Evaluation - Revision history

Mikael Häggström: /* Marking slides */ Intro

2026-01-28T18:37:37Z

Marking slides: Intro

← Older revision		Revision as of 14:37, 28 January 2026
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	==Marking slides==		==Marking slides==
			The main indications for marking slides are hard-to-see findings on a slide, and/or to distinguish one slide out of many. Just make a figure rather than a word if you are not sure what it is, as it might be confusing for reviewers if the pathology report ends up being something different.
	<gallery mode=packed heights=140>		<gallery mode=packed heights=140>
	File:Photograph of marking a microscopy slide.jpg\|To mark a microscopy slide, use an objective that gives you enough space underneath. Rest a finger on the stage, while holding the marker pen relatively close to its tip. Move the tip of the marker pen into the field of view but at least a few millimeters from the slide...		File:Photograph of marking a microscopy slide.jpg\|To mark a microscopy slide, use an objective that gives you enough space underneath. Rest a finger on the stage, while holding the marker pen relatively close to its tip. Move the tip of the marker pen into the field of view but at least a few millimeters from the slide...

Mikael Häggström: /* Microscopy settings */ Expanded

2025-06-03T20:48:09Z

Microscopy settings: Expanded

← Older revision		Revision as of 16:48, 3 June 2025
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	==Microscopy settings==		==Microscopy settings==
	[[File:Parts of a light microscope (english) - larger text.png\|thumb\|300px\|Usual parts of a microscope.]]		[[File:Parts of a light microscope (english) - larger text.png\|thumb\|300px\|Usual parts of a microscope.]]
			If only one eye piece has adjustable '''focus''', you generally raise or lower the stage until you are in focus on the non-adjustable eyepiece, and then adjust the other eyepiece. {{Memorization-worthy}} With objectives that are close to the microscope slide, start focusing from what you know is a lower stage level, and slowly raise it from there, to avoid colliding with the objective and potentially damaging the slide.

			<noinclude>Low magnification has a greater span of focus compared to high magnification, so it is normal to need to re-focus if you're switching to a higher magnification objective. However, if you find that you need to '''change focus''' even if going from high to low magnification, try the following (if you can adjust the eye piece):
			#Use high magnification and focus on a specimen using the main focus knob.
			#Switch to low magnification, and focus using the eye piece adjustment.</noinclude>
			===Condenser===
	Generally the '''condenser''' is placed in its highest position or just slightly lower. At low magnification objectives (mainly 4x and 10x objectives), the opening of the condenser (or iris) diaphragm should be wide open. This corresponds to turning away or "lowering" the condenser on microscopes where the condenser apparatus can be turned to the side (and is shown as "without condenser" in images below). For high-dry (40x) and oil-immersion objectives (100x), the diaphragm should be closed slowly while looking at a sharply focused section until the level of illumination is just slightly reduced, in order to attain optimal contrast and resolution (and corresponds to "with condenser" in images below).<ref>{{cite web\|url=https://histologylab.ctl.columbia.edu/HistologyLabManual.pdf\|title=Histology Laboratory Manual, Vagelos College of Physicians & Surgeons Columbia University\|author=Patrice F Spitalnik\|accessdate=2021-09-20}}</ref>		Generally the '''condenser''' is placed in its highest position or just slightly lower. At low magnification objectives (mainly 4x and 10x objectives), the opening of the condenser (or iris) diaphragm should be wide open. This corresponds to turning away or "lowering" the condenser on microscopes where the condenser apparatus can be turned to the side (and is shown as "without condenser" in images below). For high-dry (40x) and oil-immersion objectives (100x), the diaphragm should be closed slowly while looking at a sharply focused section until the level of illumination is just slightly reduced, in order to attain optimal contrast and resolution (and corresponds to "with condenser" in images below).<ref>{{cite web\|url=https://histologylab.ctl.columbia.edu/HistologyLabManual.pdf\|title=Histology Laboratory Manual, Vagelos College of Physicians & Surgeons Columbia University\|author=Patrice F Spitalnik\|accessdate=2021-09-20}}</ref>
	<gallery mode=packed heights=200>		<gallery mode=packed heights=200>
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	</gallery>		</gallery>

