The surgical pathologist examines tissue (specimens) removed in the operating room, out-patient clinic or doctors office. The organ (skin, stomach, breast etc.), and operation (biopsy, resection, etc. ) are recorded.
The entire specimen is first inspected for large, visible abnormalities. Thin tissue sections are then selected and prepared on glass slides for microscopic review and definitive pathologic diagnosis.
The tissue must be firm enough to cut thin slices without shredding or distortion. This can be done in one of two ways. If an immediate diagnosis is desired, the tissue is quickly frozen and cut. There is some artifact introduced with this method, therefore, it is reserved for situations where either the surgeon is waiting in the operating room for results to direct further surgery or when fresh tissue is needed for special studies. If no immediate diagnosis is required, the tissue is "fixed" in a formalin solution then passed through a series of chemical reagents until it is impregnated with wax to make it firm. Depending on the tissue type, this may take 24-48 hrs. Thin sections are then cut, placed on glass slides, and stained to make the cells visible for the pathologist to examine.
The sections selected for microscopic examination are determined by the type of tissue, the abnormalities identified and the questions needed to be answered in order to best proceed with patient care or counseling.
Example of Surgical Pathology as it relates to breast cancer.