PROCEDURE

As in all modern anatomic pathology laboratories, each histological examination carried out by ISTODIEREVNITIKI is completed in three stages, each of which requires its own individual procedures to be followed.

A. Pre-Analysis

This stage includes steps such as taking receipt of the specimens to be examined, verifying the patient’s identity, logging the case in the laboratory's electronic registers and commencing coded marking of the materials in order for them to match the patient and be traced throughout the entire course of the testing process.

Our primary aim is to ensure that end results match the right patient.

Failures in sample identification can lead to unwarranted medical procedures.

Individuals outside the laboratory (referring bodies or clinicians) are naturally involved in this process by correctly and fully filling out the referral note and complying with the instructions on how the sample is to be packaged, labelled, and transported.

B. Analysis

This stage includes all steps relating to the processing and examining of specimens in order to obtain an anatomic pathology diagnosis.

The stage begins with macroscopic processing of the specimens (in other words macroscopic description of the sample and obtaining histological sections from specific locations in the case of organs and large specimens).

It continues with the following successive steps at the prepping bench: basic chemical treatment of the tissues, "enclosing” the tissues in paraffin and creating paraffin blocks for the tissue, microincisions (i.e. taking very thin sections of tissue from the block), placing the sections on slides, staining the sections, covering the sections, comparison (i.e. carrying out quality controls on the sections on the slides), compiling all slides comprising a case and matching them to the referral note and finally allocating completed cases to pathologists who will examine them.

The last step in normal histological testing is microscopic examination. During this process the pathologist first examines all slides relating to the case under the microscope.

He/she then takes into account the clinical history (as set out in the referral note), the findings from the macroscopic description, the findings from imaging tests (x-rays, ultrasound, magnetic resonance imaging, etc.) and the results of any other lab tests.

At this point the decision is usually taken as to whether supplementary tests are required or not.

Separate procedures in this stage include rapid biopsy (intraoperative consultation) and supplementary tests (histochemistry, immunohistochemistry, molecular biology) if required.

Taking into account all the above points, the pathologist reaches an anatomic pathology diagnosis.

MICROSCOPIC EXAMINATION IS A QUALITATIVE METHOD OF EXAMINATION, IN OTHER WORDS IT IS BASED ON MEDICAL ASSESSMENT OF THE IMAGE OF THE TISSUES IN THE MICROSCOPE AND NOT ON MEASUREMENTS TAKEN FROM DEVICES.

ANATOMIC PATHOLOGY DIAGNOSIS IS A MEDICAL PROCEDURE WHICH TAKES INTO ACCOUNT MICROSCOPIC EXAMINATION AND CLINICAL DATA AND DEPENDS EXCLUSIVELY ON THE ABILITY, KNOWLEDGE AND EXPERIENCE OF THE ANATOMIC PATHOLOGIST.

C. Post-Analysis

This stage involves preparing the findings or report of the anatomic pathology diagnosis, communicating these to the doctor/patient and the keeping of laboratory records.

It starts with the anatomic pathologist dictating their findings and continues with the findings being transcribed and typed up by the medical secretary, the findings being corrected and validated (approved) by the anatomic pathologist and ends with the findings being communicated to the attendant doctor and/or patient via specific procedures.

Accuracy, precision and trueness, in other words the validity of the anatomic pathology examination overall, depends on effective implementation of all the above steps in each individual case.

A separate procedure in this stage is keeping laboratory records.

ISTODIEREVNITIKI keeps three types of records for all anatomic pathology examinations it carries out.

1. Anatomic Pathology Findings and Referral Notes Records
2. Paraffin Blocks Records
3. Slides Records

In line with international guidelines, we keep the paraffin blocks and slides records for 10 years. After that they are disposed of and destroyed.

Another separate procedure in this stage is borrowing records. Records, and in particular paraffin blocks and slides, can be used to obtain a second opinion from another anatomic pathologist. Moreover, with the ever-increasing spread and application of targeted or tailored treatments, the tissues contained in the paraffin blocks may be needed to help select a suitable treatment after they are assessed using molecular biology methods, either by ISTODIEREVNITIKI or by other specialised laboratories. It is self-evident that such Records continue to be critically important long after the time when the initial findings were made.

These records belong to the patient from whom they came. ISTODIEREVNITIKI, like any other anatomic pathology laboratory, simply acts as custodian of those records.

Patients who want to use these records in the ways outlined above should bear the following points in mind.

1. There is not an inexhaustible quantity of material in the paraffin blocks. In particular, if only small biopsies have been taken, the materials may be minimal or in extreme cases may have been used up in making the initial diagnosis.
2. The anatomic pathology diagnosis is the intellectual property of the anatomic pathologist who made it. In some cases records constitute the only evidence of the first diagnosis.
3. In order to protect both the patient and the anatomic pathologist, ISTODIEREVNITIKI follows a specific procedure (which is the one followed internationally) when lending out such Records.