Communication with the pathologist before, during, and after surgical procedures is an essential aspect of quality patient care. Standards for the technical handling of specimens and reporting of results have been developed; a few are available online at no cost. The ophthalmologist is responsible for providing relevant details regarding the clinical history when submitting the specimen to the laboratory. This history facilitates clinicopathologic correlation and enables the pathologist to provide the most accurate interpretation of the specimen. The final histologic diagnosis reflects successful collaborative work between clinician and pathologist.
In general, communication can usually be accomplished via the pathology request form and the pathology report. However, if there are any special circumstances, such as suspicion of malignancy or identification of a critical diagnosis, direct and personal communication between the ophthalmologist and the pathologist is essential. Discussion prior to surgery allows these physicians to consider the best way to collect a specimen and submit it to the laboratory. For example, the pathologist may wish to have fresh tissue for immunofluorescent staining and molecular diagnostic studies, glutaraldehyde-fixed tissue for electron microscopy, and formalin-fixed tissue for routine paraffin embedding. If the tissue is simply submitted in formalin, the opportunity to perform certain studies may be lost, resulting in a less definitive diagnosis. Communication between clinician and pathologist is especially important in ophthalmic pathology, in which specimens are often very small and require particularly careful handling. In some cases, careful selection of the surgical facility is necessary to ensure proper specimen handling. See Chapter 3, Table 3-1, for a preoperative checklist addressing the handling of ophthalmic pathology specimens.
Anytime a previous biopsy has been performed at the site of the present pathology, the clinician should request a review of the prior biopsy slides if possible, especially if there is a history of malignancy, so that the pathologist can compare the current and prior morphological features and diagnoses. The surgical plan may be altered substantially if the initial biopsy was thought to represent, for example, a basal cell carcinoma when in fact the disease was sebaceous carcinoma. In addition, when the case is reviewed in advance, the pathologist is able to interpret intraoperative frozen sections more accurately.
If there is a significant discrepancy between the clinical diagnosis and the histologic diagnosis, the ophthalmologist should promptly contact the pathologist directly to resolve the discrepancy. For example, merely correcting the patient age on the pathology request form may change the interpretation of melanocytic lesions of the conjunctiva from benign to malignant, or vice versa.
Table 2-1 Fixatives Used in Ophthalmic Pathology
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.