Painting the ‘picture’ for pathology

I felt the need to have a chat about pathology results. Outstanding results can often lead to stress and frustrations. This article is to help you better understand the ‘pathology picture’.

Before my patient navigation examination, I had to visit and get a feel for all the ‘medical disciplines’. I was shown around a phenomenal lab. At the time I hadn’t realised exactly how many steps were involved in the processing of a specimen!

When a resection specimen is received it is fixed in formalin for a sufficient period, at least one day, and then dissected into blocks by the pathologist for the tissue of interest, for example the tumour to be further processed.

Processing is performed with wax impregnation. The specimen must be dehydrated (as water can course degradation of the tissue) and the formalin is substituted with paraffin wax, after which it is then embedded onto a flat surface into the tissue block. This block is placed into the processing machine (which cannot be opened) overnight. When cooled, the wax hardens.

These blocks then go to specialist laboratory technicians who uses a microtome, which slices beyond thinly!!

These sections are picked up onto the slides and heat fixed at 60° C onto the glass. This gets washed with Xylene and the wax is washed off. The slides can now be stained.

Only after this whole process, the examining of the slides begins!

The slides are given to the pathologist who looks at it under the microscope. There are between 12 and 15 slides per patient (with a breast cancer). Once the pathologist has examined the tumour and other tissues, for example lymph nodes, additional tests are performed on the appropriate tissue block to complete the information needed to decide on all future treatments. These additional tests would normally include receptor studies like ER, PR and HER2, as well as other stains to assist in making a correct assessment of the tumour.

Once all of the information is complete, report is formulated, reviewed and sent out by the pathologist. So many of the treatment decisions in breast cancer are based on this report and there can be no short cuts!

The pathology process is part of your road to recovery.

Stay Positive!

Written by Julie Belloni.

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