FREQUENTLY ASKED QUESTIONS

According to the National Institutes of Health, precision medicine constitutes an emerging approach for the treatment as well as the prevention of diseases which takes into account not only the personal variability in genes but also the environment and the way of life of every patient. This approach will allow doctors and researchers to predict with greater accuracy which method of prevention and which method of treatment will glean the best result for specific ailments in specific groups of people. This approach comes in stark contrast to the “one size fits all” logic, in which the prevention and treatment strategy is developed with the “average human” as a template with no regard for the basic differences of every individual.

In the occasion that fluid or very small pieces of tissue need to be collected (for instance singular cells instead of cell groups, like the ones contained in the fluid around the lung), a specialized procedure may be used that is called Fine Needle Biopsy (FNA). What differentiates “Microdiagnostiki” from the competition, allowing it to provide high diagnostic accuracy and trustworthiness? “Microdiagnostiki” guarantees the correct management and handling of the FNA sample in the following ways: -Every sample that turns up at the laboratory is checked both by a technician and a doctor to determine its suitability for creating a CELL BLOCK out of it. -Immediately afterwards, the sample goes through the following process:

• Part of the sample will follow the usual treatment in the cytological department of “Microdiagnostiki” which ends with the creation of slides to be viewed under the microscope by the cytologist.
• The remaining sample will be treated at the histological laboratory of “Microdiagnostiki” to create CELL BLOCKS out of it. This has the following effects:

1. It allows for better study of the material under the microscope,
2. It secures sufficient amounts of material for further study if the need arises.
3. It increases the diagnostic accuracy (allows for specialized testing on the sample.
4. It minimizes the likelihood that a second FNA procedure will need to be performed on the patient, this cutting down on possible discomfort
It secures material for molecular examination (which increases the likelihood of providing a targeted treatment)

In every case, consult your gastroenterologist. Barrett’s esophagus is a condition during which some cells of the esophagus’ lining turn into non-normal cells (known also as intestinal metaplasia) It appears in patients witch chronic Gastroesophageal Reflux (GERD) and is associated with heightened risk of cancerogenesis and as such needs to be monitored. Who does the condition usually afflict?

– People with chronic, insistent and intense GERD
– Around 10% of patients with GERD exhibit the condition
– Smoking, obesity, consumption of meals right before sleep, fatty foods and caffeine all associate themselves with GERD and may lead to the development of Barrett’s Esophagus.

What are the symptoms?

Barrett’s Esophagus doesn’t exhibit any symptoms or indication in and of itself. The symptoms are usually associated with the reflux which causes the condition. In some cases patients show a narrowing of the esophagus due to the reflux which makes swallowing difficult.
How is it diagnosed?

Barrett’s Esophagus can only be diagnosed with the use of endoscopy (esophagoscopy) which is done by a gastroenterologist. The esophagoscopy is done by using a self-illuminating camera placed at the end of a bendable instrument that is gradually pushed through the esophagus in order for the doctor to view the internal lining. During this procedure a tissue sample or samples are collected so that they may be examined by a pathologist.

How is it treated?

– With a change in diet and habbits in order to minimize the chances of reflux.
– With pharmaceutical treatment to limit or block the acid production in the stomach

Regular esophagoscopies are necessary for all patiens with Barrett’s Esophagus. If the pathologist determines after examining the corresponding tissue that the condition has developed a dysplasia (precancerous changes) then an increase in monitoring sessions becomes necessary. Additional measures may be deemed necessary depending on the severity and size of the dysplasia.

No. The pathologist collaborates with the clinical doctor from the first to the last stage of the disease or condition that made you visit him in the first place and can offer his or her opinion if and when needed by you or your doctor, but he or she cannot substitute the clinical doctor. We are always here to offer our support yet you should never forget that the final decision for all medical matters is taken by your clinical doctor in collaboration with yourself.

The Human Papillomavirus (HPV) can enter the human body and cause an infection irrespective of the sex of the patient. More than 200 types of HPV have been observed, most of which don’t cause serious symptoms to most humans. However there are a few types that can cause condylomata (benign neoplasm), while other types may lead to the development of cancer (malevolent neoplasms) in the cervix, the vagina, the pudenda and the anus in women as well as in the anus and penis in men. The virus types responsible for the benign neoplasms are characterized as “low risk” and the types that can lead to cancer as “high risk”.
Unfortunately the majority of people affected by HPV aren’t aware of the fact. The HPV DNA test is a specialized method with which the doctor can not only detect the existence of an infection but also detect whether the virus type (in case an infection is indeed apparent) is low or high risk. Finally, the specific type of the test provided by “Microdiagnostiki” allows us to specifically identify the type of each virus (e.g type 16, 18, 45, 52, 6, 11 etc)

KRAS is a protein that in the human body is codified by the KRAS gene. If the KRAS gene suffers a mutation then it can turn into an oncogene and act as a catalyst for the development of cancers, like the large intestine cancer. After surgically removing the part of the intestine with the tumor, a special preparatory technique of the tissue ensues and a KRAS oncogene test can follow. In this way it is possible to determine whether the tumor (cancer) exhibits the KRAS mutation. If this is indeed the case a targeted pharmaceutical treatment begins which improves the response rate to the medicine.

With the term “biopsy” one means the collection of a tissue sample from the body in order to treat it more carefully.
The doctor will recommend a biopsy to be performed when an initial examination (palpation, radiography, MRI or CT scan etc) reveals an abnormality in an area of the body. The doctors describe a pathological area as a “mass” or a “tumor”. These are the generic words used to describe the unknown nature of the tissue.

Why are biopsies performed?

