Who are pathologists and what do they do?
A pathologist is a medical doctor trained in the examination of tissues who helps other doctors in diagnosing the disease process that is affecting a patient. Almost all fragments of tissue removed from a patient in a surgical biopsy or resection procedure are examined by pathologists who determine whether cancer is present among other determinations. The tissues are examined by the pathologist with the naked eye and described in what is called a gross examination. Later, the tissues are processed overnight onto glass slides and the pathologist then performs a microscopic examination. The pathologist communicates the findings in a report to the treating doctor, who then decides if further therapy or referral is necessary.
What happens to my biopsy specimen?
After a surgeon removes your biopsy specimen, he/she puts it into a container filled with formalin or formaldehyde to preserve the tissue. The specimen is transported to a tissue (histology) laboratory. There, a pathologist examines the specimen with the naked eye and records features of the specimen such as the color, size, consistency, number of pieces, and any unusual characteristics. The tissue is then machine processed and covered in paraffin, a waxy substance that makes the tissue stiff enough to be cut into slices thinner than paper. Histotechnologists slice the tissue, apply the slices to glass slides, and stain them with various dyes to make cells within the tissue stand out. The slides are examined under a microscope by a pathologist, who uses his or her eyes and judgment to determine if cancer is present and how far it has extended. Pathologists also may have diagnostic insight into inflammatory and infectious conditions. Tissue diagnosis by pathologists is the time-honored gold standard test for detecting cancer or its absence.
How will I learn the results of my test and how long will it take to find out?
Pathologists function best as consultants to other doctors. Their expertise is mainly in how to diagnose tissue samples. The best person to explain the results and ensuing plan is the clinical doctor who performed the surgery or who initiated the sequence of referrals leading up to the biopsy. Sierra Pathology Associates’ reports are sent to the treating physician(s) who then contacts the patient. A typical biopsy with straightforward results is usually in finalized report form within 36 hours of receipt of the specimen. If the results are complicated, additional consultation may be necessary, requiring a wait of up to five(5) working days, in some cases possibly more.
What does my pathology report mean?
Patient and Surgical Procedure Information
Pathology reports usually start with a lot of patient identification information so there is no mix-up on who is the subject of the biopsy. There will usually also be some doctor names, dates and specimen information to further clarify details of the surgery and the specimens.
Diagnosis
A surgical pathology report almost always has a Diagnosis section which has the most important information. This section is often set apart by lines or large bold print. The Diagnosis section will usually contain a heading for what kind of tissue was removed and just under it is the pathologist’s interpretation. Phrases that are used to express a favorable diagnosis include ‘benign’, ‘No evidence of malignancy’, and ‘No tumor present’. ‘Lipomas’ and ‘adenomas’ are benign tumors. On the other hand, words that essentially mean cancer include ‘carcinoma’, ‘adenocarcinoma’, ‘sarcoma’, ‘lymphoma’, ‘leukemia’, ‘melanoma’, and ‘malignant neoplasm’. Two exceptions to this are ‘carcinoma in situ’ which means a precancerous condition and ‘cystosarcoma phyllodes’ which is a breast tumor of uncertain malignant potential. ‘Carcinoid tumors’ are also uncertain in their behavior. The statement of cancer’s presence is usually followed by a rating system for how aggressive the cancer looks from ‘well differentiated’ and ‘Grade 1’ tumors which look only mildly aggressive to ‘poorly differentiated’ and ‘Grade 4’ tumors which look very aggressive. Unless the biopsy is very small (smaller than a corn kernel), the pathologist will usually attempt to determine how far the cancer has spread. This is governed by a staging system that includes features such as the size and depth of the tumor as well as what layers of tissue the tumor has gone through and whether it has spread to other sites called ‘lymph nodes’. There is also usually a statement about ‘margins’ which refer to whether the surgeon’s removed all of the tumor from the body or whether there might be some left behind. Pathologists often use a counterintuitive word system that is used in other fields of medicine where a ‘negative biopsy’ or ‘negative lymph node’ is actually good news meaning cancer is not present. Conversely, a ‘positive biopsy’ or ‘positive lymph node’ is usually bad news that cancer is present.
Comment
The Comment section is usually reserved to discuss more complicated issues that don’t fit neatly into a diagnostic statement.
Gross Examination
One of the duties of the pathologist is to describe with the naked eye what was received. This provides important information about the size of the specimen and the spatial relationships of features on and within the specimens. Color, size, consistency, number of pieces, and unusual characteristics are recorded in a ‘Gross Description’.
Microscopic Examination
The examination of the slides under the microscope usually yields the most important information for the pathologist. Characteristics of the tumor which may have only been suspected on the Gross Examination are confirmed on the Microscopic Examination. Tumor type, grade, stage, margin status, and node status are usually recorded in this section which serves as the rough draft of information to be included in the Diagnosis.
What is FNA?
Fine Needle Aspiration, or FNA, is a very simple procedure similar to a standard blood test, in which a needle is used to remove cells from a palpable lump. The pathologists of Sierra Pathology Associates are trained in the FNA procedure which allows the advantage of immediate bedside evaluation of the sample to make sure it is adequate for diagnosis. The amount of discomfort is comparable to a standard blood test and the risks of infection and bleeding are also very minimal. By using FNA, a lump which would otherwise require surgery to find out what it is can be diagnosed beforehand using this minimally invasive procedure. Your doctor can then keep options open about whether to observe the lump over time or to operate on it with the added knowledge of knowing what the lump is before making his or her first incision. For more information on FNA, click here.
Why did I get a bill from Sierra Pathology Associates?
Sierra Pathology Associates is contracted as a preferred provider with numerous health insurance plans in Northern Nevada and Northern California. Your doctor removed a lesion in a biopsy or resection procedure and then sent the tissue for laboratory evaluation performed by a pathologist of Sierra Pathology Associates. Bills for the evaluation services provided by the pathologists are sent directly from the Sierra Pathology Associates’ billing office and they are not included in any hospital bills. The primary operation of Sierra Pathology Associates is at Renown Regional Medical Center in Reno, Nevada, but some outpatient biopsies in the Reno-Tahoe-Portola region are also performed.
Who do I call for billing inquiries?
The billing for Sierra Pathology Associates’ services is handled through our business office, (775) 334-3450. Billing inquiries to the Renown Regional Medical Center pathology office will be referred to the business office.
If my relative has an autopsy at Renown Regional Medical Center or Renown Medical Center South Meadows, will our family be charged?
In a word, no. The cost for autopsies performed within either of these institutions is borne by the institution itself.
How long does it take to get the result of an autopsy?
If the autopsy findings are relatively straightforward, the report may be available within a week to a month after the date of autopsy. If the findings are very complex and special studies are required, the report may not be completed for several months.
How do I obtain a copy of the autopsy report?
In the case of a hospital autopsy, the report will be sent to the attending physician from whom you can request a copy. Reports for cases which fall under the purview of the Coroner or Medical Examiner can be obtained from the Washoe County Coroner-Medical Examiner Office. Phone 775-785-6114 for assistance with this process.