What are Histotechnology and Histology? Interview with an Expert

We need histologists and histotechnicians in laboratories because you can’t take away the human aspect of understanding the sample. . .Creating a good slide is considered almost an art.

Jean Cordova, Medical Technologist and Histotechnologist, Laboratory Manager for Northwest Pathology Services/Pathology Consultants in Springfield, Oregon

While histology is a word that most people don’t know, it’s probably the most hands-on part of a clinic or medical laboratory job. Histology is the study of human and animal tissue. A histotechnician or histotechnologist (there is a distinction related to level of education) handles and prepares tissue samples for observation under a microscope.

Microscopic observation is crucial to diagnosing some diseases. It also adds to the understanding of the cellular origins of disease in both plants and animals (pathology). Most histotechnologists and histotechnicians work in hospital or clinic laboratories that handle human specimens, but opportunities are also available in veterinary, pharmaceutical, biomedical, or academic settings. Currently, there is a shortage of trained histologists.

“Histology is an important hands-on career because not everything in pathology can be automated,” says Jean Cordova, a medical technologist and a histotechnologist who is also laboratory manager for Northwest Pathology Services/Pathology Consultants in Springfield, Oregon. “You need someone who understands anatomy, understands what to look for in a specimen, what to take sections of, and how to describe what they see.”

Keep reading to learn more about the important work histotechnologists do and the type of education needed for this rewarding career path.

What Education Does a Histologist Need?

An education or experience in life science or medical laboratory technology can well-equip someone for a career as a histotechnician or histotechnologist. Someone with an associate degree in a science-related field might start out as a histotechnician, or “grossing assistant.” Grossing is a common term in pathology meaning the description and examination of tissue.

“Something that comes from surgery will be looked at ‘in gross,’ in a “gross examination,'” explains Cordova. “Our grossing assistants have at least an associate’s degree in a science-related field, although all of the histotechnicians at Pathology Consultants have bachelor’s degrees.”

The histotechnician is trained to process the sample for examination. The histotechnologist, who typically does the specimen examination, has advanced training and a deeper understanding of specimen collection, processing, and examination, and typically has a bachelor’s degree.

In some small labs, exams are mainly the responsibility of a certified pathology assistant under the guidance of a pathologist. Pathology assistants require a master’s of health science. These examine complex surgical specimens. Tissue biopsies that are not as complex (e.g., colon, skin, needle biopsies) would be examined by an individual with a minimum of an associate’s degree.

Some clinics, including Pathology Consultants, have an avenue for training an employee who begins their career with an associate’s degree. Entry-level employees may advance by studying the American Society for Clinical Pathology (ASCP) certification and licensure material. Most clinics certify their employees through the ASCP, the oldest and largest certification agency for laboratory professionals. The ASCP has various routes available for certification, depending on education and experience.

ASCP Certification Eligibility Routes for Histotechnicians – HT (ASCP)

To be eligible for examination and licensure as a histotechnician by the ASCP, students must complete one of the following:

  • Route 1: Meet the minimum requirements of a histotechnician program accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) within the last five years.
  • Route 2: Complete 60 semester-hours (90 quarter-hours) of academic credit, with a combination of 12 semester-hours (18 quarter-hours) in biology and chemistry, or an associate degree with a combination of 12 semester-hours (18 quarter-hours) in biology and chemistry, along with one year of full-time experience in a histopathology within the last five years.

ASCP Certification Eligibility Routes for Histotechnologists – HTL (ASCP)

There are three routes available for certification as a histotechnologist by the ASCP:

  • Route 1: Complete a biology- and chemistry-focused baccalaureate degree and successful completion of a NAACLS-accredited histotechnician or histotechnologist program within the last five years.
  • Route 2: Complete a biology- and chemistry-focused baccalaureate degree, and one year of full-time acceptable experience in a histopathology laboratory within the last five years.
  • Route 3: Hold a valid ASCP histotechnician certification and a baccalaureate degree, as well as six months of full-time relevant histopathology laboratory experience within the last five years.

Salary of a Histotechnician or Histotechnologist

The salary of a histotechnician or histotechnologist depends on the hospital or the facility and the size of the city in which it is located. Usually, the more educational background, the higher the salary.

According to the 2017 ASCP Wage Survey, the average hourly wage for histotechnicians in the United States was $26.08, which is about $54,000 annually. Private laboratories paid the highest at $29.92 per hour. Non-academic hospitals with 100 to 299 beds paid the least, at $24.08 per hour, on average.

Lead histotechnologists are paid an average hourly rate of $28.76, while histotechnology supervisors and managers can earn $31.45 to $39.29. Out of nearly 15,000 responses, 59 percent had a bachelor’s degree, 18 percent had an associate’s degree, and 12.5 percent had a master’s degree. Fifty percent of respondents indicated that they had received their clinical training from a NAACLS-accredited training program, whereas 24.17 percent received on-the-job training.

Although the Bureau of Labor Statistics does not maintain salary and employment data separately for histology professions, it includes them under the umbrella of “clinical laboratory technologists and technicians.” According to the BLS (May 2019), there were 326,020 of these professionals employed in the United States with an average annual salary of $54,780 and the following percentiles:

  • 10th percentile: $30,920
  • 25th percentile: $39,030
  • 50th percentile (median): $53,120
  • 75th percentile: $68,100
  • 90th percentile: $81,530

Cordova says job prospects in this field remain strong. “There are not a lot of histologists out there, so it’s relatively easy to find a position,” she says.