	Low magnification has a greater span of focus compared to high magnification, so it is normal to need to focus if you're increasing magnification.<noinclude> However, if you find that you need to '''change focus''' even if going from high to low magnification, try the following (if you can adjust the eye piece):
	~~#Use high magnification and focus on a specimen using the main focus knob.~~
	~~#Switch to low magnification, and focus using the eye piece adjustment.</noinclude>~~
	If there's a '''constant visual artifact''', even after you've cleaned the eye piece and objective lenses with lens tissue, try raising or lowering the condenser if you can, and the artifact may disappear out of focus.		If there's a '''constant visual artifact''', even after you've cleaned the eye piece and objective lenses with lens tissue, try raising or lowering the condenser if you can, and the artifact may disappear out of focus.
			</noinclude>

	==Priority==		==Priority==

Mikael Häggström: /* Main steps */ .

2025-06-03T20:35:32Z

Main steps: .

← Older revision		Revision as of 16:35, 3 June 2025
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	*Try to pick up glass slides '''without touching''' the tissue area, as fingerprints may interfere with the evaluation.		*Try to pick up glass slides '''without touching''' the tissue area, as fingerprints may interfere with the evaluation.
	*Look at each microscopy slide by plain '''eye''', to plan the microscopy scanning so as to not miss peripheral fragments.		*Look at each microscopy slide by plain '''eye''', to plan the microscopy scanning so as to not miss peripheral fragments.
	*Have a '''systematic direction''' of scanning through microscopy slides, such as from top left to bottom right as seen in the microscope. When the microscope makes what you see two-way mirrored, the starting position is with the objective pointing at the bottom right of the glass slide. You may center on findings on interest and evaluate them at higher magnification, and then resume the scanning		*Have a '''systematic direction''' of scanning through microscopy slides, such as from top left to bottom right as seen in the microscope. When the microscope makes what you see two-way mirrored, the starting position is with the objective pointing at the bottom right of the glass slide. You may center on findings on interest and evaluate them at higher magnification, and then resume the scanning.
	<gallery mode=packed heights=140px>		<gallery mode=packed heights=140px>
	File:Position of objective (edited).jpg\|Example starting position of objective.		File:Position of objective (edited).jpg\|Example starting position of objective.

Mikael Häggström: /* Consideration */ Adequacy

2024-04-23T03:43:33Z

Consideration: Adequacy

← Older revision		Revision as of 23:43, 22 April 2024
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	{{further\|Cytology}}</noinclude>		{{further\|Cytology}}</noinclude>
	==Consideration==		==Consideration==
			Consider the '''adequacy''' of the specimen. Have a somewhat lower threshold to make a report of "inadequate" or "insufficient" if it is easy to resample from the patient, such as remaining diagnostic tissue at a superficial location.

	First, generally suspect the '''common conditions''' for the location at hand. A less common variant of a common condition is often still more likely than a rare condition, so generally call the latter only if it really fits the picture.		First, generally suspect the '''common conditions''' for the location at hand. A less common variant of a common condition is often still more likely than a rare condition, so generally call the latter only if it really fits the picture.

Mikael Häggström: /* Other patterns */ -Hence

2024-04-12T01:06:53Z

Other patterns: -Hence

← Older revision		Revision as of 21:06, 11 April 2024
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	File:Histology of deep zone of articular cartilage.jpg\|'''Hyaline''' usually refers to extracellular material that stains homogeneously pink on H&E stain (like the matrix of hyaline cartilage, pictured).		File:Histology of deep zone of articular cartilage.jpg\|'''Hyaline''' usually refers to extracellular material that stains homogeneously pink on H&E stain (like the matrix of hyaline cartilage, pictured).
	File:Histopathology of hyaline membranes in diffuse alveolar damage.jpg\|Example of hyaline material (in alveoli of lungs, indicating diffuse alveolar damage)		File:Histopathology of hyaline membranes in diffuse alveolar damage.jpg\|Example of hyaline material (in alveoli of lungs, indicating diffuse alveolar damage)
	File:Glass for pathologist.png\|~~Hence, this~~ is what pathologists also refer to as "glassy" (because hyaline cartilage looks like glass grossly).		File:Glass for pathologist.png\|This is what pathologists also refer to as "glassy" (because hyaline cartilage looks like glass grossly).
	</gallery>		</gallery>

