Fundamentals of Dissection
At first glance the challenges facing the surgical pathology cutter appear almost insurmountable. The types of specimens that come across the cut-ting table seem endlessly diverse, and the com-plexity of these specimens may at times be perplexing. To top it off, each specimen, whether a simple needle biopsy or a convoluted composite resection, must be handled with equal care and precision. How then does one confidently and effectively function in the surgical pathology laboratory, given the bewildering diversity and complexity of specimens that enter its doors? Where does one even begin?
For any specimen, the best place to begin is at the end. Even before making the first cut, take time to visualize the end result of your work, the surgical pathology report. Consider the is-sues that need to be addressed in that report, and then plan a dissection of the specimen that will help address these important issues. While it is true that no two specimens are exactly alike, you will find that the questions they pose are remark-ably similar. Even the most complex of specimens can be reduced to three fundamental issues: Whatstructures are present? What is the nature of the patho-logic process? How extensive is that process? If youare not familiar with the important issues for a given organ, the Association of Directors of An-atomic and Surgical Pathology have an excellent website that summarizes the important diagnos-tic and prognostic issues for many of the major tumor types (www.panix.com/ adasp/). Re-gardless of the complexity or novelty of the speci-men, these issues can be efficiently addressed by a systematic four-step approach. By mastering these four fundamental steps of surgical dissec-tion, the surgical pathology cutter will be well equipped to tackle even the most intimidating of specimens with confidence.
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