Biopsies are usually performed in order to look for cancer. However, they may also help with the detection of numerous other conditions.
In most cases a biopsy is performed in order to diagnose a problem or to help determine the best treatment option.

What happens after a biopsy?

After a biopsy the tissue is collected, preserved in specialized fixating liquid (usually formalin) and sent to the histopathology laboratory. The histopathologists (or pathologists) are doctors that specialize in the diagnosis of diseases based on biopsies.

The pathologist examines the biopsy tissue under a microscope. By noting the type of cells that make up the tissue, the shape and the external activity, in most cases he or she is able to diagnose the problem (a process known as a histological exam)
The time that is required for a diagnosis after a biopsy may vary. When a surgery is taking place, the pathologist may be asked to examine a biopsy and provide a report to a surgeon within mere minutes (rapid biopsy). However, in order to obtain extremely detailed and accurate results, sometimes a week or more may be needed.

In all likelihood, you are going to meet face to face with your doctor who is responsible for your treatment in order to discuss the results of the histological exam.

Until recently the histopathologist was asked to make a reliable diagnosis and with the utmost precision, by managing biopsies and large surgical specimens.
Today more than ever the role of histopathologist does not end in the preparation of histological report, but is involved in the clinical management of every oncology patient along with the rest of clinicians’ team.
This is succeeded by offering advanced and reliable precision tests that will determine the treatment of oncological patient.
These molecular tests, i.e. the protein & molecules analysis (nucleic acid) and interpretation of the results, aim in directing the treatment that will be followed to the appropriate drug selection.
A typical example is the contribution of histopathology in diagnosis, treatment and prognosis of breast cancer.
The final findings of histopathology will affect the choice between three different types of treatment:
1. Hormone therapy (estrogen – progestin)
2. Chemotherapy
3. Anti-HER2 therapy

Cytology is the study of the various diseased cells. For the exercise, a sample of liquid or tissue is collected which is spread over a microscope slide and subjected to staining (usually a Pap smear technique).
Thereafter, this sample is examined under the microscope by the histopathologist and cytopathologist to distinguish:
• the number of cells in the tile, • their type, • how they are grouped • as well as what kind of details they present (shape, size, core, etc.).
This information is useful to show whether the cells present some kind of disease as well as what is the most likely diagnosis.

Cytology is primarily used as a disease assessment tool as well as for deciding whether further testing is needed. An example of this kind of assessment is the examination of a breast tumor.
Clinical physician examinations, imaging tests in combination with a fine needle biopsy (FNAB) of the tumor undergoing cytology, can indicate whether breast cancer cells are suspected of cancer or are common / benign.
In case they are suspect for malignancy, a core biopsy with a larger needle can be carried out whereby a larger sample of tissue is collected, allowing a definitive diagnosis by the histopathologist before a decision is made on the type of surgery required to treat the event (local removal of the tumor or removal of the whole breast).

According to the recent European definition:
The pathologist (histologist) is the specialist physician whose mission is
• diagnosis,
• the prognosis of the disease, and
• predicting the response to treatment,
through morphological studies of tissues, cells, and their derivatives.

In day-by-day practice by macroscopic, microscopic examination and molecular methods we are
• defining prognostic and predictive indicators

we follow clear guidelines, both Greek and international.

With precision and clarity, we provide
• final diagnosis,
• sign the histological report.

Our medical acts are repeated many times, as we may be the medical specialty that places and signifies the highest number of diagnoses every day.

The turnaround time, for the reporting of the results, the diagnosis, depends on the following vital parameters: 1. The nature of the lesion is the lesion a well-differentiated tumor? So it is relatively easy to identify. 2. The illustrative findings Is there no other lesion to the patient’s body elsewhere? 3. The history Is this lesion first appearing? Does the examinee have a history of any other tumor? (eg cancer history) Ideally, if the above parameters are met (well-differentiated tumor, new-onset, without any previous history of tumor, without any other lesion to the body at the time of diagnosis), then usually 2 to 3 days are enough for the pathologist to finalize his diagnosis. However, there are many cases where the initial parameters do not contribute to the possibility of a “fast” and reliable diagnosis: – The biopsy specimen contains a very small portion of the lesion – The tumor is of low differentiation – There is a known history of tumor in the past – There is a suspicious focus/lesion to another organ of the body – The biopsy was taken from a metastatic site and not from the primary tumor In these cases, the pathologist is called to use special diagnostic techniques, which aim to reveal: 1. the true nature of the tumor 2. the organ of origin of the tumor, if it is a biopsy from metastatic site 3. the actual biological behavior of the tumor (degree of malignancy) 4. tumor prognosis (chance of recurrence) 5. the optimal choice of drug treatment for the tumor (prediction) The main special techniques are Immunohistochemistry, tumor mutation profile (NGS, rt-PCR), FISH (fluorescent in situ hybridization). It, therefore, becomes a necessary condition, for each such case, to accept that a period of more than 3 days will be necessary to establish a diagnosis as valid as possible. The time frame in these cases depends on the depth of study that will be needed. For example, for the neoplastic disease of the lymphatic system (eg lymphoma), one-week to 10 calendar days is an expected time to complete the study.

Cases of malignant soft tissue tumors (sarcomas), melanocyte lesions of the skin (melanoma), or rare tumors that will require extensive immunohistochemical (or molecular) testing, 7-10 or more days may be required to finalize the diagnosis. THE CHALLENGE By definition, the material that the pathology laboratory is supposed to handle when it comes to analyzing a biopsy is ideally tiny pieces of tissue (tissue pieces) that have a total length of 1 to 1.5 cm and a width of about 0.3 cm. There are cases where the biopsy sample will be even smaller pieces of total length.