Mikael Häggström: /* Other patterns */ Glassy

2024-04-11T22:18:01Z

Other patterns: Glassy

← Older revision		Revision as of 18:18, 11 April 2024
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	File:Histology of deep zone of articular cartilage.jpg\|'''Hyaline''' usually refers to extracellular material that stains homogeneously pink on H&E stain (like the matrix of hyaline cartilage, pictured).		File:Histology of deep zone of articular cartilage.jpg\|'''Hyaline''' usually refers to extracellular material that stains homogeneously pink on H&E stain (like the matrix of hyaline cartilage, pictured).
	File:Histopathology of hyaline membranes in diffuse alveolar damage.jpg\|Example of hyaline material (in alveoli of lungs, indicating diffuse alveolar damage)		File:Histopathology of hyaline membranes in diffuse alveolar damage.jpg\|Example of hyaline material (in alveoli of lungs, indicating diffuse alveolar damage)
			File:Glass for pathologist.png\|Hence, this is what pathologists also refer to as "glassy" (because hyaline cartilage looks like glass grossly).
	</gallery>		</gallery>

Mikael Häggström: /* Consideration */ better or worse

2024-01-03T17:44:51Z

Consideration: better or worse

← Older revision		Revision as of 13:44, 3 January 2024
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	==Consideration==		==Consideration==
	First, generally suspect the '''common conditions''' for the location at hand. A less common variant of a common condition is often still more likely than a rare condition, so generally call the latter only if it really fits the picture.		First, generally suspect the '''common conditions''' for the location at hand. A less common variant of a common condition is often still more likely than a rare condition, so generally call the latter only if it really fits the picture.

			Whenever you consider a certain diagnosis, also consider whether it is one step '''better or worse'''. For example, when you consider a non-invasive but high-grade dysplasia, also consider both low-grade dysplasia and invasiveness.
	</noinclude>		</noinclude>
	{{General notes}}		{{General notes}}
	{{Bottom}}		{{Bottom}}
	</noinclude>		</noinclude>

Mikael Häggström: /* Main steps */ Not exact

2023-11-21T01:10:04Z

Main steps: Not exact

← Older revision		Revision as of 21:10, 20 November 2023
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	File:Screening method 1.jpg\|Starting at top left in the view, aim to scan a strip that trajects a circular field of view approximately at the clock positions shown...		File:Screening method 1.jpg\|Starting at top left in the view, aim to scan a strip that trajects a circular field of view approximately at the clock positions shown...
	File:Screening method 2.jpg\|...When reaching the end of relevant material, set your eyes on any object at the edge of the strip that you just scanned...		File:Screening method 2.jpg\|...When reaching the end of relevant material, set your eyes on any object at the edge of the strip that you just scanned...
	File:Screening method 3.jpg\|...Move the field of view over so that the object is seen on the opposite side. The new strip to be scanned will now be juxtaposed to the one you previously scanned~~, both making sure you don't miss any area, as well as minimizing redundant scanning~~.		File:Screening method 3.jpg\|...Move the field of view over so that the object is seen on the opposite side. The new strip to be scanned will now be juxtaposed to the one you previously scanned.
	</gallery>		</gallery>
			This scanning technique above makes sure that you don't miss any area, and also minimizes redundant scanning. The width or clock position that you scan in each field of view is not exact, as you may scan up to the entire width in cases where you think relevant findings will clearly present themselves even if only partially showing in the periphery of your view.
	*Look in particular for whatever is '''requested''' or '''suspected''' on the requisition form or equivalent. For each type of condition, initially you will generally focus relatively more on high magnification features with high specificity, but you should still have a habit of looking at '''low magnification''' as well to get an idea of its pattern. In time, you will increasingly correlate diseases and conditions with their overall low magnification patterns - patterns that may require 1000 words to describe and thus cannot conveniently be part of written criteria, but will nevertheless allow you to make quicker and more accurate diagnoses, or at least clues thereof.		*Look in particular for whatever is '''requested''' or '''suspected''' on the requisition form or equivalent. For each type of condition, initially you will generally focus relatively more on high magnification features with high specificity, but you should still have a habit of looking at '''low magnification''' as well to get an idea of its pattern. In time, you will increasingly correlate diseases and conditions with their overall low magnification patterns - patterns that may require 1000 words to describe and thus cannot conveniently be part of written criteria, but will nevertheless allow you to make quicker and more accurate diagnoses, or at least clues thereof.
	*When you find something suspicious, it is helpful at least in the beginning to evaluate them systematically by a '''low-to-high magnification approach''' (example below showing a [[basal-cell carcinoma]]):		*When you find something suspicious, it is helpful at least in the beginning to evaluate them systematically by a '''low-to-high magnification approach''' (example below showing a [[basal-cell carcinoma]]):

