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February 11, 2020 Tuesday 04:15:33 PM IST

Exploring the causes of Diseases

Health Monitor

“Under the pathologists’s microscope,life and death fight in an illuminated circle in a sort of cellular bullfight.The pathologist’s job is to find the bull among the matador cells---Yann Martel.”

What does a pathologist do? “As a doctor, do you see patients? Do you just test blood and urine in the lab?” These are frequent questions as pathologists we encounter in our daily life. We even have colleagues in medical fraternity who believe that as the tests are run in machines, pathologists do not have much to do.

Pathology is a branch of Laboratory Medicine which is an integral part of every hospital and most medical diagnosis and treatment is complete only with proper laboratory testing.The Laboratory has 3 main divisions which are Pathology,BIochemistry and Microbiology each having specific roles in supporting medical diagnosis. A Pathologist examines specimens microscopically.

Who is a pathologist?

Pathologists are physicians who specialize in the diagnosis of diseases through conducting laboratory tests and performing study of body tissues to see if it is normal or abnormal. They identify diseases by examining human cells and tissues under the microscope.  While you may never meet one,a pathologist can impact your medical care in important ways. They are an integral part of any treatment team. In his bestseller book ‘The Final diagnosis’, Arthur Hailey has beautifully captured the importance of pathology in medicine for delivering a clearcut diagnosis. The pathologist plays a key role in evaluating human tissue samples at the cellular level , supports other healthcare providers in making a  definite diagnosis and aids in guiding the course of treatment.

As with most of the modern medical care, the practice of pathology is a team activity.The Pathologist’s work has major consequences for patients. They guide the diagnostic processes working as an important part of clinical team behind the curtains along with physicians, surgeons, radiologists and indeed all medical specialties.On one hand, there is a range of members comprising the laboratory team which include doctors and trained technical staff for providing pathology testing. On the other hand are the clinicians who are specialists in their own field of medicine ,who refer patients to pathologists for investigation and thereafter treat patients guided by the pathologist’s test results. In essence, the pathologists, through their medical background and extensive training, understand the needs of other clinicians caring directly for patients and at the same time understand the exact requirements in the laboratory to produce accurate, appropriate and timely results.

Pathology is a medical discipline with major subspecialties .These include Histopathology or Surgical Pathology, Cytopathology, Hematopathology, Clinical pathology and Molecular pathology.

What does a histopathologist do? He or she looks at biopsies(tissue samples) and helps in diagnosing the diseases, including confirmation of presence of cancer or an infection. A biopsy is taken by the surgeon and send to the pathology wing of the laboratory where it is processed .Ultra thin sections of this tissue are made on glass slides, stained and then examined under the microscope by the pathologist. The pathologist  looks at the patterns and  the arrangement of cells in the tissue, the nuclei and cytoplasm of the cell etc. and determines whether it is normal or abnormal. These test results are communicated to the primary consultant for medical or surgical treatment and follow up of patients.

Pathologists have a major role in cancer diagnosis. They receive the tumour which has been sampled or completely removed along with nearby lymph nodes or other tissues. Pathologist during a process called as Grossing looks at the tissue and takes representative tissue bits from relevant areas. Using a microscope she or he determines whether cancer cells are present, what the type of cancer is, what grade the cancer is, whether it has been completely removed during surgery, how far it has grown and whether it has spread to lymph nodes or blood vessels. Sometimes intra operative consultation or frozen section is done to help the surgeon determine the adequacy of resection or type of surgery. Additional tests like immunohistochemistry or molecular studies are required at times to determine the type or behavior of the tumour and determine the most appropriate therapy. A cancer diagnosis is usually incomplete without a pathology report.

Cytopathology is the diagnostic technique that examines cells obtained by the aspiration of a tumour or swelling using a needle or from cells obtained from body secretions and body fluids to determine the nature of disease. Specimens are processed into slides, examined microscopically for diagnosis of cancer, precancerous conditions, benign tumours and infectious conditions.

Hematopathology is the study of diseases affecting blood cells, their production and organs involved in blood cell production such as bone marrow and spleen. Hematological tests help in diagnosis of anemias, blood cancers, blood clotting disorders and certain infections. In diagnosis of leukemias and lymphomas, morphologic findings are integrated with the results of special procedures such as immmmunohistochemistry, flow cytometry, molecular studies and cytogenetic analysis to arrive at a final diagnosis.

Molecular pathology is an emerging discipline within pathology which is focused on the study and diagnosis of disease through the examination of molecules within organs, tissues or body fluids.Molecular pathology is commonly used in diagnosis of cancer and infectious diseases.

Pathologists have a major role in running of laboratories and has the ultimate responsibility for the test results in pathology lab, ensuring the quality and safety standards of the laboratory. Pathologists routinely supervise the laboratory to ensure pathology results are appropriate and of the highest standard, and provide interpretation and further advice on the clinical implications of these results.

As in any other fields advancements in technology has led to newer developments like telepathology and digital pathology where microscopes can be replaced by computer monitors .

Dr Sunitha Thomas

(Dr Sunitha Thomas is a Consultant Pathologist, Rajagiri Hospital)

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