I recently heard from a student who had come across the professions of cytotechnologist, histotechnologist, and pathologists’ assistant but wasn’t entirely sure how they differ or what each role actually involves. I remember when I was first trying to learn about the pathologists’ assistant career, scrolling through pages and pages of career and job info postings trying to figure out what exactly it was that a pathologists’ assistant did before I signed my life away to grad school.
Cytotechnology, histotechnology, and working in the gross room as a pathologists’ assistant are all essential parts of the pathology lab. However, the day-to-day responsibilities, training requirements, and work environments differ considerably. Understanding how these roles fit together can help you choose the career that best aligns with your skills and interests.
Cytotechnologists
Cytotechnologists specialize in the microscopic evaluation of cells. They prepare cytology samples and screen tests like Pap smears, body fluids, and fine needle aspirates under a microscope to spot abnormalities and to screen for specimen adequacy (e.g. to make sure a diagnostic specimen has been collected and to make sure the collection procedure does not need to be repeated).
This can help to minimize the likelihood of an inadequate biopsy and avoids the necessity of repeat biopsy procedures. This can also potentially avoid more invasive diagnostic procedures and delays in diagnosis. They may also perform some triage work for ancillary studies. This requires strong pattern recognition and an eye for subtle cellular changes.
After screening, these cytology samples are forwarded to a cytopathologist for diagnosis.
Cytotechs are not responsible for making a diagnosis and training takes approximately 4-6 years, which includes:
- A bachelor’s degree in a science-related field
- 1-2 year cytology program
A diagnosis made from the cells in this type of sample can provide information like whether something is or isn’t cancer, but other components of a diagnosis, like the stage of the cancer or the extent of tumor involvement, cannot be done on these samples alone. When this type of information is required, like after a person goes in for cancer surgery, this is where the pathologists’ assistant and the histotech come in.
A specimen prepared by a cytotech would end up looking like what you see below. This shows several cells without any surrounding tissue architecture. Sometimes, even seeing just a few malignant cells is enough to diagnose something as cancer. But type of sample cannot show how big the tumor is or what else it might be invading into (eg blood vessels, nerves, lymphatics, or even other adjacent tissue). This is what is meant in saying there is no surrounding tissue architecture.
Nephron, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Small_cell_lung_cancer_-_cytology.jpg
Histotechnologists
Histotechnologists are experts in tissue processing and staining. They handle surgical specimens after dissection by PAs which includes embedding tissues in paraffin, cutting thin sections, mounting those sections on slides, and applying stains (including immunohistochemistry) which allow a pathologist to view tissue under a microscope.
The surgical specimens they work on are what pathologists’ assistants generated the day before during grossing. They take tissue sections and turn them into slides that a pathologist can look at.
Histotechs are not responsible for making a diagnosis and their requirements/training takes approximately two years, which includes:
- High school-level courses in math, English, chemistry, and biology
- A two-year Medical Laboratory Technology diploma program
A specimen prepared by a histotech would look like this on a slide, reflecting cells from a biopsy with surrounding tissue architecture. In this type of preparation, under a microscope a pathologist can see individual cells, but they can also see how those cells relate to other adjacent cells and whether or not the tumor is invading into blood vessels, lymphatics, or adjacent tissue. A pathologist can also measure the size of the tumor on their slides which often makes a difference for tumor staging.
Bronchioloalveolar Cell Adenocarcinoma of the Lung by Ed Uthman, via Flickr https://www.flickr.com/photos/euthman/4669552489), licensed under CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/)
Pathologists’ Assistants (PAs)
Pathologists’ assistants (PAs) focus on grossing (grossing = macroscopic examination of a sample or looking with your eyes). They dissect and describe surgical specimens, everything from small biopsies to large resections, and assist with autopsies. We handle the tissue before it ever gets to the slide.
There is more day to day variety involved in this role compared to a histotech. Working on biopsies is relatively simple (although still diagnostically important for patients!) but larger cancer specimens or complex multi-organ resections require a strong understanding of anatomy, cancer staging protocols, disease appearance and progression, dissection procedures and can also involve consultation with surgeons or pathologists. Most of the day is spent standing (although it is possible to sit).
A pathologist’s assistant is not responsible for making a diagnosis, although the information they provide during grossing is often used in the final diagnosis of cases. Their job requirements/training takes approximately six years, which includes:
- A bachelor’s degree in a science-related field
- A two-year master’s program from a NAACLS-accredited training institution
A surgical specimen received and prepared by a PA would look something like this (below is a cut of a piece of lung). A portion of this lung (indicated by the red rectangle) would be placed into a cassette to be further processed by a histotech before finally being passed on to a pathologist.
“Honeycomb lung” by Pulmonary Pathology Society, via Flickr https://www.flickr.com/photos/pulmonary_pathology/4840519803/), licensed under CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/). Modified.
This is what a cassette looks like that a piece of tissue would be placed into after grossing. Something simple like a biopsy would only use one of these cassettes, but a larger surgical specimen, like a piece of lung, similar to what we saw above, could take 10 to 20 or more of these cassettes to show the pathologist everything they need to see to make a complete diagnosis.
Which is right for you?
If you’re fascinated by anatomy, specimen dissection, and hands-on lab work, the PA profession might be a great fit. Alternatively, if you love microscopy, pattern recognition, and cellular detail, you might lean more toward cytotechnology or histotechnology.
To learn more about what a pathologists’ assistant does, check out my YouTube channel or browse the Articles section – I cover everything from training pathways to what a day in the life of a PA looks like in Canada.