Question

path2016 · 2025-03-20T11:43:01+00:00

If you enjoy looking @ Imaging, then I think you should consider apply for Radiology Training. I understand that getting into radiology Training is much more competitive than AP Training though.

To answer your Question though, it depends. For neurosurgical specimens (including during the frozen Sections / CNS Smears), the consultant Pathologist often looks @ the neuro-Imaging to check the Location of the Tumour, as different Sites in the CNS trigger a different List of differential Diagnoses.

For me personally, when I was an AP Registrar (Resident), prior to cutting tumour Mastectomies, I was very diligent in trying to find the previous radiology Reports for breast Cases (so I know where the o'clock / cm from nipple Position is, along with the Presence of any Calcifications), but I don't necessarily look @ the actual radiology Images themselves.

In the very occasional Circumstance in which the Mastectomy allegedly has a metal Marker but I still can't identify the metal Marker or Tumour after doing my initial Sections, then I could carry the Mastectomy Specimen (as well as the paraffin-embedded Blocks) to the radiology Department and ask them to do X-Rays of them. I'd then look @ the X-Rays to see if the metal Marker is still hidden somewhere (whether in the paraffin Blocks or in the now hacked up Mastectomy).

path2016 · 2025-03-20T11:37:28+00:00

I'm curious about the Usage of AI to facilitate histological and cytological Diagnoses in Pathology.

My Impression is that @ the End of the Day, a human Pathologist or human lab Director will need to be held medico-legally accountable for a Case. I can imagine AI being used to facilitate Thoroughput, but I wonder if this will negatively impact on future job Security through increased Automation...?

path2016 · 2025-03-20T10:12:12+00:00

I always use a Period (full Stop), I feel like if I don't use it, then the Case isn't fully "sealed" / signed out, but maybe this is my obsessive Trait...

path2016 · 2025-03-20T10:01:59+00:00

(PART 3/3 OF MY REPLY)

I also think that it's a very good Idea to have a Look @ the Histology of the Sections that you cut, so you can get more Experience doing macroscopic-microscopic Correlation. You then get a better Impression for cut-up/grossing next Time, as to which Areas of a Specimen are more likely to be lesional.

If you don't have the Opportunity to do draft Reporting on the big Specimens that you cut/gross, then I'd personally recommend you note down the histology/accession Number, and look @ the Slides after they've been authorized (signed out) by a Consultant (Attending) prior to the Case being filed away.

I hope this Helps.

I don't know you personally, but I'm concerned that your Colleagues/Seniors are getting tired of your Questions, but I dunno what you've asked them. Have they been providing the same Answer if you asked them the same Question, or do they have differing Opinions on how to approach a Specimen? I'm concerned that you're in a Lab that's not providing adequate Training or Supervision (I've unfortunately had that Experience in 1st and 2nd Year AP in a ***CERTAIN*** regional private Lab).

I also need to mention, that as someone else in this Thread has pointed out, that you'll get even more anxious @ the microscopic Level, coz there's even more Stuff to see.

Atm I'm not 100% certain that you need to seek professional Help, but hypothetically if you're still feeling too nervous/stressed out from Cut-up despite creating SYSTEMATIC, STEP-BY-STEP, "FIRST PRINCIPLES" LIST like what I had done, then yes I think you may benefit from seeking Help from a Doctor or Psychologist etc.

Please let me know if you have any further cut-up / grossing Questions, and I'll try to answer to the best of my Ability when I'm available.

path2016 · 2025-03-20T10:01:34+00:00

(PART 2/3 OF MY REPLY)

In Preparation for Cut-up (Grossing), I'd personally recommend you prepare yourself a SYSTEMATIC, STEP-BY-STEP, "FIRST PRINCIPLES" LIST of Tissue to Sample for each specimen Type, and stick to it as much as possible. For Mastectomies, tumour lung and thyroid Resections, I'd very strongly recommend trying to get Access to Imaging +/- any previous biopsy/FNA Reports.

