Waiting on a Diagnosis: What You Need to Know
By Amy Schiller, B.S., MLT (ASCP) cm
If you’ve ever had an EGD or Colonoscopy, chances are you have had a polyp removed, or biopsy taken, for further study. Waiting on a diagnosis can be a time filled with anxiety. You may wonder why your physician cannot always give you immediate answers to your health concerns after your procedure is completed. Well, in order to make an accurate diagnosis, your tissue sample must undergo several steps before it is possible to be used for diagnostic interpretation.
A biopsy is a small sample of tissue taken from an area where your physician would like a more in depth look at the tissue. It is important to remember that having a biopsy taken for study does not necessarily indicate a problem. The doctor will inform you of his reasons for biopsy removal after your procedure. This tissue is immediately placed in a jar of Formalin and labeled with your patient information. Formalin is a fixative, and it will bind the proteins in the tissue to prevent the tissue from biodegrading. The specimen is then sent to the laboratory where your patient information is verified, and your specimen is assigned a unique number. A laboratory technician removes the tissue from its container and records its size, color, and any specific features. Some specimen are sectioned, depending on size, to give the doctor a deeper look at the inner cells of the tissue sample.
A tiny, plastic holder, called a biopsy cassette, is labeled with your name and accession number, and then the tissue is placed inside. These cassettes will go on a machine that processes the tissue by removing the water content of the cells and replacing it with paraffin wax. Once processing is complete, the tissue is placed in a mold and surrounded with more paraffin wax. Once the wax hardens, it can be placed on a machine called a microtome where the technician makes very fine slices of the tissue (about 1 cell layer thick). These are floated on a bath of warm water then picked up on a microscope slide. The slides are then stained with 2 separate dyes; one that stains the cells’ nuclei a dark blue color, and one that stains the rest of the cell contents various shades of pink, red, and orange.
The slide is now ready for viewing under a microscope by a Pathologist. A Pathologist is a doctor who specializes in the microscopic examination of tissue. The Pathologist will look at the types of cells present, their arrangement, and if they have any abnormalities. Normally, cells have certain characteristics that help them do their jobs. The size and shape of normal cells should be relatively uniform with other cells of their type, whereas cancer cells vary in size and shape and can be distorted. Their nuclei should have a certain shape and color and the cells should have a distinct arrangement depending on what type of cells they are. Often, nuclei of cancer cells will stain darker because they contain too much DNA. Their arrangement will be haphazard or they will not form glands when they are supposed to. Cancer cells have the ability to invade normal tissue and crowd out healthy cells. They can travel through the blood and lymph system and start growing in other parts of the body. Finding cells in areas where they are not supposed to be can be an indication of cancer. All this information is used by the Pathologist to determine a diagnosis.
A Pathology Report is generated by the Pathologist that contains your diagnostic information. This report can be difficult to understand. Your doctor will go over the results with you. Let’s take a look at some of the terms he or she may use when discussing your report:
The pathologist may order additional slides to be made from your tissue for further testing with different types of stains or different methods of staining. These stains can demonstrate pathological abnormalities, such as parasites, yeasts and fungus, and certain cell molecular markers that are expressed in some cancers. Your physician will review any additional tests with you and determine any further course of treatment.
The entire process, from start to finish, can be time consuming. In most cases, we can have results within a day or two of your procedure. At DDA, we strive to achieve the most accurate results in the shortest time possible to minimize the wait time for our patients. Our lab accepts most insurance plans and is certified by the College of American Pathologists (CAP), which is the leader in advocating excellence in laboratory medicine. We are dedicated to our patients and to providing the best possible care as part of the team at DDA.