The great unknowns who give names and surnames to their tumor

Almost nobody knows them. They do not see patients and their specialty does not enjoy the fame of others such as Dermatology, Cardiology, Neurology, Oncology… But none of these could live without the Pathological Anatomy laboratories. They are one of the central and transversal services of any large hospital and, although they are in the shadows, they cannot allow any mistakes because they have the patient’s fate in their hands. ABC has had the opportunity to visit the Pathological Anatomy laboratories of the La Paz University Hospital in Madrid, where doctors and technicians specializing in this branch receive tissue samples (biopsies and surgical specimens) and cells (cytologies) every day, which must be guard and process with great care, using a protocolized system, to be able to give an accurate diagnosis to the patient. If you have ever undergone a biopsy, cytology or have had your appendix removed, for example, know that your sample has had to go through a place like this. With the help of Dr. David Hardisson, head of the Pathological Anatomy Service of La Paz, we have followed the same route. When you enter the general laboratory, the first thing that catches your attention is the special smell that floats in the environment. It is a mixture, they tell us, of products such as formalin (in the case of biopsies of tissue samples, they require an initial fixation process with this substance to prepare the tissue), paraffin and the human tissues themselves that are going to be analyzed. . It is not unpleasant, but it is strange. The samples are saved in these cassettes Tania SieiraThe pathologist does not look at the sample directly under the microscope. Previously, there is an entire process, which is carried out by specialist technicians, which begins with the identification of the sample and the assignment of its own study number, such as a Pathological Anatomy DNI, and a two-dimensional code, to avoid any confusion. Then it goes to the carving room, where a few pieces of the fabric, previously fixed with formaldehyde, are extracted and placed in perfectly identified ‘cassettes’. They are covered in paraffin to turn them into blocks that are then cut into sheets with a thickness of 4 microns; They are placed in a bath of warm water to expand the tissue and placed on the slide. The sample is given a paraffin support, which is then cut into very thin sheets Tania Sieira Once the crystals are obtained with the undyed tissue Staining with hematoxylin eosin is done in an automatic device. We have gone from a ball of tissue to a histological section stained in colors between pink and purple. And this is what is given to the pathologist to make the diagnosis. «It is a job that requires a lot of concentration. We are the foundation of a building. If we are not there, the building will not go up. Our goal is to give the patient a diagnosis as soon as possible,” says Marina Capa, coordinator of Pathological Anatomy technicians in La Paz. Dr. Hardisson invites us to look at a sample of breast tissue, already processed, under the microscope. Any layman simply sees a plate with different colors. The pathologist is able to appreciate cancer. He points with an arrow and says: -Do you see these little nests arranged in a disorganized way in this pink fabric? This is a cancer. They are tumor cells. The darkest thing is the core; the clearest thing, the cytoplasm,” he points out. The universal stain colors cells and tissues with a color spectrum that depends on their characteristics. Cancer dyes it purple and the rest pink. Cancer cells have the largest nucleus in relation to the cytoplasm and then there are infinite variants. Intraoperative biopsySometimes, this entire process that we have already described must be done expressly, with other techniques, because the specimen comes directly from the operating room. This is what they call an intraoperative biopsy. During the surgical procedure to remove a tumor, the surgeon takes a sample and quickly sends it to Pathology to check if the surgical edges are free or need to be cleaned more; for confirmation of diagnosis in case of doubt because it could not be established in a previous biopsy; or due to an unexpected surgical finding. The patient is not closed until the result is received, so time is money. Afterwards, the study of the sample will be completed following the normal protocol. A rib cage obtained through an intraoperative biopsy Tania Sieira La Paz is not the only hospital in Spain that has an area of ​​these characteristics, but it is, due to its dimensions and be a reference center, one of the centers with the highest volume of work. About 70 people work in this service, including doctors, technicians, administrators and guards. They estimate that 2024 will end with a balance of more than 70,000 biopsies and surgical specimens, around 45,000 cytology tests; about 140,000 tissue blocks processed; and approximately 300,000 histological preparations studied. “This healthcare activity has been increasing by around 5-10% annually in recent years,” says Dr. David Hardisson. One of the determining factors for this increase in the annual workload is that there are more and more conditions that require the diagnosis of Pathological Anatomy. One of the most important, due to the majority of patients, is cancer, a disease of which there are more and more cases. It is not the case for pathologists to have such familiarity with the patient that they speak possessively about them, as happens with other clinical specialties: my dermatologist, my cardiologist, etc. «That ‘my’ terminology is applied to us by our oncologist colleagues. “They are the ones who talk about ‘my pathologist’.” And this has an explanation. In the entire hospital care activity, approximately more than half of the diagnoses are made in Pathological Anatomy. And if we talk about specific areas, the field of Oncology is where they are best known, because they make practically 100% of the diagnoses in solid tumors. «Today no oncologist is going to treat his patient if he does not have the diagnosis confirmed by Pathological Anatomy. It is a relevant part of our activity. In addition to diagnosing, and in the specific case of the oncological field, we establish parameters that are essential for prognosis and treatment. We determine biomarkers that are essential to be able to decide the most appropriate treatment for the patient,” explains Dr. Hardisson. Pathologists are in charge of analyzing the samples already processed in the microscope. Tania SieiraIn this Service, the pathologist is the last link in the chain. Previously, there is a team of technicians specializing in Pathological Anatomy and Cytology who are essential because they process the organs, tissue samples and cells. Also the administrative staff, who are responsible for transcribing the doctors’ audio notes with the findings to capture them in the patient’s report. «It is a very complex machine. For the final result to be optimal, all the gears have to be perfectly adjusted and coordinated,” emphasizes Dr. Hardisson. The promotion of new technologies in this area is also important because it allows tasks to be optimized to be increasingly faster, more efficient and more reliable in diagnoses. Dr. Hardisson recognizes that much progress has been made in terms of automation in the procedures followed in the laboratory, but there is still significant room for improvement. There is already equipment in the markets that will allow this ‘gap’ to be bridged, but investment is needed. Likewise, digitalization is on the table. «We are in a phase of replacing the optical microscope with the digitalized image, of moving towards digital pathology and incorporating the AI ​​algorithm as an aid to diagnosis. Molecular pathology is essential to advance towards personalized medicine. We have improved and advanced a lot, but there is still a way to go and that is where we are, in a paradigm shift of what our discipline is going to be,” he says.

#great #unknowns #give #names #surnames #tumor