Established in 2013, the Macroscopic Cut-up Manual is an online information resource for pathologists, registrars and non-pathologist staff, to support macroscopic dissection in Anatomical Pathology laboratories. Put together by RCPA Fellows, Dr Simon King and Margaret Dimech with the support of the Project Steering Committee, and many contributors from the RCPA including Expert Groups of the Structured Reporting of Cancer Project, the manual has reached all corners of the globe, supporting laboratories as far afield as the UK, America, Africa and Europe.

“In Anatomical Pathology, we cut up specimens into smaller sections so that we can examine them on slides under a microscope. The cut-up manual is a guide on how to cut them up. It outlines the process of evaluating a specimen and processing it so that we can guarantee the best outcomes for patients. This process is important because what sections we take from a specimen will get examined and will make a difference to how a patient is staged and ultimately managed by the treating clinician. By standardising this approach, patients get the same expertise and specimen cut up, no matter where they live in Australia.

“When we first started this project, there was nothing out there which would show how things should be cut up in a standardised way. There were a few books that had been written but there was nothing else in the world that was interactive. We designed a website which was based on references from current literature and is very user friendly for people on the bench. Not only did we standardise the process, we made it accessible for everyone in a digestible format,” said Dr King.

The manual includes protocols for the range of specimens processed in diagnostic pathology laboratories, along with detailed illustrations, a number of instructive videos and general laboratory information. Dictation templates are also included in every specimen protocol.

“When it was first published, the manual got a lot of hits – about 18k a month – we were quite surprised! Because it is free, we noticed people from all over the world were using it. A breast in Australia is the same as a breast in the UK, in Africa, in America. The surgery is similar and so it is still applicable wherever you live,” said Dr King.

Dr Thanolo Kashamba is a consultant Anatomical Pathologist and Cytopathologist at Sir Ketumile Masire Teaching Hospital (SKMTH) in Botswana. Prior to SKMTH, Dr Kashamba worked at the National Health Laboratory of Botswana where he says he used the cut - up manual heavily. The manual proved to be so useful that Dr Kashamba is looking at ways to utilise the manual in his new role at SKMTH.

“Overall, it is a fantastic manual. It is digital and easy to navigate. Moreover, instructions are systematic and easy to follow. Additionally, it assists the novice in concisely and accurately describing the different specimens i.e., size, colour, consistency, etc. There are accompanying annotated diagrams that enhance understanding and provide clarity where words may lead to ambiguity. The videos are hugely invaluable. Furthermore, the videos help where there may be a language barrier. The key to blocks is also useful as it ensures uniformity within the laboratory. On the whole, the provision of evidence – based references allows one to read further to understand the rationale for the particular method of cut - up.

“We've photocopied and laminated instructions for the cut-up of common and complex specimens in our setting i.e., hysterectomy for cancer, cervical loop electrosurgical excision procedure (LEEP), total mastectomy, breast - wide local excision (WLE), and placenta. These copies have been mounted on the wall by the cut - up stations for easy viewing for the residents / registrars and pathologists. I've also utilised the videos to train laboratory technicians and scientists on how to cut up simple specimens in order to empower them and reduce the workload on the residents / pathologists. There is nothing else like it in the world,” said Dr Kashamba.

With the need for anatomical pathology increasing due to the high incidence of cancer and other target diseases, and the growing focus on standardisation of practices across different laboratories throughout Australia and the rest of the world, Dr King believes that the popularity of the manual will continue to increase with the growth in anatomical pathology.