, the technique is called FISH.
Cytopathology - the examination of loose cells spread and stained on glass slides using cytology
techniques.
Electron microscopy - the examination of tissue with an electron microscope, which allows
much greater magnification, enabling the visualization of organelles within the cells.
Its use has been largely supplanted by immunohistochemistry, but it is still in common use for certain
tasks, including the diagnosis of kidney disease and the identification of immotile cilia syndrome.
Tissue cytogenetics - the visualization of chromosomes to identify genetics defects such
as chromosomal translocation.
Flow immunophenotyping - the determination of the immunophenotype of cells using flow
cytometry techniques.
It is very useful to diagnose the different types of leukemia and lymphoma.
Subspecialties Surgical pathology
Surgical pathology is the most significant and time-consuming area of practice for most
anatomical pathologists.
Surgical pathology involves the gross and microscopic examination of surgical specimens,
as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists,
dermatologists, and interventional radiologists.
Surgical pathology increasingly requires technologies and skills traditionally associated with clinical
pathology such as molecular diagnostics.
Oral and maxillofacial pathology
In the United States, subspecialty-trained doctors of dentistry, rather than medical
doctors, can be certified by a professional board to practice Oral and Maxillofacial Pathology.
Cytopathology
Cytopathology is a sub-discipline of anatomical pathology concerned with the microscopic examination
of whole, individual cells obtained from smears or fine needle aspirates.
Cytopathologists are trained to perform fine-needle aspirates of superficially located organs,
masses, or cysts, and are often able to render an immediate diagnosis in the presence of
the patient and consulting physician.
In the case of screening tests such as the Papanicolaou smear, non-physician cytotechnologists
are often employed to perform initial reviews, with only positive or uncertain cases examined
by the pathologist.
Cytopathology is a board-certifiable subspecialty in the U.S.
Molecular pathology
Molecular pathology is an emerging discipline within anatomical and clinical pathology that
is focused on the use of nucleic acid-based techniques such as in-situ hybridization,
reverse-transcriptase polymerase chain reaction, and nucleic acid microarrays for specialized
studies of disease in tissues and cells.
Molecular pathology shares some aspects of practice with both anatomic and clinical pathology,
and is sometimes considered a "crossover" discipline.
Forensic pathology
Forensic pathologists receive specialized training in determining the cause of death
and other legally relevant information from the bodies of persons who died suddenly with
no known medical condition, those who die from non-natural causes, as well as those
dying as a result of homicide, or other criminally suspicious deaths.
A majority of the forensic pathologists cases are due to natural causes.
Often, additional tests such as toxicology, histology, and genetic testing will be used
to help the pathologist determine the cause of death.
Forensic pathologists will often testify in courts regarding their findings in cases of
homicide and suspicious death.
They also play a large role in public health, such as investigating deaths in the workplace,
deaths in custody, as well as sudden and unexpected deaths in children.
Forensic pathologists often have special areas of interest within their practice, such as
sudden death due to cardiac pathology, deaths due to drugs, or Sudden Infant Death, and
various others.
Training and certification of Anatomical Pathologists Australia
(Also New Zealand, Hong Kong, Singapore, Malaysia, and Saudi Arabia)
Anatomical Pathology one of the specialty training programs offered by the Royal College
of Pathologists of Australasia.
The RCPA.
To qualify as a Fellow of the RCPA in Anatomical Pathology, the candidate must complete a recognised
undergraduate or postgraduate medical qualification, then complete a minimum of 1 year of clinical
medical experienceas a prerequisite to selection as a training registrar.
The training program is a minimum of 5 years, served in at least two laboratories, and candidates
must pass a Basic Pathological Sciences examination, the Part 1 examination and the Part 2 examination.
Fellows may then continue into subspecialty training.
Canada Anatomical Pathology is one of the specialist
certificates granted by the Royal College of Physicians and Surgeons of Canada.
Other certificates related to pathology include general pathology, hematopathology, and neuropathology.
Candidates for any of these must have completed four years of medical school and five years
of residency training.
USA Anatomic Pathology is one of the two primary
certifications offered by the American Board of Pathology) and one of three primary certifications
offered by the American Osteopathic Board of Pathology.
To be certified in anatomic pathology, the trainee must complete four years of medical
school followed by three years of residency training.
Many U.S. pathologists are certified in both AP and CP, which requires a total of four
years of residency.
After completing residency, many pathologists enroll in further years of fellowship training
to gain expertise in a subspecialty of AP.
Anatomical pathology practice settings Academic anatomical pathology is practiced
at university medical centers by pathologists who are also university faculty.
As such, they often have diverse responsibilities that may include training pathology residents,
teaching medical students, conducting basic, clinical, or translational research, and/or
performing administrative duties, all in addition to the practice of diagnostic anatomical pathology.
Pathologists in academic settings often sub-specialize in a particular area of anatomic pathology
and may serve as consultants to other pathologists regarding cases in their specific area of
expertise.
Group practice is the most traditional private practice model.
In this arrangement, a group of senior pathologists will control a partnership that employs junior
pathologists and contracts independently with hospitals to provide diagnostic services,
as well as attracting referral business from local clinicians who practice in the outpatient
setting.
The group often owns a laboratory for histology and ancillary testing of tissue, and may hold
contracts to run hospital-owned labs.
Many pathologists who practice in this setting are trained and certified in both anatomical
pathology and clinical pathology, which allows them to supervise blood banks, clinical chemistry
laboratories, and medical microbiology laboratories as well.
Large corporate providers of anatomical pathology services, such as AmeriPath in the United
States.
In this model, pathologists are employees, rather than independent partners.
This model has been criticized for reducing physician independence, but defenders claim
that the larger size of these practices allows for economies of scale and greater specialization,
as well a sufficient volume to support more specialized testing methods.
Multispecialty groups, composed of physicians from clinical specialties as well as radiology
and pathology, are another practice model.
In some case, these may be large groups controlled by an HMO or other large health care organization.
In others, they are in essence clinician group practices that employ pathologists to provide
diagnostic services for the group.
These groups may own their own laboratories, or, in some cases may make controversial arrangements
with "pod labs" that allow clinician groups to lease space, with the clinician groups
receiving direct insurance payments for pathology services.
Proposed changes to Medicare regulations may essentially eliminate these arrangements in
the United States.
See also Pathology
Digital pathology and Telepathology Clinical pathology
Forensic pathology Laser capture microdissection
List of pathologists History of pathology
United States and Canadian Academy of Pathology Notes and references
External links "Conversations with Pathologists", a website
based on a book project by Sue Armstrong, sponsored by Genentech and The Pathological
Society of Great Britain and Ireland PathReports.in: Make Anatomical pathology
reporting paperless and save trees.
PathMax, a collection of online Pathology resources
MyBiopsy.org, information on more than 25 of the most common cancers and cancer-related
conditions The Doctor's doctor, a very useful web site
for patients and pathologists Pathologie Online, online Pathology resources
in German Pathology Outlines, an online textbook of
anatomic pathology College of American Pathologists
American Board of Pathology CYTOPATHNET Online Resource Center for Cytopathology
Histology Group of Victoria Incorporated Flickr group: Pathology and Lab Medicine:
numerous photos illustrating the work of pathologists.
Pathtalk.org: A multiple-author weblog by and for anatomic pathologists, with illustrative
cases and specialty-related discussions.
PathologyPics.com: An interactive histology database for the Practicing Anatomic Pathologist
as well as Pathology Trainees.