Histopathology is the study of tissues (histology) and cells (cytology) and usually includes morbid anatomy (autopsies). Many refer to this specialty as Cellular Pathology. Because of the autopsies histopathologists are the doctors the general public think of as pathologists. In fact many histopathologists do not perform autopsies and for most histopathologists in the UK this is a minor part of their work. Histopathologists do not work in a laboratory in isolation but work closely with other doctors in the hospital. For cancers they are part of the team that meet and discuss every patient. The team includes surgeons, oncologists (cancer doctors), radiologists (X-Ray doctors), nurses and many other healthcare workers. This relationship between histopathology and others in the team is a key advantage in communication, team-working and planning in UK compared with some other healthcare systems.
Histopathologists examine biopsies and larger pieces of tissue to aid in the diagnosis and treatment of patients. The tissue has to be processed to enable thin enough slices of the tissue to be cut to examine under a microscope. With cytology a thin layer of cells is put on a glass slide and can be examined directly without any complicated processing. Autopsies are performed either at the request of the doctor who looked after the patient during life or a statutory legal authority eg Coroner in England, Wales and Northern Ireland and Procurator Fiscal in Scotland.
Biopsies are usually obtained either during an investigation or as an arranged procedure. Examples of investigations when biopsies may be taken include an endoscopy (for example looking at the oesophagus (gullet) and stomach) or colposcopy (examination of the cervix with a magnifying instrument). An example of an arranged procedure is of a kidney biopsy when a core of tissue is obtained by passing a needle through the skin and into the kidney. Usually little information can be obtained looking at these biopsies by naked eye and the key information is only obtained under a microscope. Many biopsies are reassuring as they have been taken, by a doctor, to rule out cancer and the biopsy does not show cancer but may, for instance, show inflammation which explains the symptoms and signs. Other biopsies may show cancer and the pathologist is able to look for features that can tell what sort of cancer is present, how aggressive it is and whether it may respond to certain types of treatment.
Examples of larger pieces of tissue come from surgical operations for example for bowel cancer. The majority of these specimens are not from operations for cancer and one of the commonest specimens is a hysterectomy (for instance for fibroids). The pathologist carefully examines these specimens by naked eye and removes small postage stamp size pieces of tissue for examination under the microscope for more detailed examination. A breast lump removed for cancer can take 30 – 60 minutes to examine by naked eye to mark and sample the edges of the tissue and search for small lymph glands in the tissue removed with it. This is important to see the size of the cancer, whether it is too close to the edge of the specimen, if it has spread and, if it has, how many glands are involved. Another 30 – 60 minutes will be taken examining the pieces under the microscope with measurements, looking carefully for spread etc., writing and issuing the report.
With cytology across the UK most people first think about the cervical screening programme but cytology is also used to look at fluids that have collected in the body during illnesses for example pleural (chest) fluid. Fine needles are often used to aspirate cells from suspicious lumps for example in the neck. There are specialist cytopathologists who concentrate exclusively on cytology. These are normally based in large centres. Most cytology in the UK is performed by histopathologists who devote part of their time to cytology and part to histology.
Autopsies performed at the request of the doctors who looked after the patient and with the permission of the next of kin have steeply declined in numbers in the last 15 years. They are requested to help confirm the illness the patient was suffering from, to see if the treatment given had had any effect on the disease and the effect of the disease on various organs and whether the patient was suffering from any other disease. Many doctors and medical students have not seen the actual appearances of diseased organs and the autopsy can be a powerful teaching tool for current and future generations of doctors and other healthcare workers.
Dr I Chaudhry (Chair)
Dr K Skordilis (Vice Chair)
Dr M Wilkins
Dr M Evans
Dr M Dada
Dr U Chandran
Dr A Pugh
Dr N Wong (Best Practice Editor & BMA Pathology sub-committee CCSC)
Trainee members’ representative
Dr M Clarke
Honorary Officers ex officio
Dr S Knowles
Additionally, Council members who attend this specialty committee are:-
Dr A Oriolowo (NQAAP)
Prof. M Ilyas
Dr D Parham
Dr K Robson