What Does a Histologist Do?

Again, the U.S. Bureau of Labor Statistics (BLS) classifies histology assistants as medical and laboratory technicians. These professionals are also called histologists, histology technicians, and grossing assistants.

As a histology technician, you will work under the supervision of pathologists and pathology assistants in clinics, hospitals, laboratories, and physicians’ offices. Some of your job duties may include dissecting and processing tissue specimens for microscopic exams, cleaning and maintaining equipment, tracking processed specimens, organizing slides, preparing stains or dyes, placing specimens into cassettes (holders), and submitting specimens for further testing.

A histologist’s role begins after a sample is taken during a biopsy, surgery, or some other procedure that results in a sample of tissue or bodily fluid that needs to be examined. As with many medical terms, the root word “hist” is a Greek word meaning “web,” from which we get the notion of “tissue” as a supporting framework for the body. While it seems like it’s related to the word “history,” the Greek root for things that happened in the past is actually from a different word.

Once the sample is taken, it must be handled and prepared in a way that preserves it, and makes it easy to generate the very thin samples, called sections, that are examined microscopically.

When a histologist receives a sample, for instance, taken from a biopsy, it is usually in some sort of preservative and must be handled with care. Labelling and numbering for tracking is the first step, followed by preparing the specimen. Fresh tissue is very delicate, and unless it is treated in some way, it would be impossible to slice it thinly enough to be examined.

The sample is added to the cassette, then put into a tissue processor, which slowly dehydrates the specimen in a process that could take two hours up to six-and-a-half hours, depending on the size of the specimen.

Many specimens must be converted into a special solid form that will allow very thin sections to be cut from it. This is a mold-making of a sort, in which the specimen is injected with paraffin, which hardens. Then the histotechnician will use a microtome to cut extremely thin slices of material, known as sections, four microns in size, from the paraffin block. (A micron is one millionth of a meter. The average cross-section of a human hair is 50 microns.)

“They will cut it to give it sufficient representation of the tissue but in a way that leaves enough in that paraffin block to allow for future testing if needed,” says Cordova.

The microtome turns as it cuts the sections, resulting in a ribbon that is placed in a warm water bath to gently flatten them. Then, the microscope slide is placed under this ribbon to “pick up” the sections that need to be examined.

Cells are routinely stained using dyes to reveal structural detail. A universally used stain in this setting is the hematoxylin and eosin (H&E) stain. This stain is often enough by itself to reveal issues. If not, other specialized staining techniques can be implemented.

The paraffin blocks are stored for a minimum of ten years. This allows the specimen to be reexamined later if treatment options change, or some other question is raised or more information is needed about the sample. Electronic records related to the interpretation of the sample are kept indefinitely.

“We need histologists and histotechnicians in laboratories because you can’t take away the human aspect of understanding the sample” says Cordova. “People have attempted to produce machines to cut a paraffin block, but you need a person handling a tiny, one millimeter biopsy, or a needle biopsy that’s as thin as a thread that you need to get 25 sections of so that you can diagnose a lung issue. Creating a good slide is considered almost an art.”

Before the arrival of COVID-19, which virtually shut down elective procedures in many hospitals and clinics across the country, Pathology Consultants was creating 350 to 400 paraffin blocks a day.

Career Paths for Histotechnicians or Histotechnologists

Histotechnologists and histotechnicians can work in just about any setting where biological tests, diagnostics, or education is performed. Within many of these fields are specialties, such as specialized skin tissue sampling for dermatologists (Mohs histology), or immunohistotechnologists, who are often employed in cancer diagnostics and are a major part of many histology laboratories.

Histotechnologist Employers in Medicine

  • Hospital laboratory
  • Research facility
  • Private clinic
  • Forensics laboratory
  • Reference laboratory
  • Dermatology clinic
  • Cancer center
  • Electron microscopy facility
  • Medical examiner / autopsy facility
  • Speciality clinic such as kidney or urology center

Histotechnologist Employers in Animal Settings

  • Veterinary diagnostic facility
  • Wildlife disease research
  • Zoo or animal sanctuary

Histotechnologist Employers in Academic Settings

  • Educational facility
  • Medical teaching school
  • Licensing board examiner

Histotechnologist Employers in Industry

  • Life sciences manufacturing
  • Equipment training
  • Equipment sales
  • Technology support services
  • Research and development

The Future of Histotechnology

The job outlook for medical and clinical laboratory technologists and technicians is expected to grow 11 percent between 2018 to 2028, which is much faster than the average for all occupations (5 percent), according to the U.S. Department of Labor Bureau of Labor Statistics. An increase in the aging population is expected to lead to a greater need to diagnose medical conditions through laboratory procedures, and medical laboratory staff such as histotechnicians and histotechnologists will be right there, ready to do that important work.

Vanessa Salvia
Vanessa Salvia Writer

Vanessa Salvia is an Oregon-based freelance writer and editor with a bachelor's degree in chemistry. As fun as rigorous studies in math and science were, Vanessa took an independent path and developed a prolific career covering lifestyle topics for magazines and newspapers, important industries such as concrete construction and building waterproofing, and even hard science. You can get in touch at www.sagemediaandmarketing.com.