Dr. George Hollenberg of Acupath Lab Offers Tips for Understanding the Mysteries of Biopsies

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Being able to treat a malignancy in its early stages increases the chance of recovery. This is when possibilities of a cure are greatest, and treatment is least costly. The missing link: how pathologists save lives.

A doctor you never meet may be the one who saves your life. Pathologists, doctors who specialize in the diagnosis and classification of diseases by analyzing cells under a microscope and through medical laboratory tests, often detect a disease in its infancy.

“Being able to treat a malignancy in its early stages increases the chance of recovery,” says Dr. Hollenberg of Acupath Laboratories, a specialty medical lab based in New York. “This is when possibilities of a cure are greatest, and treatment is least costly.”

Pathologists are the unsung heroes of the healthcare industry. According to the American Society of Clinical Pathology, laboratory services may be allotted 5 percent of a hospital’s budget, but they leverage 60 - 70% of all critical decision-making, such as admittance, discharge, and medication. They generate data that physicians use to make their diagnoses on infectious diseases ranging from cancer to the H1N1 virus, which is expected to resurge this fall.

When a pathologist examines a tissue sample, he or she determines whether a tumor is benign or cancerous, what type of cancer is present, how it looks (cancer grade), how far it has spread (cancer stage), and other aspects.

According to the National Cancer Institute, pathologists are on the cutting edge of proteomics, the study of all proteins in a cell, tissue, or organism. “The proteome is much larger and more complex than the human genome,” says Dr. Hollenberg. “The hope is that proteomics may revolutionize methods for the early detection, diagnosis, and prognosis of cancer.”

After an initial test suggests that an area of tissue in the body isn't normal, a doctor may want to biopsy a sample of tissue from the area to examine it more closely. Biopsies are usually performed to look for cancer, but they can help identify many other conditions, including infections and autoimmune disorders, such as lupus.

Dr. Hollenberg addresses some of concerns patients commonly have about the biopsy process.

What kind of biopsy will I have, and who will perform it?
There are many different kinds of biopsies, including needle biopsies, for which cells are extracted through a needle; incisional biopsies, for which tissue is removed through a small cut in the skin; and excisional biopsies, for which part or all of a tumor is surgically removed. Your primary care physician will refer you to a specialist, such as a dermatologist or urologist, or to a same-day surgery unit.

What should I expect during the procedure?
Biopsies vary greatly according to how difficult the tissue is to obtain. A minimally invasive biopsy (for example, most skin biopsies) may be done during the same visit to the doctor’s office in which the lesion is discovered. A small injection of numbing medicine can make the procedure nearly painless. More invasive biopsies may be done in a hospital or a specialized doctor's office. In most cases, sedating and pain relief medicines are given, and the patient most likely won’t be able to drive afterward.

Who will read my biopsy, and what can they learn from it?
Besides identifying cancer, biopsies can determine the hormone receptor status of certain cancer,; infer the speed of the cancer's growth, the likelihood of metastasis, and the grade or stage of the cancer.
Many popular health insurance plans either require or encourage patients and their doctors to choose their “mega lab” services. At some of these mega labs, the qualifications and the identity of the pathologist reading the specimens are nearly impossible for the primary care physician to determine. This anonymity is an obstacle if the physician needs to consult the pathologist regarding the results.

"Patients can choose to have their samples sent to an independent pathology lab specializing in the type of biopsy they're having, or in the type of cancer for which the biopsy is testing," says Dr. Hollenberg. “At Acupath, each doctor on staff specializes in a particular area of pathology, assuring the primary care physician and/or specialist, as well as the patient, that a qualified expert is available for everything from gastroenterology samples to breast biopsies.”

How will I feel afterward, and how can I expedite recovery?
Most biopsies, even minimally invasive ones, are outpatient procedures that allow patients to recover at home. For surgical biopsies with a likelihood of subsequent pain at the site, most doctors will recommend prescription-strength medication or over-the-counter pain relievers for the first few days. Patients should also receive information on how to care for the wound, instructions for bathing or showering, and a follow-up appointment within one week of the surgery.

How and when will I get my results?
The time it takes to get results varies. During a surgery, a pathologist may read a biopsy, and report back to a surgeon, in a few minutes. In most cases, a diagnosis will be available within 24 - 48 hours. Final, highly accurate conclusions on biopsies often take a week or longer. The prescribing physician should contact the patient to confirm the results, and discuss the next steps. For life-threatening results, patients may want to consider a second opinion by an independent pathologist. The most common cause of misdiagnosis is “premature closing”, a physician’s failure to consider other possibilities after an initial diagnosis is reached.

Bio: As the founding director of Acupath Laboratories, Inc., Dr. George Hollenberg supervises the analysis of thousands of biopsies each year, utilizing the most cutting-edge technology in histology and immunocytochemistry, as well as the latest advances in computerized report preparation. He is a veteran in the fields of pathology and dermatopathology, with expertise in the areas of dysplastic nevi, melanoma and other forms of cancer. Board-certified in dermatopathology, and clinical and anatomic pathology, Dr. Hollenberg boasts visiting fellowships in dermatopathology from New York University Medical Center and Jefferson University Medical Center. After receiving his medical degree from New York Medical College, he completed his residency in clinical pathology at Cornell University Medical Center and in anatomic pathology at Columbia Presbyterian Medical Center. Dr. Hollenberg is currently a consultant in dermatopathology for North Shore University Hospital in Manhasset and an assistant professor in dermatology at Stony Brook University Medical Center. Often contacted by editors for his expertise, Dr. Hollenberg has written dozens of medical articles and has had his work published in various acclaimed medical journals and publications.

Acupath Laboratories, Inc. located in Plainview, New York, is an anatomic pathology and cancer genetics laboratory. http://www.acupath.com


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