Behind many patient diagnoses is a process that starts in the operating room and ends under a microscope.
UR Medicine Labs has a team of histotechnicians (HT) and histotechnologists (HLT), often referred to as "histotechs," who work around the clock to complete the steps leading up to patient diagnoses for cancer and other diseases.
Histotechs are responsible for taking human tissue to prep, cut, and stain before it's examined by a pathologist. We recognize this important work in honor of Histotechnology Professionals' Day on Thursday, March 10.
"I think most people have never heard of histology," said histotech Wally Pryjmak, who has worked at UR Medicine Labs for two years. He didn't even know what a histologist was when he became a certified medical lab technician. Nevertheless, Pryjmak wants patients to understand the link between his work and their treatment. As he says, "We create the slides your diagnosis is based on, so without us it would be a lot harder to get diagnosed."
The tissue prep process starts after a patient has surgery to remove tissue from the body, often in a biopsy. This tissue is brought to the Surgical Pathology area (located on the ground floor of SMH) and is most often examined first by a pathologist's assistant (PA) who dissects the tissue at a grossing station.
The tissue sample then goes into the hands of a histologist who processes it through a series of alcohols to remove any water, clears tissue in xylene and infiltrates it in paraffin wax. The tissue is then embedded into a paraffin block and the histologist cuts it into paper-thin slices.
Wax slices of tissue then go into a warm water bath to stretch them out and prevent wrinkles before carefully placing the tissue onto a glass microscope slide. The histologist gently scoops the section of tissue onto the slide to dry. He or she then treats the slide with a basic stain (hematoxylin and eosin) to make the sample is easy to see under the lens.
There are up to 75 different stains that reveal certain tissue elements, fungus, or bacteria. A pathologist can request any combination of stains be added before viewing the slide close-up.
In this way, the histologist is part artist and part chef: they must follow a "recipe" of stains to yield a proper reading. Even a small misstep can compromise the diagnosis. Once the slide is treated with the proper stains, it goes to a pathologist who examines it and issues the diagnosis.
The work of a histologist requires careful attention to detail and physical stamina. On average, the histology team at Strong prepares between 800 and 1,200 slides each day.
Diana Scott is the supervisor for histopathology at Strong. To her, the work of a histologist is like an art form. And while patients don't see or speak with the lab team helping behind the scenes, the connection is still very meaningful.
"We care about the production side of things and the quality of the slides," said Scott. "We treat every specimen like it belongs to one of our family members waiting for their test results to come back."
(Top) Histologist Lisa Torregrossa embeds a tissue sample into paraffin wax. Once the wax hardens, the block can be sliced for examination. (Top right) Elizabeth Pilon uses a microtome instrument to slice a piece of human breast tissue that has been embedded in wax.
(Above right) There are more than 75 special stains used to dye tissues so they can be viewed clearly under a microscope. The stains highlight specific tissue components (nuclei, muscle, etc.) or microorganisms (bacteria, fungus) and a combination of stains is often necessary.
(Right) Tissue blocks, or cassettes, are preserved and filed for at least 20 years after a diagnosis is given.
This year, the Department of Pathology and Lab Medicine is benefiting from donations provided by Friends of Strong, a volunteer organization that supports Strong Memorial Hospital through fundraising.
In 2015, FOS allocated a total of $110,004 to Pathology. These funds were used to purchase lab equipment including a triple headed microscope, four centrifuges, a spectrophotometer, a tissue cassette printer and gel photography system.
"The Department of Pathology and Laboratory Medicine is both thankful and gratified at the generous contributions from the Friends of Strong," said Dr. Bruce Smoller, department chair. "So often, a supporting department such as ours, and its needs fall beneath the radar screens of well-meaning organizations and individuals and we are genuinely delighted that the Friends of Strong recognize the manifold important functions of our department."
Friends of Strong is supported by proceeds from Friends of Gift Shop, Finger Lakes Coffee Roasters, the Specialty Shop, and Baby Prints Photography at Strong Memorial Hospital.
In photo: Friends of Strong Council President and volunteer, Rose Faucette (left), Pathology Department Chair Dr. Bruce Smoller, Friends of Strong Director Sandy Arbasak, and Pathology Vice Chair for Administration David Strong.
In February, Pathology residents celebrated the opening of a new and improved study room.
Renovations to the space included new cubicle walls, carpet and a fresh paint job.
The room, which serves as a meeting place and quiet study area, is located on the second floor at 2-6440.
It was previously home to cytopathology, whose office moved to 2-2100 in 1997.
In photos: (Above) Pathology residents Shira Winters, Nisha Patel, and Hani Katerji in the newly renovated resident study room. (Bottom) Sohaib Abu-Farsakh examines slides.
In photo: From left, Dr. David Linehan, chair of Surgery for the School of Medicine and Dentistry, Dr. Hartmut Juhl Founder and CEO of Indivumed, Dr. David Hicks, Dr. Bruce Smoller, and Andrew Deubler, deputy vice president for University Advancement.
About the partnership
The department of Pathology and Laboratory Medicine is now the gatekeeper of a human tissue bank at the University of Rochester Medical Center (URMC).
URMC has signed a 3-year contract with German-based company, Indivumed, to allow patients to give access to having their tissues classified and used for cancer research worldwide.
The operation is fully funded by Indivumed, a startup founded by Dr. Harmut Juhl in 2002. The company will fully fund the biobank in exchange for half of the available samples.
How does it work?
Patients at Wilmot Cancer Center will have the option of giving consent to allow samples of their tissues - taken from biopsies and other procedures - catalogued and used for research. When consenting patients are in surgery, an employee will be stationed in the operating room to immediately take tissue to Surgical Pathology to be examined by a pathologist.
The process must be completed within moments of the extraction. When the tissue arrives, a pathologist must first examine a segment to determine a patient diagnosis. Once confirmed, the remaining tissue is divided into samples that are labeled and entered into a database. Some will be set aside for Indivumed's use.
Dr. David Zhou serves as director of the bank. Dr. David Hicks helped establish protocol for managing samples from the second they arrive to Surg-Path.
How will it be used?
URMC has not yet established protocol for deciding who gets access to the tissue first. Dr. Bruce Smoller, Pathology chair, said protocol will be determined by a group of URMC leaders.
"(Participating) will increase our profile in the research realm at URMC," said Smoller. "One of the goals is to build our research profile by accessing the available resources."
Three Pathology department residents volunteered their time at URMC’s annual Student National Medical Association (SNMA) Pre Medical Conference hosted by current SMD medical students on Saturday, Jan. 30.
Drs. Sapna Patel, Diana Agostini-Vulaj, and Sachica Cheris participated in the daylong event which exposed potential pre medical students – both high school and college to the field of medicine.
The residents were joined by former cytopathology fellow and resident, Dr. Amanda Martin, as well as current URMC medical students. Pathology faculty, Drs. Metlay and Goldman, assisted residents in choosing pertinent cases for the workshop.
For the event, residents organized a hands-on pathology lab with a focus on cardiac pathology. In addition, Sachica and Diana participated in the physician luncheon where they answered student questions and spoke in greater detail about their journeys into the medical field.
Pictured above: Chief Resident of Pathology, Dr. Diana Agostini-Vulaj, examines the lungs and heart of a patient with truncus arteriosus at a cardiac pathology lab demonstration with high school students at the annual Student National Medical Association (SNMA) Conference at University of Rochester Medical Center. Photo provided by Diana Agostini-Vulaj.