Pathology clinic brings biopsy services to the community

Aug 11

*Ashley Ortlieb, left, licensed practical nurse, and Jodi Russell, clerk, are part of the team that supports the pathology clinic at the Stelmach Community Health Centre.*

The pathology clinic at the Stelmach Community Health Centre helps patients get answers about unexplained lumps and growths found in the body. Formerly located at the Grey Nuns Community hospital, it now offers specialized diagnostic services in a modern, community-based setting.

What the clinic does

The pathology clinic performs needle biopsies — quick, minimally invasive procedures for detecting cancer, infection and other conditions. Using ultrasound guidance and local anesthetic, physicians insert small needles to collect tissue samples from suspicious growths. Patients are awake during the procedure, and the anesthetic keeps discomfort to a minimum.

"We’re basically a biopsy clinic," says Dr. Adrian Sim, a physician who has been working with the clinic since it began in 2009. "If there are lumps in a patient, we will biopsy them — if they're clinically appropriate to biopsy."

The clinic handles superficial sites, anything that can be scanned with an ultrasound. It does not biopsy growths inside body cavities like the chest or abdomen.

Most procedures are fine needle biopsies, where small amounts of cells are drawn from a lump and analyzed under a microscope. The clinic can also perform larger needle biopsies when intact tissue fragments are needed. Many of the lumps biopsied are thyroid nodules, which can only be detected by ultrasound.

Results while you wait

One of the clinic's strengths is its ability to prepare and assess biopsy samples on-site, during a single appointment, says Adrian.

Once a tissue sample is collected, clinical staff prepare a slide, dry it with a slide dryer and apply stains so it can be examined under a microscope right away. This immediate assessment tells the team whether the sample is adequate and gives early insight into the nature of the lump — whether it is cancerous, infectious or something else entirely.

That initial read shapes what happens next, says Adrian. Depending on the findings, he may take additional samples or submit tissue for different types of analysis, all while the patient is still in the room.

Who the clinic serves

The pathology clinic is referral-based. Physicians refer patients who have lumps that need investigation, and the clinic books them for assessment. If Adrian has seen a patient before and believes a repeat biopsy is needed, the clinic can book a follow-up directly.

The clinic serves adults of all ages. Pediatric cases are possible but can be more challenging due to patient co-operation, so very young patients are typically redirected to the Stollery Children's Hospital.

The team

Adrian is the primary physician serving the clinic from the Grey Nuns Community Hospital. Dr. Cherif Garady, a colleague from the Royal Alexandra Hospital, also operates out of the same space.

Supporting them are clinical assistants and nursing staff who help room patients, assist during procedures and prepare biopsy material for analysis. Booking clerks round out the team.

Before the move to the Stelmach Community Health Centre, lab staff from Alberta Precision Laboratories handled slide preparation and staining for the clinic. Since the transition, the clinic’s staff have taken on those responsibilities — a steep learning curve, but one the team has embraced, says Adrian.

"It's a bit of a challenge, but they're very persistent and hardworking and very conscientious. They're learning the skills quite well," he says.

Clinic schedule

Adrian performs biopsies on Wednesday mornings, and Cherif performs Wednesday afternoons. Adrian also runs additional clinics on Friday afternoons based on referral volume and his availability from his hospital duties.

A bigger space with better equipment

The move from the Grey Nuns hospital to the Stelmach Community Health Centre brought a significant upgrade in both space and technology for the clinic, says Adrian. It now has a new state-of-the-art ultrasound machine, a new microscope and a new cart.

"The new equipment that replaced the old equipment is top-notch. I can't complain. (Covenant Health) was very generous."

The larger facility also means more room for other clinics and for patients to relax before and after their procedures — a change from the tighter quarters of the old outpatient department.

"It's a much bigger building. It's newer, and patients have more room to wander and just relax," he says. "That general aesthetic can really help the patient's psyche as well."

One-stop convenience and easy parking

Adrian notes that as more services come online at the Stelmach Community Health Centre — including radiology, laboratory services and pharmacy — patients will be able to co-ordinate multiple appointments in a single visit.

"Let's say they have a lab test, a biopsy and an X-ray — they can get it all done in one visit."

This wasn’t possible at the clinic’s former location. At the hospital, diagnostic services like radiology were available but not always accessible to outpatients, since hospital patients took priority. The community-based setting is designed to change that.

Another practical improvement for patients is parking, Adrian says. At the hospital, finding a spot was a challenge that sometimes made patients late for their appointments. The Stelmach Community Health Centre's underground parkade and surface lot have made parking a non-issue.

"That's a big advantage," says Adrian.

Room to grow

Adrian sees the Stelmach Community Health Centre as a facility whose potential is still being realized. There is physical space for expansion, and as staffing grows and more vendors and services fill the building, the centre's overall value to the community will only increase.

"It's an impressive facility," Adrian says. "The foundations are there. Once we have the infrastructure, we can increase the staffing and hopefully increase the level of service to the community."