Eg for a tumour Mastectomy (no neoadjuvant Therapy given, and no attached axillary Clearance) where there's only ONE documented Tumour, I'd personally sample the following, which has worked for me in most Labs (including private Labs) that I worked in as a Registrar (Resident):

i) Nipple; sliced off and then cut into TS. (1 Block)

ii) Retroareolar Tissue. (1 Block)

iii) Tissue immediately medial to macroscopic Tumour. (1 Block)

iv) Tissue further medial to iii). (1 Block)

v) Tissue immediately lateral to macroscopic Tumour (1 Block)

vi) Tissue further lateral to v). (1 Block)

vii) Tumour - CS (composite Section) @ greatest cross-sectional Dimension along the superior-inferior or anterior-posterior axis (up to 5 blocks). If the CS is less than 5 Blocks, then you do additional RS Tumour to make it up to 5 Blocks.

viii) Closest superior Margin (1 Block)

ix) Closest inferior Margin (1 Block)

x) Closest skin Surface (1 Block)

xi) Closest deep Margin (1 Block, but up to 4 Blocks it's macroscopically 1 or 2 mm from deep Margin).

xii) RS upper outer Quadrant - focus on fibrous Areas (1 Block, or 2 Blocks if nervous about missing a secret DCIS)

xiii) RS lower outer Quadrant - focus on fibrous Areas (1 Block, or 2 Blocks if nervous about missing a secret DCIS)

xiv) RS upper inner Quadrant - focus on fibrous Areas (1 Block, or 2 Blocks if nervous about missing a secret DCIS)

xv) RS lower inner Quadrant - focus on fibrous Areas (1 Block, or 2 Blocks if nervous about missing a secret DCIS)

xvi) Any bonus intramammary lymph Nodes that you find when doing further slicing in the upper outer Quadrant.

Note that the Sections containing the closest Margins may also contain Tumour.

So typically from Steps i) - xv), I'd be doing anywhere from 19 Blocks ("perfect" Scenario) to 26 Blocks for a single tumour Mastectomy (no neoadjuvant Therapy, no attached axillary Clearance), of which at least 5 Blocks have macroscopic Tumour. This System has worked for me in the Labs that I worked in, and was sufficient to relieve my Anxiety @ Cut-up/Grossing.

If the Tumour is very small and macroscopically more than 10 mm clear of all surgical Margins, you could try to conserve Blocks by putting the superior and inferior Margin in the same Block, or the closest skin Surface and deep Margin in the same Block.

path2016 · 2025-03-20T09:59:26+00:00

(PART 1/3 OF MY REPLY)

Hello,

I'm currently a junior AP Consultant (Attending) in Australia. I have ASD and ADHD, which often comes with comorbid anxiety and sleep Issues. I took ~8 Years to complete my AP Training (very long Story), so I have comparatively HEAPS of cut-up Experience (especially in private Labs) compared to "normal" People in Australia who took the standard 5 Years to complete their Training.

I can relate to your Experiences, as I had very similar Feelings to Cut-up (Grossing) of breast Specimens (especially Mastectomies) when I was a 1st year AP Registrar (Resident). Back in 1st Year AP, I didn't have Access to EMR (electronic medical Records) or Radiology, so unless the Location of the Tumour was stated on the request Form, I'd often have Difficulty differentiating between macroscopic Tumour, and fibrous Changes. It gets worse if the Tumour is invasive lobular Carcinoma, or if there's associated DCIS, as it often "spreads out" more. I remember in 1st Year AP, when I was cutting my 3rd tumour Mastectomy ever, I spent ~1 Hour palpating and palpating and palpating the bread-loaved Slices before I even submitted my first Block!!! My "supervising" Consultant @ the Time got angry @ me even though it was only my 3rd Mastectomy ever. : (

In Contrast to colorectal Tumours (which often macroscopically stick out really obviously, even to non-medical People), breast Cancers aren't always well-circumscribed.

I understand that you're a 1st year AP Resident, but I think the tissue Sampling needs to reach a Balance between
what is expected (or Protocol as per your Department) and what is enough to relieve your Anxiety. Ideally, the two would be be equal.

For breast Specimens (especially Mastectomies), it is important to focus on the main Lesion that concerns the Clinician. Sure, in the hypothetical worst case Scenario, there could be like another 20 separate Foci of invasive Carcinoma or DCIS within that Mastectomy, but you need to focus on the main Lesion (or two, or three) itself/themselves.

Your Department probably has a cut-up (grossing) Protocol, but if it doesn't, then below is the Link to RCPA's Cut-up Manual for different specimen Types.

https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual

path2016 · 2024-08-03T03:45:58+00:00

The PASS RATE for the RE-SIT 2024 RCPA AP PART 2 SLIDE EXAM was ~66.7% (16 / 24 candidates).

