"There's only one way to find out" replied the surgeon. She aimed her gun and shot the bird dead, then gave it to the pathologist who made the diagnosis -- a pheasant.
We always believe that the pathologists can provide us with the definitive answer. What I remember from pathology lectures at med school is being presented with picture after picture of pink shapes with a various number of black dots. Generally, the darker the slide, the worse the diagnosis. Have things changed since labs have become more automated?
|A portion of breast tissue imbedded and waiting to be processed|
The process involves many steps of fixing and unfixing and is partially automated. Tissue can be taken from the tumour using a biopsy needle which gives a core of tissue. A representative part of the tumour must be biopsied. When the tumour is placed in formalin, the time must be written on the jar as the formalin MUST be fixed for at least 6 hours. The tissue is cut up and parts are imbedded in paraffin.
|Phumeza Siziba slicing up specimens and preparing slides|
|Nahwahl Isaacs processing the tissue for ER testing.|
At the end of the day, the staining is quantified by the pathologist.
Even in a first world lab, there are many steps involved and many possibilities for error to creep in. My last blog dealt with the issue of diagnosis and management of breast cancer in low income countries. I didn't deal with the paucity of reliable laboratory services in Southern African countries. In South Africa, we are lucky to have access to world class facilities. To get serious about improving breast cancer management in low income countries, access to reliable pathology services is as important as access to drugs.
Many thanks to Nicole Morse and Judy Whittaker from Well Woman diagnostics for letting me spend time in their lab.