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In preparation for a pathology report, specimens are most often sent by surgeons from the operating room or from physicians’ offices directly to the pathologist for examination. (By contrast, Fine Needle Aspirations are generally obtained by a cytopathologist who interprets the results on the spot while the patient is still in the office.) The specimens are transported in special containers with a pathology laboratory requisition attached that contains all of the relevant information on the patient, specimen, and the referring physician.

Each specimen sample is assigned a unique case number in the laboratory computer system called an accession number. This is the beginning of the specimen processing as well as the foundation for the Pathology Report. First, either a Pathology Assistant (that is, a trained staff technician) or a Pathology Resident or both, under supervision by a pathologist, will examine the specimen and provide a macroscopic or gross description for the report that includes specimen type, location, size, weight, color, and any other distinguishing characteristics.

The specimens are then embedded in paraffin blocks, cut into slices with a microtome, and processed in a special tissue processor overnight. Once prepared, these samples become the basis for pathology slides. Slides are then stained with hematoxylin/eosin dyes (“H&E stain”), so that they can be carefully examined under a microscope. Depending on the specimen type, several additional stains may be developed as a standard procedure and the number of slides prepared can also vary widely by specimen type. For instance, a small colon biopsy may only require one or two slides, whereas a larger colectomy specimen may have many dozen slides in order to make certain that the margins are clear and that all disease has been removed.

For cytology specimens such as fine needle aspirations the slide is created by smearing the cells directly onto a glass slide after obtaining the specimen. Cytology slides are also accessioned with requisitions into the laboratory computer. Some cytology specimens such as urines, bronchial fluids, or pleural fluids are sent directly to the laboratory for processing.

When the slides have been prepared properly, they are ready for the pathologist’s examination. Since pathology is a field comprised of many sub-specialties, these slides are reviewed by physicians or technicians in each service area. For example, our laboratory relies on the Surepath method for the interpretation of pap smears. NYU pathologists are also teaching physicians, and cases are reviewed with a multi-headed microscope so that training residents and fellows can review the case in conjunction with the supervising pathologist.

After this elaborate procedure of examining the specimen under the microscope, the pathologist dictates a microscopic description of the findings and a diagnosis for the pathology report. Generally, if disease has been detected or is determined as present, the pathologist will immediately contact the referring physician by telephone and provide the preliminary diagnosis. In many cases, pathologists may then order additional and more specialized testing.

Once all of these test results are available, the case is reviewed again and the additional findings are dictated for the report. The final pathology report, with accession number, gross and microscopic descriptions, results of all special studies, and the final diagnosis is signed by the Pathologist and sent to the patient’s physician. While the pathologist will, of course, be available for subsequent consultations with the patient’s physician, the overall results of the pathology report and its findings are generally communicated to patients by their own surgeon or physician and discussed in private.