J. Greenlee

What is histology???

So, you just had a biopsy done, do you know what happens next???

Inevitably at some point throughout our lives we will know someone, whether a friend, family member, or ourselves, who will have a biopsy performed. The diagnosis from that biopsy has the potential to be life-altering, whether it is cancer or some other disease. Despite this, most people have absolutely no idea what happens to that biopsy between the time it was removed from their body and receiving the final diagnosis. People know that it gets sent off to the “lab,” of course, but for the average person, that is about all they know.

For people who have worked in histology, we know this is true based on the reaction we get any time someone asks the question, “What do you do for a living?” This is how that situation usually plays out.

       Them: “Hey, so what do you do for a living?”
       Us: “Oh, I work in histology?”
       Them: blank, confused stare <crickets chirping>

Then, after reading the face of the person as we explain how we process and cut up body parts and pieces of tissue all day, we often feel compelled to clarify that it is, in fact, a real job and we aren’t masquerading as some Dexter-like serial killer.

The lack of knowledge about histology is quite unfortunate, so in this blog article I would like to shed just a bit of light on what histology is, the histology process, who performs the work, and finally how we can bring more awareness to this extremely important laboratory science.

In the simplest terms, histology is the study of the microscopic structure of tissues. This branch of science allows us to understand the intricacies of life at a cellular level, providing insights into the composition, function, and disease state of tissues.

Histology plays a crucial role in our healthcare system when it comes to diagnostics. A histological examination can identify diseases like cancer at a cellular level, in some cases, long before they may be detected otherwise. This early detection allows for timely treatment, improving patient prognosis significantly. In essence, histology equips doctors with valuable information that directly influences treatment plans and patient care. It is estimated that roughly 2 million people will be diagnosed with cancer in the United States this year, and histology will play a role in almost all those cases. Outside of cancer, there are many other pathologies diagnosed through tissue biopsies as well. Histology also plays a crucial role in research when it comes to the development of new therapies to treat diseases.

Humans are not the only ones benefiting from the work done in histology either. We can’t forget about all our animal friends. Millions of biopsies are done each year for the diagnosis of disease in our pets and other animals.

Unlike many other forms of laboratory testing that involve putting specimens like blood or urine on an analyzer and having that laboratory equipment provide a result, the histology process is an elaborate journey that involves several steps and many transformations of the specimen before it gets to the pathologist. The process begins with the receipt of a tissue sample in the laboratory. The tissue then embarks on a precise series of processes: fixation to preserve the tissue, grossing to describe and prepare the tissue for processing, processing to remove water and infiltrate the tissue, embedding in paraffin typically to provide structure, microtomy to create ultra-thin sections, and finally, staining to highlight different cellular components. Throughout this process, the tissue goes from the state at which it was removed from the body to a cassette, then a block, then finally a stained slide before it can be diagnosed by a pathologist.

All this work isn’t done by magic elves in a hollowed-out tree somewhere like Keebler cookies either. The work is done in histology laboratories by histotechnicians and histotechnologists. Histologists are skilled professionals who prepare these tissue samples for examination under a microscope. Their work requires a meticulous eye for detail, combined with precision, dexterity, and care.

Histologists, therefore, are not just laboratory workers; they are indispensable members of the healthcare team. Their meticulous work behind the scenes paves the way for accurate diagnoses and effective treatment strategies. In short, they significantly impact patients' lives and overall health outcomes.

Yet, despite the vital role they play, there is a growing concern: a shortage of qualified histologists. The field is experiencing a high demand for these professionals, and to put it very plainly, there are simply not enough people coming into the field right now to fill this need.

Why is this happening? One cause is that histology continues to experience high rates of retirement of experienced staff. Others are leaving the field for a variety of reasons like progressing in their careers or, in some negative cases, because they are simply getting burnt out because of staffing shortages. There is also not enough people coming into the field. There are currently only 37 NACCLS accredited HT programs in the United States educating new histologists. There isn’t even a program in each state. In fact, because some states have multiple programs (looking at you California and Texas) it means that barely half of the states in the country have an accredited program teaching histology.

Another reason, as I explained earlier, is that most average folks don’t even know that histology exists. Histology could desperately use a marketing and PR team. Even as I create this blog the words “histotechnician” and “histology” have triggered my spelling and grammar check software multiple times. Yes, I am sure I meant “histology” and not “historians,” but thank you for checking.