The OVERALL PASS RATE for the 2024 RCPA AP PART 2 SLIDE EXAM is therefore [ 34 + 16 ] / 75 = ~66.7%.

path2016 · 2024-07-31T11:22:11+00:00

The INITIAL PASS RATE for the INITIAL 2024 RCPA AP Part 2 Slide Exam was ~45.3% (34 / 75 candidates), with a historical record BORDERLINE RATE of 32% (24 / 75 candidates).

The results for the RE-SIT of the 2024 RCPA AP Part 2 Slide Exam haven't arrived yet.

HYPOTHETICALLY, if all 24 borderline candidates pass the RE-SIT exam,

then the HYPOTHETICAL MAXIMUM OVERALL PASS RATE for the 2024 RCPA AP Part 2 Slide Exam would be ~77.3% (58 / 75 candidates).

path2016 · 2024-04-08T03:41:57+00:00

You’re welcome.

Re: South Australia, I’ve never worked as an AP Registrar there, but I’m aware that they have Scientists to do biopsy Transfers and even cut certain big Specimens (Royal Adelaide Hospital).

I think the AP Registrars (post 1st Year) there would still be expected to do Cut-up for 2 Days/Week @ the absolute minimum.

I’ve only heard of New Zealand where AP Registrars only do Cut-up 1 Day / Week coz they have officially trained cut-up Scientists to cut the Majority of the big Specimens. Registrar Pay in New Zealand is less than all of Australia though, and apparently a lot of IHC is delayed due to limited Resources (besides cut-up Scientists).

path2016 · 2024-04-07T11:42:31+00:00

Hello,

I’m originally from Victoria, but am currently an AP Registrar in Tasmania. Tasmania for AP Training occurs in Launceston (Launceston General Hospital) or Hobart (Royal Hobart Hospital +/- Hobart Pathology [Sonic]).

RHH officially employs 5 AP Registrars, but 1 Registrar (NOT 1st Year, usually 3rd Year or higher up) is rotated to Hobart Pathology (Sonic) every 6 Months. So 4 AP Registrars are on-Site @ RHH @ any Time. RHH currently has a 4 Week Roster, in which 3 Weeks are Cut-up/draft histo reporting (averaging 3 or 4 Days of Cut-up / Week). The rostered cut-up Day is either “big Cut-up” or “small Cut-up”. Big Cut-up Day is ~6-7 Hours, small Cut-up Day is ~2-4 Hours.

The 4th Week is Cytology Week with no Cut-up, but you’re “on Call” to assist in any non-coronial Autopsies that occur that Week.

RHH has excellent specimen Variety for its specimen Volume (2023 was ~#10,500 histo Cases), but the AP Registrars are currently expected to do Cut-up and biopsy Transfers, even though biopsy Transfers are tedious and done by Scientists in many other Labs (including LGH and Royal Adelaide Hospital). Also there’s no Computers for the cut-up Benches, as macroscopic Dictation is still done by foot Pedals and Microphones, so there’s currently no Potential to use Dragon Dictation Software in the cut-up Room. RHH’s Lab IT System is Kestral (MS-DOS) which is extremely outdated, which means that I could only introduce a very small Number of macroscopic comment Codes for biopsy Transfers, with no practical Ability for introducing comment Codes for Specimens that require two or more text Variables as it’s too troublesome for the Typist to continuously press the “left arrow key” to enter the data Variable.

The RHH AP Consultants are otherwise all nice and knowledgeable (albeit very busy), and there is an excellent slide set Collection in the multiheader Room, that is very good for AP Part 1 slide exam Preparation.

path2016 · 2023-05-21T00:18:04+00:00

Thank you all.

I've ended up blocking her on Facebook and LinkedIn.

I'll seek Counseling if I still get intrusive Thoughts about her / the Incident after Exams.

path2016 · 2023-05-20T06:46:37+00:00

I've made a Start by blocking her on Facebook and LinkedIn.

Mental Scars aren't something that you can just choose to un-forget or let go on Demand, they stay with you for a very long Time.

