Anatomic pathology: behind-the-scenes pathology teams save lives

Anatomic pathology technician Kelsey Hendry, shown measuring and identifying specimens at her work station, logs the metrics into a voice-activated computer at the University of Chicago Medicine. (Photo by Megan Doherty)

Anatomic pathology technician Kelsey Hendry, shown measuring and identifying specimens at her work station, logs the metrics into a voice-activated computer at the University of Chicago Medicine. (Photo by Megan Doherty)

By Molly Woulfe and Megan Doherty

The realm of Anatomic Pathology (AP) is an intense world of slides, stains, and microscopic examinations of organ and tissue samples. Yet these cellular sleuths — who make or break a diagnosis — tend to be overlooked.

“We deal with living people. We just never meet them,” said Pathologist’s Assistant Charlene Gettings, MS, PA (ASCP). “When a patient gets a result, they think, `Oh, my doctor found this out.’ There’s a whole group of people taking care of patients that one never meets.”

Of the 88 members of the AP team at the University of Chicago Medicine, most spend their time preparing or examining specimens for 35,000 cases annually. Like patients, each sample is unique and merits painstaking evaluation.

Since each patient is waiting for an answer, every specimen “deserves our utmost care in handling and accuracy in diagnosis,” said Nicole Cipriani, MD, Medical Director of Gross Pathology.

First-year resident Lily Tran, MD, examines cancer cells under a microscope. (Photo by Molly Woulfe)

First-year resident Lily Tran, MD, examines cancer cells under a microscope. (Photo by Molly Woulfe)

The process of analyzing a tissue or organ sample is complex. The first step involves the arrival of a specimen via a pneumatic tube or a dumbwaiter to the pathology gross room on the second floor of the Center for Care and Discovery.

“Gross” stands for “gross examination,” a visual inspection of tissue. But team members also eye surgical hardware or foreign objects removed from bodies. These include coins that children have swallowed, “plates and screws from broken bones, and bizarre objects such as arrows,” Gettings said.

Technicians ensure that each specimen is logged into the computer system. Then pathology residents or pathologist’s assistants measure, photograph, weigh, ink and section the samples to fit into tiny trays called “cassettes” at their work stations. Their tools of the trade include probes and forceps.

Some take notes, but others, like Ryan Dunning, don a headset and quietly record the data. “Voice-recognition dictation software inputs it directly into the computer,” the technician said.

Enter the histology techs, who whisk the cassettes to their lab in the Billings Hospital across campus. There the specimens are processed, embedded in paraffin, sliced, stained and put on pathologists’ desks.

Technician Ryan Dunning’s work station features this row of surgical scissors, forceps, probes and trim blades. (Photo by Molly Woulfe)

Technician Ryan Dunning’s work station features this row of surgical scissors, forceps, probes and trim blades. (Photo by Molly Woulfe)

These experts scrutinize the impossibly tiny samples under a microscope and make a diagnosis. The stains define cell structures, highlighting anomalies and the presence or absence of disease.

It takes 24 hours to 48 hours to process a routine specimen. But Pathology can expedite matters if a diagnosis is needed while a patient is still in the operating room. The team deploys a cryostat, a combination freezer-“deli cutter” that freezes the sample to -16 to -24 degrees F.

The machine slices the sample to a microscopic width of 4 to 5 microns (a human hair is about 75 microns). The pathologist reviews the sample under a microscope and relays the findings to the surgeon by phone and/or live video feeds.

Not everyone has a sharp eye — or strong stomach — for scrutinizing fragments of tissue and bone. Yet these behind-the-scenes experts are committed to their science. “We know that the patients are the beneficiaries of our hard work, and are proud to be part of their care team,” Cipriani said.

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