 While visiting and working with laboratories around the country, I often find myself asking the staff working at the front information desks or even nurses in some cases if they can direct me to the histology or pathology laboratory. After a few moments of giving me the blank, confused stare I described earlier, “I don’t know where that is” or “I don’t know what that is” is often what I hear, and this is coming from people who work in the same building.

If even the people working in the same facility are not aware about histology, how do we reach the average person on the street? One way is to raise awareness about histotechnology as a profession, emphasizing its importance in healthcare and its potential to significantly impact patient care. Educators and professionals should promote it as a rewarding and respected career choice within the scientific and medical community.

Histotechnology is a rewarding career field, and, compared to some occupations, the requirements to get started are not that grueling. Recruitment really needs to begin at the high school level. Several years ago, I had the opportunity to present a talk about histology to a packed room full of high school students at an event put on by HOSA – Future Health Professionals (hosa.org). HOSA was formed in 1976 and was formally known as Health Occupations Students of America and is a global student-led organization that is recognized by the U.S. Department of Education as well as the Department of Health and Human Services. They actively promote career opportunities in the healthcare industry.

When I say that the room was packed, there was standing room only and students were even sitting on the floor. As much as I would like to say it was because of my riveting presentation style, the reality was they were simply interested in the subject, and based on the questions several students asked, many had no idea a career in histotechnology was even an option. Laboratory people are not the most extroverted group on the planet, but as a community, the more we can get ourselves out there so the younger generation is aware of their options, the better the future of the profession will be.

Secondly, we must make education and training in histotechnology more accessible. Institutions should strive to provide comprehensive, hands-on training programs that prepare students for the rigors of the profession. There have been strides made in this area. Some of the NAACLS accredited programs have begun offering distance learning options with local externship coordination. Now students who may not have a local program have options. Indiana University (iu.edu) and the University of North Dakota (med.und.edu) are a couple of examples of programs offering these opportunities.

Supporting local accredited programs is, of course, also important. There are many ways to lend support. Histology programs are often in need of laboratories willing to participate as externship sites. Those expired reagents or older pieces of equipment that may be a waste to working laboratories are extremely valuable to histology programs. Donate them. If you feel like you have experience and knowledge to offer, investigate getting involved as adjunct faculty.

We should not neglect these programs, and our employers should not either. A student today could be a local laboratory’s next super tech. Hospitals and medical facilities can help by possibly offering scholarships for local programs to encourage students to choose this path. A medical center contributing a small investment via a scholarship for a local histology program can ensure they maintain a steady stream of potential new, qualified employees for the future.

Some major hospitals and laboratories have also started their own training programs. Some of these programs have been formed out of sheer desperation to develop staff. There is a risk that the time and exposure these individuals get for training can be limited, and in some cases the training is simply conducted by co-workers in the laboratory rather than trained educators. Despite potential drawbacks, though, these programs are a clear step forward, and some have even become NAACLS accredited, which is great. As a community, we need to increase exposure to these programs so that people know that opportunities exist outside of a typical classroom setting.

Supporting local and national histology societies (nsh.org) is also important for the histology community to thrive. Not only are these societies great for continuing education, but they are also amazing networking opportunities. Unfortunately, the support and participation in these societies is on the decline. Many employers no longer provide financial support or time off to attend society conferences. There is an epidemic of burnout in histology, so the last thing some techs want to do is take their own vacation time and money to attend a work event. For any supervisors, lab managers, or administrators who may read this, this is where you come in. Push to include money in the budget and programs in your laboratories to enable your staff to attend society events. The return on investment is worth it, and the alternative can prove costly. Continuing education brings important experience back into the laboratory. Benefits like this also promote retaining good employees, and the network aspect may help fill open positions quicker.

Finally, we should recognize and appreciate the work of histotechnicians more. Their contribution to healthcare is immense, and they deserve recognition for their crucial role. Histotechnology Professionals Day was started in 2010 and is celebrated every March 10th. That was a good start toward recognizing the profession, but there is still work to be done.

That is the world of histology in a nutshell. Whether you're a seasoned histotechnician, an aspiring student, or simply intrigued by the world of histology, remember: each tissue sample has a story to tell, and histotechnicians have the unique privilege of helping to decipher it. Histology is an interesting and rewarding field, and we all can play a part in encouraging others to be a part of it.

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