Pathology in motion: automation from specimen to report

Pathology laboratories are increasingly strained by rising diagnostic demand, greater case complexity, and limited staffing. Manual, analog workflows continue to dominate, yet they are time-consuming, prone to error, and contribute to inefficiency and staff burnout. Automation has been proposed as a strategy to address these challenges and improve sustainability. We reviewed current automation solutions available for key phases of the pathology workflow, including grossing, labeling, processing, embedding, microtomy, and archiving. Data were compared against estimates from traditional manual workflows to highlight potential gains in efficiency, accuracy, and traceability. Automation was shown to improve both efficiency and reliability across multiple stages. Advanced processing systems, such as microwave-assisted and ultrasound-based instruments, allowed faster turnaround with better tissue preservation. Embedding automation reduced operator time by more than 50%, sparing up to 40 working days annually. Automated microtomes cut sectioning times nearly in half, saving up to 470 hours per year, though adoption remains limited by high cost and a slow return on investment. Automated archival systems decreased manual handling by approximately 550 hours per year, while also ensuring controlled storage conditions and improved sample tracking. Automation offers clear benefits for standardization, efficiency, and diagnostic safety, while allowing staff to focus on higher-value activities. However, high implementation costs, infrastructural demands, and incomplete coverage of specialized needs remain barriers. Despite these limitations, automation represents a critical pathway toward resilient and future-ready pathology services. • Pathology laboratories face increasing workloads (+5–10% annually) and growing case complexity, leading to staff burnout and risks to patient care. Manual workflows are error-prone and time-consuming, particularly in pre-analytical handling. • Integrating digital imaging and automated cassette/barcode labeling reduces errors, improves efficiency, enhances traceability, and supports education and retrospective review • Automated tissue processors, embedding systems, and microtomes significantly reduce hands-on time (up to 80% in embedding; 40–59 working days saved in microtomy), standardize outputs, and improve sample quality for downstream analyses • Robotics and digital archiving improve specimen tracking, environmental control, and time management, freeing personnel for other tasks while ensuring higher reliability and traceability.