if micro exams aren't necessary do we still need gross exams?

[pathstudent]

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Micro exams are becoming more and more of an arcane practice. In fact I have seen reports from JHU and BWH where it doesn't even say "microscopic examination: Performed". It just gives the diagnosis.

Would it be OK to just forget the gross and maybe just have a list of basic details:

Like "Whipple, tumor 2.5 cm, radial margin Black"

Then a cassette summary.

If micro exams are irrelevant, then why not gross exams?

 

[sohsie]

Micro exams are becoming more and more of an arcane practice. In fact I have seen reports from JHU and BWH where it doesn't even say "microscopic examination: Performed". It just gives the diagnosis.

Would it be OK to just forget the gross and maybe just have a list of basic details:

Like "Whipple, tumor 2.5 cm, radial margin Black"

Then a cassette summary.

If micro exams are irrelevant, then why not gross exams?

Micro exams are irrelevant in many cases because the diagnosis encompasses the microscopic findings. This is best illustrated if one uses the Sydney system to sign out gastric biopsies, where all of the microscopic details are encompassed by the diagnosis.

Gross exams, however, are never encompassed by the diagnosis. Also, the gross exam is the interface between the surgeon/clinician and the pathologist. The surgeon sends for instance a 5 cm fatty lesion, and the gross reflects the fact that that is what was received.

 

[JPR22]

Still, a photograph from 2 or 3 views should cover most of the important gross findings. Ive seen programs where a PA/resident could take a photo, draw a line where sections are taken..all electronic,no verbage required, much faster.

 

[Pingu]

Still, a photograph from 2 or 3 views should cover most of the important gross findings. Ive seen programs where a PA/resident could take a photo, draw a line where sections are taken..all electronic,no verbage required, much faster.

Photos are 2-Dimensional. Specimens are 3-Dimensional.

You would need a minimum of three photos with appropriately focused ruler for even the simplest of specimens. I'd bet a pair of shoes that I can dictate the gross on a gallbladder or hernia sac faster than someone could take three focused orientated pictures of the same specimen that would give the same information I gave in my dictation.

With a tumor, you would also have to take each picture and measure the tumor dimension and distance to margins, which would definitely NOT be faster.

 

[green mantis]

Still, a photograph from 2 or 3 views should cover most of the important gross findings. Ive seen programs where a PA/resident could take a photo, draw a line where sections are taken..all electronic,no verbage required, much faster.

At my residency, those photos supplement the gross description. Sometimes, it's hard to describe where you take the section from. It also helps to map your sections in case you need to go back.


----- Antony

 

[mcfaddens]

At my residency, those photos supplement the gross description. Sometimes, it's hard to describe where you take the section from. It also helps to map your sections in case you need to go back.


----- Antony

Agreed Also some of the gyns want to know the weight of their hysterectomy specimens I think for billing purposes on their end

 

[pathstudent]

Micro exams are irrelevant in many cases because the diagnosis encompasses the microscopic findings. This is best illustrated if one uses the Sydney system to sign out gastric biopsies, where all of the microscopic details are encompassed by the diagnosis.

Gross exams, however, are never encompassed by the diagnosis. Also, the gross exam is the interface between the surgeon/clinician and the pathologist. The surgeon sends for instance a 5 cm fatty lesion, and the gross reflects the fact that that is what was received.

Never?

If the diagnosis is "lipoma 5 cm" isn't that the gross also or if is adenocarcimoma od the prostate involving both lobes, confined to the prostate, with lympovascular invasion and no seminal vesicle involvement.". Would the gross add anything to that?

 

[yaah]

Gross exam is important because it documents receipt of specimen and decribes it. I'm sure there are legal precedents there. There are many instances in which what is received does not jive with what was supposedly submitted. Obviously, the gross exam is much more important in cases of resections where it can make the diagnosis better than the micro.

That being said, a gross does not have to be long and drawn out to be effective. Biopsy gross descriptions are often, "A 0.2 cm tan bit." Resections can be, "a liver lobe with a 6 cm tumor bulging through the capsule, 1 cm from the margin."

 

[Parts Unknown]

If micro exams are irrelevant, then why not gross exams?

How long does your institution hold on to glass slides after they have been read? How long does it hold on to specimens after they have been grossed?

 

[pathstudent]

How long does your institution hold on to glass slides after they have been read? How long does it hold on to specimens after they have been grossed?

Forever and a couple months.

Mayo stores grosses I think for a long long time.

I am just saying this because micros were routine on every single case for decades and they just got phased out in the last decade or so.

We all accept that microscopic exams are a waste of time and that no one wants to read them, so could we possibly accept the same thing about gross exams.

 

[2121115]

The gross and micro are different because 90% of the time the attending who signs out the case didn't see the gross specimen at all and depends entirely on the description while, obviously, if you signed out the case then you saw the micro. That is why gross descriptions are so important, especially in academics where different people are always rotating through grossing for multiple different attendings who will never see the gross specimen.

 

[Parts Unknown]

Forever and a couple months.

So one form of information (microscopic) is retrievable and the other (gross) is not. Sounds like a good enough reason to keep doing gross descriptions.

 

[malchik]

So one form of information (microscopic) is retrievable and the other (gross) is not. Sounds like a good enough reason to keep doing gross descriptions.

Then how about a few good photographs?

 

[Parts Unknown]

Then how about a few good photographs?

Even more work.

 

[lipomas]

A proper gross exam should include details that are not in question, like tumor measurements, what the specimen includes, what ink denotes what margin, things like that. Micro exams are more subjective and are not very important next to the diagnosis and comment section. Gross exams are necessary. Microscopic descriptions are not, except maybe in bone marrow biopsies and kidney biopsies.