MSK offers clinical autopsy examinations free of charge to families of anyone who had been under the treatment of our doctors at any time during the course of their lives. A clinical autopsy can determine how effective a treatment was, whether there were any identifiable complications, and the ultimate cause of death. An autopsy can give a more complete picture of the disease than what was afforded by tests performed while the patient was alive.

MSK also has a medical donation program, called the Last Wish Program, which is used for research purposes only. Tissues are collected under a special research protocol, with the consent of the family or the patient. The program allows researchers to analyze tumors that they otherwise would not have been able to access safely while the patient was alive. From these tumors, we can better understand the causes of cancer’s spread and progression. For further information about the Last Wish Program, please call 646-888-3253 or email pthLastWish@mskcc.org.

Both of these options are available to families regardless of whether the patient dies in Memorial Hospital or somewhere else, such as at home or in a hospice facility.

The Clinical Autopsy Service is led by Dilip Giri. The Last Wish Program is led by Rajmohan Murali.

With cytology, diagnosis is made on the basis of dispersed cells rather than samples of tissue. These cells are obtained from fluids (such as urine or sputum) or by using fine needle aspiration or brushing techniques. In the past, cytology was used mostly as a screening tool — Pap smears to detect precancerous lesions of the cervix, for example — but advances in imaging technologies have led to an increase in the number of biopsies that are performed using minimally invasive fine needle aspiration. These biopsies provide cells that can be analyzed for diagnosis and for treatment monitoring.

MSK’s Cytology Service, which focuses on solid tumors, is composed of cytopathologists who are supported by a dedicated staff and state-of-the-art infrastructure, including laboratories for immunohistochemistry, flow cytometry, cytogenetics, and molecular pathology. The service has an active fine needle aspiration practice, in which specially trained cytopathologists employ ultrasound guidance to more accurately direct biopsies. Our cytopathologists also use leading-edge telepathology systems so we can rapidly assess biopsies performed at MSK’s regional sites. In addition, the service has an active fellowship program that’s accredited by the Accreditation Council for Graduate Medical Education; we host three fellows per year.

The Cytology Service is led by Oscar Lin.

Diagnostic molecular pathology focuses on characterizing tumors based on the genetic changes in their cells. This diagnosis forms the basis for targeted therapies, for which tumors are analyzed and matched with appropriate drugs based on the genetic alterations that are driving cancer growth. In some cases, genetic changes can identify people who are candidates for a cancer clinical trial.

Since 2014, pathologists in the Molecular Diagnostics Service have been using MSK-IMPACT to analyze the tumor DNA of essentially all MSK patients with advanced cancer. MSK-IMPACT is based on next-generation sequencing, which means that the most-critical parts of the cancer genome can be profiled very quickly and with great sensitivity. The test allows us to detect hundreds of mutations and other genetic changes in tumors. Being able to use this test as part of a care plan is a noteworthy accomplishment.

Additionally, the laboratory performs dozens of other sophisticated molecular tests on tumor samples, using a wide array of technologies. Separate laboratories perform studies for chromosomal alterations using karyotyping and fluorescence in-situ hybridization (cytogenetics) as well as assessing for hereditary mutations in cancer predisposition genes (diagnostic molecular genetics).

The Diagnostic Pathology Service is led by Marc Ladanyi.

Hematopathology analyzes cancers that originate in the hematolymphoid system. This includes the blood, bone marrow, lymph nodes, and other lymphoid tissues. Everyone diagnosed with a blood cancer at Memorial Sloan Kettering has their samples analyzed by a member of MSK’s expert hematopathology team.

We review about 20,000 samples every year. For each one, we provide a comprehensive diagnostic report that integrates complex information from morphological assessment, immunohistochemistry and flow cytometric analysis, and cytogenetic and molecular genetic studies. Our laboratories are internationally recognized for their innovation in clinical test development. In particular, we are well regarded for our development of assays to detect minimal residual disease and comprehensive proteomic and genomic analysis, for which we work with the Molecular Diagnostics Service.

The Hematopathology Service is led by Ahmet Dogan.

Surgical pathology is one of the major functions of the Pathology Department. Surgical pathologists make their diagnoses by looking at tissue samples under a microscope. Samples from a surgery or biopsy are processed, embedded in paraffin, cut into thin slices, and placed on a glass slide. They are then stained to make the cells visible under magnification.

If a disease is complicated, additional testing may need to be done. For example, immunohistochemistry procedures direct labeled antibodies against particular proteins that are specific to certain tumor types or genetic changes. Defining the spectrum of protein expression allows a more accurate diagnosis and often provides prognostic or therapeutic information as well. Our Surgical Pathology Service can also perform diagnoses using frozen sections if a quicker diagnosis is needed. Findings that can guide a procedure can be immediately shared while a surgeon is still in the operating room.

The Surgical Pathology Service is led by Meera Hameed.

Research in the Experimental Pathology Division is focused on decoding the complex changes that occur in cancer cells. Members of this team investigate the molecular basis for the morphologic features observed when tumor tissue is examined under the microscope.

MSK’s experimental pathologists have pioneered much of the DNA analysis technology that’s used to improve diagnoses and develop personalized treatments. Thanks to this work, we now have extraordinary opportunities to provide insights into what causes cancer to form or progress, and to suggest strategies for blocking it. Another area that this practice has helped immensely is in subtyping rare tumors — a feat that has always been challenging on the basis of histology alone.

The Experimental Pathology Division is led by Jorge Reis-Filho.