October 18, 2012

When patients are awaiting the results of a biopsy, they may not consider the processes involved in making a diagnosis and the importance of the pathologist’s expertise. In addition to highly-trained general anatomic and clinical pathologists, CAMC’s pathology team includes physicians who have trained in several subspecialties.
“Pathology specialties require an additional type of fellowship training,” said Todd Kuenstner, MD, director of clinical laboratories at CAMC. “We have specialists in hematopathology, blood banking, cytopathology, which is a growing field, and neuropathology, which is an unusual expertise to have. We have a specialist in renal pathology with special training in urologic tumors. This is one of our busiest surgical services, and we need the expertise to match the growing caseload of urological surgeries. Also, we have a specialist in pediatric pathology and we are a member of the Children’s Oncology Group network. We have the capability to provide advanced cancer care for children.”

A unique service that CAMC’s pathologists provide is telepathology, which is the transfer of pathology images and data from one location to another. “Our computers and microscopes go together. For example, if we have a brain biopsy ready and the neuropathologist is at another hospital, it can be viewed by them in real time,” Kuenstner said.

CAMC’s process for grossing (inspecting) specimens is efficient. “We also have a centralized grossing laboratory to better cover the grossing of all samples in the system. We can better cover the grossing of specimens if more people are there to do them,” Kuenstner said.

The typical process for diagnosis is about two to three days from the receipt of the specimen. “If it’s a standard biopsy, we can usually have the final report within two to three days. We put the specimen in formalin to fix at least six hours or overnight. The specimen is grossed in and then the tissue is cut to make slides. The tissue is put in plastic cassettes, then filled with paraffin. It is made into very thin sections, put on slides and then stained, so the pathologist can look at them. A report is typically generated within two to three working days. If the specimen requires special stains, the process will take longer,” Kuenstner said.

The frozen section diagnostic process is rapid, but incomplete. This process is followed when a surgeon needs to have a diagnosis while the patient is still in the operating room. It is then followed by the traditional process before the complete report is done.

“If a frozen section diagnosis is required, tissue is frozen in a cryostat then cut into very thin sections, put on a slide and rapidly stained. This process takes less than 20 minutes, so a diagnosis can be available while the patient is in surgery to guide the procedure. This is done in addition to the traditional procedure to follow up with the final report,” Kuenstner said.

CAMC recently joined a statewide initiative, the West Virginia Genome Network, to enhance cancer research and patient care. West Virginia has the fourth highest cancer-related mortality in the nation, and some cancers occur at a disproportionately higher rate among our residents.

“We are joining the West Virginia Genome Network and are setting up a tumor registry, which is a central repository for tissue and information. Researchers will be able to access a database. Because West Virginia has a relatively small and homogeneous population, this particular network may provide unique information about cancers. Patients will be approached about whether they want to donate their tissue. This is remnant tissue – it’s not necessary for diagnosis or care – and would normally be disposed of,” Kuenstner said.

For more information, visit camc.org/pathology.

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