Synopsis
In recent years, new evaluation criteria in surgical pathology have gained popularity in both research and diagnostics. These criteria primarily involve morphological analysis, molecular diagnosis, and immunohistochemistry (IHC). The development of digital microscopy has played a crucial role in advancing these methods, making them more accessible and widely used. These innovative techniques offer a robust platform for handling vast amounts of information that were previously unattainable. As a result, the use of morphological analysis, molecular diagnosis, and IHC is expected to continue to increase in the future. Today we will highlight some of the most popular surgical pathology criteria employed in diagnosis and research. These criteria are particularly important for shaping the future of surgical pathology and achieving optimal outcomes in this field.
New Criteria in Surgical Pathology
The world of contemporary medicine has seen the relatively easy demise of traditional processes, and the rising popularity of new methods in surgical pathology diagnostics. Morphological analysis and H&E staining enable you to obtain the amount of information that represents a windfall in data quality, quantity, and cost as compared to any other available technique. The value of an interpretation like this is irreplaceable as newer and more sophisticated technologies grow constantly.
Morphology in Surgical Pathology
Morphological analysis in surgical pathology refers to the examination and evaluation of tissue samples and specimens obtained during surgical procedures. It involves the microscopic examination of cells and tissues to identify and diagnose various diseases, disorders, and abnormalities. By analyzing the morphology (structure and appearance) of cells and tissues, you can make informed assessments regarding the nature, progression, and treatment options for a wide range of medical conditions. This analysis often includes observing cellular characteristics, such as cell shape, size, arrangement, and the presence of any cellular anomalies or abnormalities, which aids in accurate diagnosis and treatment planning.
Case Study #1: Surgical Pathology Practice in Centro Diagnostico Italiano in Milan
World-renowned physician Juan Rosai from Centro Diagnostico Italiano in Milan, Italy mentions in one of his articles some examples where the surgical pathology evaluation criteria are applied in practice. When a biopsy was taken from a cervical lymph node from a 25-year-old woman and examined under H&E sections, the pathologist could see the presence of papillary carcinoma with nuclear pseudo inclusions and psammoma. He then informed the clinician that the patient likely had metastatic papillary carcinoma originating from the unilateral lobe of the thyroid gland, possibly accompanied by multicentric disease.
Case Study #2: Rapidly Growing Mass in the Thyroid Gland
Another use case was a biopsy from a rapidly growing large mass centered in the thyroid gland of a 72-year-old man showing a malignant spindle cell tumor featuring numerous mitoses, extensive necrosis, and blood vessel invasion. When a surgical pathologist looked at the H&E section of this tumor, it was obvious that the tumor was likely to be an anaplastic thyroid carcinoma. It usually arises from a pre-existing well-differentiated papillary or follicular carcinoma, invades most of the gland, metastasizes to nodes and distant sites, and is present at the surgical margins of resection.
Molecular Diagnosis
With the advance of science, biology finally can start revealing the causal links between genotype and phenotype in the wide sense. The pursuit of comprehending the functional expression of genes within the framework of integrated biological systems has made biological research nearly synonymous with this endeavor. Morphology and molecular biology are in perfect correlation. They are already playing an important role in oncology, or more precisely, in the diagnosis, prognosis, and prediction of therapeutic response.
What is Molecular Diagnosis?
Molecular diagnosis in surgical pathology involves the utilization of molecular techniques and assays to aid in the diagnosis and characterization of diseases and conditions at a molecular level. By analyzing specific genes, genetic mutations, chromosomal alterations, and expression patterns, molecular diagnosis in surgical pathology offers valuable insights into the fundamental mechanisms and behavior of diseases.
Purpose of Molecular Diagnosis
Molecular diagnosis helps you obtain a more accurate and precise understanding of various diseases, including cancers and genetic disorders. These techniques can detect specific genetic mutations or alterations that may have diagnostic, prognostic, or therapeutic implications. Molecular diagnosis in surgical pathology allows for personalized medicine approaches, as it helps guide treatment decisions based on the molecular profile of the patient’s disease.
Common Techniques Used
Common techniques used within the framework of molecular diagnosis include polymerase chain reaction (PCR), fluorescence in situ hybridization (FISH), gene sequencing, and gene expression profiling. These methods enable the detection of genetic mutations, gene amplifications, translocations, or aberrant gene expression patterns, providing critical information for diagnosis, risk stratification, and treatment selection.
Immunohistochemical Analysis
Immunohistochemical analysis is significantly important in surgical pathology as it enables the detection and characterization of specific proteins within tissue samples. It involves the application of specific antibodies that bind to target proteins, allowing pathologists to visualize and identify the presence, location, and distribution of these proteins within the tissues under examination.
Role of Immunohistochemical
IHC plays a crucial role in the diagnosis, classification, and prognosis of various diseases, including cancers. It helps in distinguishing between different tumor types, subtypes, and grades, aiding in the accurate diagnosis and appropriate treatment selection. By identifying specific protein markers, IHC can also provide valuable information about the biological behavior of tumors, such as their aggressiveness or likelihood of metastasis.
Area of Application
Furthermore, immunohistochemical analysis contributes to the understanding of disease mechanisms and helps uncover underlying molecular pathways involved in various pathological conditions. It assists in research studies, allowing scientists to investigate the expression patterns of specific proteins in normal and diseased tissues, providing insights into disease progression, identifying potential therapeutic targets, and monitoring treatment responses.
Helps in Prognostic Assessment
IHC is also valuable in prognostic assessment, helping predict patient outcomes by identifying certain biomarkers associated with disease aggressiveness or response to specific therapies. This information can guide treatment decisions, providing a more personalized approach to patient care.
Enhances Diagnostic Accuracy
Overall, immunohistochemical analysis is of paramount importance in surgical pathology as it enhances diagnostic accuracy, aids in tumor classification and prognostication, unravels disease mechanisms, facilitates research, and ultimately contributes to improved patient management and outcomes.
Conclusion
The emerging techniques in surgical pathology hold immense potential for establishing precise diagnoses and monitoring disease-related alterations. Morphological analysis, molecular diagnosis, and immunohistochemical analysis stand out as highly valuable and precise tools. Implementation of these processes gives a detailed diagnosis and the most accurate possible research results. If you do the morphologic analysis, you can estimate how much chance of survival the patient has. The morphological analysis provides a wealth of information regarding the illness and offers valuable insights into its characteristics. Molecular diagnosis takes this a step further, allowing for detailed observation of the disease’s specific traits. Immunohistochemistry (IHC) emerges as a vital tool, playing a pivotal role in determining the prognosis of the condition. The analysis of the function of the whole molecule is better when the immunohistochemical staining results are taken into consideration. For the successful application of these criteria, you’ll need a high-quality device.