Mikael Häggström: /* Priority */ Delegated

2023-03-21T17:54:32Z

Priority: Delegated

← Older revision		Revision as of 13:54, 21 March 2023
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	* There's a significant probability that it will require '''further workup''' such as [[immunohistochemistry]], especially when there is an impending deadline for ordering it.		* There's a significant probability that it will require '''further workup''' such as [[immunohistochemistry]], especially when there is an impending deadline for ordering it.
	* The optimal person to ask for '''advice''' may not be available later. {{Further\|Consultation}}		* The optimal person to ask for '''advice''' may not be available later. {{Further\|Consultation}}
	For a pile of many cases of relatively low risk of a need to prioritize any one over another, such as [[gastrointestinal biopsies]], a very quick glance at the forms and/or a naked eye look at the glass slides is generally ~~acceptable~~.		As part of initial triaging, also determine what tasks can be '''delegated'' to juniors or pathologist assistants.

			For a pile of many cases of relatively low risk of a need to prioritize any one over another, such as [[gastrointestinal biopsies]], a very quick glance at the forms and/or a naked eye look at the glass slides is generally sufficient.

	==Main steps==		==Main steps==

Mikael Häggström: /* Marking slides */ WSI

2023-02-11T04:33:33Z

Marking slides: WSI

← Older revision		Revision as of 00:33, 11 February 2023
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	<gallery mode=packed heights=140>		<gallery mode=packed heights=140>
	File:Photograph of marking a microscopy slide.jpg\|To mark a microscopy slide, use an objective that gives you enough space underneath. Rest a finger on the stage, while holding the marker pen relatively close to its tip. Move the tip of the marker pen into the field of view but at least a few millimeters from the slide...		File:Photograph of marking a microscopy slide.jpg\|To mark a microscopy slide, use an objective that gives you enough space underneath. Rest a finger on the stage, while holding the marker pen relatively close to its tip. Move the tip of the marker pen into the field of view but at least a few millimeters from the slide...
	File:Micrograph of marking a microscopy slide.jpg\|...Then slowly approach the slide while making sure that the tip remains in the location you want to mark. Be careful not to obscure findings of interest with the mark.		File:Micrograph of marking a microscopy slide.jpg\|...Then slowly approach the slide while making sure that the tip remains in the location you want to mark. Be careful not to obscure findings of interest with the mark. If the slide is likely to undergo whole slide imaging, make the mark on the back and not on the coverslip (as it reduces the risk of erroneous focusing of the cameras).
	File:Wiping a slide.png\|You can generally remove marks from a microscopy slide by using alcohol. Hold the cover slip in place with two fingers while wiping from side to side, to avoid the risk of moving the coverslip. Don't press hard against the glass, as it may disrupt the tissue.		File:Wiping a slide.png\|You can generally remove marks from a microscopy slide by using alcohol. Hold the cover slip in place with two fingers while wiping from side to side, to avoid the risk of moving the coverslip. Don't press hard against the glass, as it may disrupt the tissue.
	</gallery>		</gallery>