Summary
Pathologists’ assistants (PAs) are vital to pathology practice, but there is room for improvement in collaboration with pathologists. While PAs receive appropriate education, more pathologist involvement is needed to fine-tune their skills and ensure accurate and relevant gross descriptions. This collaboration is crucial for accurate cancer diagnoses and staging, especially as pathologists become less involved with gross examinations.
The training of pathologists’ assistants
March 2026—I wholeheartedly agree with Arthur Mensch, MD, about the need for more pathologist involvement in supervising gross examinations of resection specimens (Letters, January 2026). I also agree with the American Association of Pathologists’ Assistants’ statement definition and roles of grossing technician versus pathologists’ assistant (Letters, September 2025). As things have evolved, pathologists have become much less involved with the critical aspects of grossing, which translates into potential problems in accurate cancer diagnoses and staging. Although PAs spend an appropriate amount of time in their educational programs, I have found through anecdotal surveys with PAs across the country that they are not receiving teaching from real-world practicing pathologists, and that there is a disconnect between the concepts being perpetuated and what information is actually important to clinicians for patient care. Also troubling in many cases is the suboptimal description of tumors and lesions.
I have been in practice now for 30 years, the first 12 of which we pathologists grossed our own specimens. Although I learned the basics of grossing as a resident, I solidified my skills by reading (over and over) the gross descriptions of tumors as described in the AFIP Fascicles and other textbooks, and then later by aligning gross descriptions with the CAP cancer protocols. The role of the grossing individual has not changed in the past 30 years. It is to give a clear, concise mental picture of a specimen, including all relevant information (and excluding irrelevant information), to the pathologist tasked to sign out the case. In this era of pathologists rarely laying eyes on gross specimens, it is more important than ever for gross descriptions to be accurate and relevant.
Pathologists’ assistants do outstanding work and are vital to pathology practice. However, I believe there is much room for improvement in regard to collaboration with pathologists. It is vitally important to work closely with PAs to “fine-tune” what they have learned in their programs. The PA’s education, like the pathology resident’s education, is just a starting point, a stepping stone. This fine-tuning can only be done by attending pathologists. When discussing in detail how to approach specimens and what is really important for patient care, I have found a lot of misconceptions and gaps in knowledge among PAs, which could easily be corrected through more pathologist involvement.
David J. Eisenstein, MD
Pathologist, SLUCare Physician Group
Medical Director of Laboratories
SSM Health Good Samaritan Hospital Mount Vernon, Ill.
SSM Health St. Mary’s Hospital
Centralia, Ill.
SSM Health St. Mary’s Hospital
Jefferson City, Mo.
Indispensable grossing technicians and PAs
I am writing in response to the retired pathologist who questioned the use or overuse of pathologist extenders (pathologists’ assistants and grossing technicians) (Letters, January 2026). His comments did not ring true with my past and current experiences in a 400-bed and then a 200-bed community hospital setting. I have practiced for more than 30 years in those hospitals, administering the entire laboratory and signing out a robust case mix of complex and simple specimens at an average rate of 4,500 cases per pathologist per annum. That, along with the occasional autopsy as well as gynecologic and nongynecologic cytologies and fielding clinicians’ questions, has made up the bulk of my workload. We train the grossing technicians (small biopsies only) extremely well, and the histology supervisor oversees them. The PAs are certified after formal, rigorous postgraduate training.