In pathology, every accurate diagnosis starts with a foundational step: the gross examination. Yet as Jennifer Hudson, MD, compellingly argues in The Pathologist, this critical stage is vulnerable—especially when gauntlets are handed to personnel without standardized training or proper oversight.
“Diagnosis begins at the gross bench. If that part of the process is not done correctly, the downstream effects can be catastrophic.”
— Jennifer Hudson, The Pathologist
The Stakes: Who’s at the Bench Matters
Grossing was once the purview of pathologists and their residents. But mounting workloads prompted the adoption of pathologists’ assistants (PAs) and grossing technicians (GTs). While PAs emerge from accredited programs supplemented by robust hands-on experience, GTs often lack such rigorous education.
As pathology increasingly shifts toward digital diagnostics and complex analyses, the role and competency of the person at the gross bench matters more than ever.
Regulatory Gaps in a High-Stakes Role
Despite its complexity, grossing remains a high-complexity task under CLIA ’88. Yet in most U.S. states, requirements remain minimal—often just an associate degree in lab science. Only California has implemented tiered oversight, and a mere three states formally license PAs.
Such regulatory gaps are concerning, particularly when moderately or highly complex specimens—like cancer resections—are handled by underqualified staff.
AAPA’s POV: Define Roles. Elevate Training.
According to the American Association of Pathologists’ Assistants (AAPA), GTs should be limited to handling low-complexity specimens that don’t require selective sampling. PAs, by contrast, should graduate from NAACLS-accredited programs, pass the ASCP board certification exam, and handle moderate to high-complexity tasks—including selective sampling and frozen sections.
This role delineation allows pathologists to focus on microscopic diagnosis while ensuring grossing is done with the right level of training, ultimately protecting diagnostic integrity and workflows.
Conclusion
At Cision Vision, we believe that excellence in pathology starts at the gross bench. The article reinforces what we champion every day:
- Training matters: Only personnel with rigorous education and certification should handle complex specimens.
- Role clarity is critical: Clearly defined scopes ensure each team member works at the top of their competency.
- Regulations need updating: National standards should reflect modern diagnostic complexity.
By empowering pathology teams with both technology and defined training frameworks, we enable faster, safer, and more accurate diagnoses from the very first step.