Lithuanian Laboratory Implementation Guide, published by Lithuanian Medical Library. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7LT/ig-lt-lab/ and changes regularly. See the Directory of published versions

Pathology Workflow

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Pathology workflow

The pathology pathway begins when a clinician identifies a suspicious lesion during examination or imaging and places an order for histology or cytology. The same step is illustrated with a pathology order example. The request records the anatomical site, the type of procedure, and the clinical question—such as confirming or excluding malignancy.

Next, the tissue is obtained. In the illustrative case, a breast biopsy is performed and material is submitted as separate left and right samples. Each sample is represented in the record as a laboratory specimen: labelled, traceable, and sent to the laboratory under conditions that preserve tissue quality.

When the material arrives, staff perform macroscopic (gross) assessment: inspection, description, and measurement of weight, dimensions, and—when relevant—how many lymph nodes are in the excision. That information is captured as gross specimen measurements, with an example observation. A histology laboratory step may be recorded separately to reflect processing in the lab.

The tissue is then fixed (for example in formalin), embedded in paraffin, and cut into a tissue block suitable for sectioning. A block taken from a parent specimen is modelled as a paraffin tissue block; see the block example. Thin sections are cut and placed on slides.

​Slides are stained—commonly with haematoxylin and eosin (H\&E)—and additional techniques may be used as needed. For breast disease, immunohistochemistry can include oestrogen receptor (ER), progesterone receptor (PR), and HER2 status, which guide treatment decisions.

Under the microscope, the pathologist records how the tumour behaves and is distributed: for example focality, histologic type, and extent. Those findings align with a tumour characterisation observation, as in this example. Tumour size on the slide (largest dimension and further dimensions) is recorded separately as tumour measurements; see the measurement example.

For prostate cancer, the pathological T category, nodal (N) and distant (M) status, and tumour morphology are brought together in a single prostate cancer diagnosis and stage. Other tumour sites use analogous staging approaches outside this illustration.

Finally, findings are assembled into a diagnostic report. The authoritative pathology document brings together clinical context, specimen and procedure information, microscopic results, and the conclusion - then reviewed, authorised, and returned to the referring clinician.