Do you know what happens to a stomach biopsy after you have had your endoscopy test?
Have you ever wondered why you don’t get results straight away?
Do you think it just goes to a lab to look at under a microscope?
If your answer is YES, then you are wrong. It is more extraordinary than you can ever imagine and I will show you why!
The journey starts at the point of your endoscopy test.
Your 'endoscopist' sees an abnormality, in your case a possible cancer, and wants to confirm the diagnosis so they take a stomach biopsy.
Why take a biopsy when you have an endoscopic diagnosis? Well, there are two parts to this answer.
The first is your endoscopist can be wrong. We all get it wrong sometimes, its a very human trait, something that looks like a tumor isn't always what it seems.
Think of it this way, you are walking along the street and you see your friend in the distance. You know it’s your friend because they have a certain phenotype or characteristic.
Perhaps they are bold headed, short in stature, always wear the same coat, walk with a certain gait…you know what I mean.
You call out to them and they don’t answer so you increase your pace to catch up with them, but when you tap them on the shoulder…embarrassing moment now and you know what I'm going to say! Well, let’s just say it’s not your friend!
I'm sure this or something similar has happened to you at some point in your life, it certainly has with me!
In the same way, an endoscopist can get it wrong too, although common things being common, they are usually right.
If you are waiting on your result, don’t hold on to that glimmer of hope, because in most cases they are right.
Also, if you don’t have that ‘glimmer’, when you get your result, if it is negative then the feeling of euphoria will be that much greater!
So, back to the stomach biopsy, it’s now in the grasp of special forceps and the journey begins. It’s normally put in to a pot with a preservative, usually formalin or formaldehyde.
Sometimes its placed on a special paper, before going in to the pot. Most endoscopists will take multiple biopsies during your examination if they suspect cancer.
The pot Is labelled with your identification details which usually includes name, date of birth, hospital identifier number and what the pot contains.
It then gets placed in to a sealable bag which has a form attached so the endoscopist can provide your details again and what the specimen is, who has asked for it and where to send the result.
This ‘procedure’ is very important as it is a secure way of sending the correct specimen with the correct details to the lab.
However, like any system, mistakes do happen, particularly if there is more than one person involved with the process.
Usually this is picked up at the time or when it reaches the lab, but of course it should be a ‘never event’.
Your stomach biopsy really does travel, yes I bet you didn't know it travels, but it does!
There are two ways biopsies usually travel, either by hand with a porter or by pod system.
Pod systems are vacuum tubes that connect one part of a hospital to another. In the biopsies case, it’s a pod from endoscopy to the laboratory.
This system is quick and the specimen gets there faster than a porter can walk, which in my experience is quite slow (only joking – I was a porter once as medical student and they do walk a lot of miles in a day).
I've always wondered whether a porter should have a pedometer attached to measure this and become a ‘pay as you go porter’.
It really would be an excellent performance related pay technique, so if there is anyone in health employment reading this, take note!
Anyway, your biopsy now arrives at its final destination and that is usually a laboratory.
The lab technician or MLSO (medical laboratory scientific officer) will accept the specimen, confirm what it is and check that the details are correct.
In days gone by, they would log the sample in a book, but these days its pretty much IT technology that has taken the roll.
Let’s now look at the process of preparation. Each tissue sample taken is millimetres rather than centimetres in size, depending on the size of the forceps that were used.
Of course, you can look at it under the microscope like this, but the best way of having a look is to take slices of tissue from it.
Of course, you can’t just cut a specimen this size with a knife, so it has to go through some preparation. That preparation is to ‘fix’ the tissue in a medium that makes it less compliant so that it is easier to slice. The medium used is paraffin wax.
Usually, biopsies are placed in liquid paraffin wax and are then left overnight to set.
The following day, the block of wax with your specimen in can be sliced in to very fine slithers using a microtome.
This is like a miniature ham slicer and makes wafer thin (actually finer than that) slices of your specimen.
Once these have been done, it can be coated with various stains that show up different features of cells.
When your sample has been stained, it can be looked at under the microscope. The microscopic structures of your stomach lining and the cells that make this up can then be analysed.
In most situations, the biopsies will be looked at by one microscopist and then confirmed or checked by another.
What they are looking for is abnormal cells, cells that don’t look like normal cells and have active mitoses going on (you may remember this term from biology).
Cancer cells, depending on type, have very specific features although I won’t burden you with these details.
Further processing may need to be done over the coming days with special stains to look for very specific features and this is why you don’t get results straight away, it’s a process.
Of course, labs also get a lot of specimens and they only have a finite group of people to look at them, so it depends on the numbers as to how long a result takes.
So now, your stomach biopsy has been looked at and a diagnosis has been made, but wait that’s not always the case!
Sometimes, the diagnosis is still not certain and the lab may advise re-sampling in this situation. As a result, it is possible that you may be asked to have further biopsies taken although this is unusual.
A report is created and this is sent to the doctor who took your biopsy or the doctor looking after you. Again, this is something that is usually done with IT these days, to speed up the process.
However, in days gone by (and may still be the case in your hospital), paper reports were generated and sent.
This was cumbersome and subject to possibly being ‘lost in the system’, which can’t happen quite so easily with computers.
Can the histopathologist get it wrong? Very unlikely these days as the result is usually double checked with a second colleague.
You can never say never when it comes to human fallibility, but highly unlikely.
Biopsies are kept for a finite time, depending on the hospital policy which can vary.
Eventually though, your biopsies will be disposed of in a safe way, usually by incineration.
So, this is the extraordinary life of a stomach biopsy, one that has quite a journey which I am sure you will agree!
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