I was incredibly privileged to have a tour of cytology and histology lab today. I’m not really sure what you call it. I thought it was called pathology, and bits of it are..but it seems that all the terms have specific meanings. In lay man’s terms the place where they look at bits of you to decide what’s wrong!!
It was not what I was expecting. Here’s the danger of stereotypes again! It was not rows of white coated folk looking into microscopes. Yes there was some of that but lots of other things too.
The smear samples come in predominately from GP’s but also from Colposcopy clinics. There is a machine (That apparently costs over £200k) that takes the lids off the samples that have been loaded into it, pushes the liquid through a sieve so fine that it traps samples of the cells from your cervix. The machine then goes on to create a glass slide of the sample from the glass sieve. The cells being dyed to show up better under the microscope. This then has to be looked at by a human!
I looked through the microscope at a slide with normal results, one with moderate abnormalities, one with high grade abnormalities and one with high grade abnormalities and suspected malignancy. The abnormality can be seen in the nucleus of the cell. Abnormal cells having a much bigger nucleus and are shaped differently from a normal cell. I saw samples of CGIN. Also a really good explanation of the transformation zone. It was also explained to me how someone can have a clear smear but have cancer. Sometimes the cancerous cells (tumour) can grow into the skin and healthy cells cover it up. As the smear only brushes the cells off the surface of the cervix the abnormal cancer cells are not sampled.
What shocked me was how long it takes to look at each sample. He said 5 minutes for one that is clearly normal, 20 minutes to 30 minutes for one that is ‘interesting’. I thought it would be much quicker than this.
One’s that are considered abnormal are then asked to attend colposcopy clinic.
While we all clearly believe our result is the most important result in the world it is amazing to see the sheer amount of samples they are dealing with.
Biopsies come in from all over the hospital. They arrive in reception and are ‘booked in’ and sent to the relevant department…different samples require different techniques to get the sample in a state that it can be examined under the microscope. It is not just a case of the pathologist tipiing your sample out, sticking it under the microscope and saying clear or unclear.
I was shown some biopsy samples from different bits of bodies. These are soaked in all sorts of chemicals to prepare them. The main process is to remove water from them, This takes at least 24 hours. They are then placed into a block of wax. The wax is then ‘cut’. I saw a sample being sliced into wafer thin slices to then be put onto slides ready for the pathologists to look at. The person cutting the slide is skilled in knowing exactly which part of the sample will show the best ‘picture’. The examples I saw had several slides made for one biopsy sample.
Some samples coming into the lab are much are much bigger…..whole organs. The lady showing me around explained how problematic samples containing bone or cartilage are as it is incredibly hard to cut through thin enough for the microscopes. There is a machine that they have just acquired that has made this job incredibly quicker and therefore allowing patients to get their results quicker too. Obviously if a whole organ comes in it has to be cut up to be processed. I saw some interesting things in that department!! These have to be cut in a certain way and are then processed in a similar manner. The wax blocks are bigger, The almost look like a fossil. A sample of tissue suspended in wax. I also saw a cancerous tumour. I had been asked before I went if I would be ok seeing these things and was asked again if I was ok with it. I found it truly fascinating. The names on all the samples were covered up for confidentiality but I wished everyone ‘Good Luck Mate’ as I went round!
A fascinating tour, and really interesting to see what has happened to my various and numerous samples over the years. A great insight to what is actually happening while we are ‘waiting for results’.