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 h per year, though adoption remains limited by high cost and a slow return on investment. Automated archival systems decreased manual handling by approximately 550 h 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.