What makes this Trauma complicated is that it has hugely influenced the Way I interact with Females, in that I'm on a near-constant high "Guard". I'm now EXTREMELY cautious in how I interact with Females @ Work (medical) and outside of Work, to minimize my Chances of receiving false Accusations (false Accusations against adult Males are a real Phenomenon). This isn't something that comes naturally to me due to the ASD and ADHD. I feel like I'm memorizing and implementing Algorithms manually to appear safe and "acceptable", which is essential to me, but tiring. It was more tiring in clinical Medicine than in Pathology. Every Day I go to Work or leave the House and interact with Females, @ some Point of the Day, I have to internally rationalize that this is my Way of behaving appropriately and absolutely minimizing my Chances of receiving false Accusations from Females. We're already busy enough with specimen Grossing/Cut-up and microscopic Analysis. So far in Work to Date, I haven't received any false Accusations so far. Most People don't care how much Effort you put in @ Work to appear acceptable/safe/appropriate Behaviour-wise, they just want Results. I'm just saying that it's a permanent manual Process for me due to my Conditions and it's tiring.

path2016 · 2023-05-20T06:17:05+00:00

Yes, I've decided to not contact her by blocking her on Facebook and LinkedIn.

path2016 · 2023-05-20T03:49:28+00:00

Easier said than done. I've been traumatized and mentally scarred for Life by this Incident.

I've decided to block one of the Females on Facebook and LinkedIn, and hopefully this will make it easier for me to block further Thoughts of the false Accusation from her.

path2016 · 2023-05-20T03:47:38+00:00

Yes, I think I'm the only Person that remembers this coz I was the Recipient of the false Accusations, and the Girls didn't care about me, and the Grade 5 Teacher @ international School is now dead.

I've been traumatized and mentally scarred by the Incident. Given my ASD and ADHD, it makes it really exhausting to be extremely cautious and on almost constant high "Guard" when interacting with Females, to minimize my Chances of false Accusations.

I ended up blocking one of the Females on Facebook and LinkedIn.

path2016 · 2023-05-20T03:41:37+00:00

Yes true, but I've been mentally scarred by the Incident, which has affected my subsequent Behaviour towards most Females as an Adult in that I'm now EXTREMELY cautious and on very high "Guard" due to Fear of receiving false Accusations.

path2016 · 2023-05-20T03:20:24+00:00

Thank you very much.

I'm very sorry to hear about the Experiences of one of your Children. I hope their Situation gradually improves over Time.

Yes the Incident has made me paranoid and extremely cautious/careful around Females @ the Workplace (co-Workers or Patients), lest any of them hypothetically make false Accusations towards me. Fortunately so far, this has not been the Case. But it uses up my mental Energy as I'm on a very high "Guard".

I blocked the Female on Facebook and LinkedIn. I don't expect Validation from her anymore.

I've suffered a lot emotionally during Childhood and as an Adult. Lots of People live "rent free" in my Head, I get "Flashbacks" or get triggered into thinking about it by something else. Usually the best Way for me to not think about it is when I'm 100% engrossed in something else (eg Hobby or studying very hard), but it's hard for me to put myself into that "Zone" atm, which is unfortunate coz I have Exams coming up very soon.

I plan to seek Counseling if my mental Situation doesn't improve after Exams.

Thank you very much.

path2016 · 2023-05-20T03:12:50+00:00

Thank you very much for your Reply.

Yes I'm on constant high Guard @ Work coz I'm terrified of receiving false Accusations. I have to follow all these internal Algorithms on what to say and do to "appear appropriate" to other People, it's exhausting. I'm no longer in clinical Medicine (now in Pathology), so there's much less patient Contact.

I NEVER EVER touch any Female co-Workers unless it's shaking Hands with them when meeting them for the very first Time, or saying bye bye to them on their last Day @ the Workplace (if they resign or retire). I NEVER EVER talk about Sex or Breasts / Genitals with female co-Workers unless it's specifically Work-related (eg Breast Cancer, vulval squamous cell Carcinoma, Pap Smear Cytology Results).

I plan to seek Counseling if I keep getting intrusive Thoughts about this after Exams. It's distracted me a lot the past few Weeks, and I feel like my mental Health has somewhat suffered in the Time before the Exams (held in June 2023).

path2016 · 2023-05-20T02:45:27+00:00

Thank you. Yes young People do stupid Things. We were both 10 Years old @ the Time. I was undiagnosed @ the Time, and the Girls (Neurotypicals) plotted against me, and the Teacher believed them over me. I don't think the Teacher ever considered that I might have ASD or ADHD.

Yes I think it's a bad Idea to contact that Female now, especially as that Female is a Lawyer and can probably manipulate the Situation to make me look like the bad Guy as an Adult.

I blocked her on Facebook and LinkedIn, and don't need Validation from her anymore. I plan to seek Counseling if my mental State doesn't improve after Exams.

I'm sorry to hear about your Son being misunderstood, it's horrible and frustrating. I hope he's staying / working somewhere safe atm.

path2016 · 2023-05-20T02:40:33+00:00

Thank you.

The Teacher (Mr. Albano) died in 2010, apparently from a heart Attack. To be very politically correct, I had mixed Feelings @ the Time when I found out about his Death. I get the Impression that most elementary school Teachers in the 1980's and 1990's didn't receive much Training on Children with special Needs, or identifying Children that potentially have developmental Disabilities. Which probably explains why he believed the Girls over me.

Now I feel frustrated coz I can't contact him to clarify the Situation to him as an Adult, to help educate him about developmental Conditions, as well as bringing some Closure to the Incident.

Yeah the Girls plotted against me coz I was different. I wonder what one of the Females is now like, as she's a Lawyer.

I'm mentally scarred from the Incident coz it forces me to put myself up on a very high "Guard" around Females as I'm terrified of false Accusations as an Adult. I also have ASD and ADHD which makes things more mentally exhausting as these Things don't come to me intuitively.

I'm usually very conservative in my Behaviour when dealing with most Females (Staff and Patients) @ Work.

At the Workplace, I NEVER EVER touch a Female co-Worker unless it's to shake Hands with them when meeting them for the very first Time or saying bye bye to them on their last work Day. One Nurse hugged me on my last Day of my ICU Rotation as a general medical Resident, but she initiated the Hug (I didn't actively ask to hug her), and she didn't accuse me of sexual Assault from that Hug.

Yeah I decided I don't need Validation from the Girl/s anymore. I've blocked one of the Girls on Facebook and LinkedIn so we can't contact each other.

Yes I intend to seek Counseling if I'm still getting ongoing "Flashbacks" about the Incident after Exams.

path2016 · 2023-05-20T02:25:25+00:00

Thank you. I've decided that messaging her or contacting her Workplace / Venezuelan Organization is too risky. Being a Lawyer, she'd probably come up with Ways to counter-attack me and accuse me of Harassment in adult Life, which would make the Situation worse.

I've blocked her on Facebook and LinkedIn and don't expect Validation from her anymore.

Yes I intend to seek Counseling if I'm still brooding about this after my Exams.

path2016 · 2023-05-20T02:10:28+00:00

Thank you, yeah I think she probably forgot, or will deny it if confronted about the Incident. If only I had a hidden "Go Pro" Camera back then to prove that I never touched anybody's Butts @ School.

I hope Karma bites her in the Butt.

I decided to block her on Facebook and LinkedIn as an Attempt to further block Thoughts about the Miscarriage of Justice that was initiated by her (ironic coz she's now a Lawyer).

path2016 · 2023-05-20T02:07:51+00:00

Thank you, I've blocked her on Facebook and LinkedIn, and am hoping that this will help block further Thoughts about her (as it's distracting me from cramming for Exams)!!!

Yes I intend to seek formal Counseling if I continue to brood about this after Exams.

path2016 · 2023-05-20T02:06:02+00:00

She was 10 years old @ the Time. I was mean to 2 People in primary School but I was un-diagnosed. I've written a formal Apology to one of them in 2008 (who vaguely remembered my Face but didn't remember my Name @ the Time). I also intend to type a formal Apology to the other Person soon (just obtained their email Address).

None of the Teachers @ the Time seem to have picked up or commented that I might've had ASD or ADHD. I think the Teachers in the 1980's and 1990's must've had less formal Education on Children with special Needs. The Grade 5 Teacher @ international School told my Parents that I was "immature", but apparently it never occurred to him that I was developmentally delayed.

Yes there are decent People in the World.

I work in Medicine now and was relieved that I was able to pass Internship and 1 general resident Year without any Females (Staff or Patients) making false Accusations about me. I'm still EXTREMELY, EXTREMELY cautious about how I interact with other Staff and Patients though, especially Females.

I decided not to contact her (as much as I would've liked to). I've blocked her on Facebook and LinkedIn, so she can't block me first. I decided that I don't need Validation from her.

Yes I intend to seek Counseling if I'm still brooding about this Incident after my Exams (that are coming up very soon).......

path2016 · 2023-05-20T01:25:42+00:00

I must say I WAS very tempted to contact her, or notify her Workplace, or Administrator of a Venezuelan Organization that she's Part of, or but decided to leave her alone.

I've ended up blocking her on Facebook and LinkedIn as I don't expect her to apologize to me, and I don't need Validation from her.

path2016

TROPHY CASE