Our scope of practice encompasses all the major areas of anatomic and clinical pathology, including histology, cytology, flow cytometry and molecular. We have a complete cytology lab, including ThinPrep and AutoPap equipment.
The Delta Pathology Group, L.L.C. is a full service, CAP certified, state of the art pathology laboratory providing pathology services to medical clinics, surgery centers, and hospitals throughout our region. Our areas of interest include:
Diagnostic Services and Consultation
- Anatomic and clinical pathology
- Full service anatomic pathology laboratory serving local and regional clients
- Advanced testing methodologies available in-house
- Rapid test reporting through our electronic reporting system
- Rapid turn around time of test results
Anatomic Pathology Service
- Breast Pathology
- Cytopathology, including thin layer technology
- Gastrointestinal Pathology
- Genitourinary Pathology
- Gynecologic Pathology
- Pediatric Pathology
- Surgical Pathology
- Veterinary Pathology
- Flow Cytometry Service
- Immunohistochemistry and FISH Technology
- Molecular & Cytogenetic testing
- Consultative Services through Pathology Resource Network, L.L.C.
- Administrative Consultation
- Compliance Service
- Billing Services
- Accounting /Payroll
- Human Resources
- Stat Service
- Courier Representative
- Client Service
- Client Representative
- Pathologist availability 24/7
- Laboratory Directorship
- Information Technology
- Web Portal
SPOTLIGHT ON – FLOW CYTOMETRY
The Delta Pathology Group, L.L.C. uses the most current dual laser flow cytometer and a comprehensive battery of monoclonal antibodies to test blood, bone marrow, tissues, and fine needle aspirates for the presence of leukemia and lymphoma cells. Monoclonal antibodies may also be used to define a patient’s immune status.
BREAST PATHOLOGY :
Breast disease is a prominent cause of pathology in medicine. While it is a much greater problem among women, it is also seen in men. A variety of non-malignant diseases are seen in our practice. These include benign tumors, cysts and inflammatory diseases. It is the malignant breast tumor that is the process of most concern. While malignant diseases can be seen in the first three decades of life these tumors are increasingly more common from the fourth decade into the later years of life. Treatment varies according to the cell type and the other prognostic factors, and it is the pathologist that must provide the details of the features of the individual neoplasm so that the therapy can be individualized. The Delta Pathology Laboratory provides histologic diagnosis as well as on site specialized breast studies including ERA, PRA, Ki-67, and Her-2-neu tests that allow the oncologist and radiation therapist to individualize the treatment. We work closely with the breast surgeon and the oncologists while the patient is being evaluated and treated and are available for any follow-up studies that are required for continued monitoring.
CLINICAL PATHOLOGY :
When diseases assault the human body, many physiological and immunological changes occur. Such changes may be hematologic, with abnormal blood cells or cell counts; biochemical, with variation in chemical ions, compounds, enzymes, or other proteins; or measurable antibody responses. In infectious disease states, the offending bacteria, virus, or parasite may be isolated and identified.
In conditions requiring transfusion of blood or blood products, tests must be performed to assure serological compatibility, so that serious or even fatal transfusion reactions do not occur.
All of these procedures and many more, constitute the realm of clinical pathology. It is the responsibility of the clinical pathologist to assure that each test or procedure produces results which are reliable, reproducable, and accurate. The clinical pathologist is often called upon as a consultant by other physicians to assist in interpreting laboratory results. In this sense, the pathologist is the physician’s physician.
All pathologists in The Delta Pathology Group, L.L.P. are board certified clinical pathologists. We provide services to the vast majority of clinical laboratories in North Louisiana from small “stat” laboratories to very large hospital clinical laboratories which perform almost two million lab tests annually.
As in every specialty in pathology, the pathologists of Delta Pathology are available twenty-four hours per day, seven days per week to assist laboratories and physicians that utilize our services to assure the highest level of patient care.
Cyto (Greek for cell) pathology (Greek for study of disease) is the science of diagnosing disease by looking at individual cells spread on a glass slide. Doctors obtain a specimen by scraping or brushing a body surface (such as taking a pap smear) or by removing or aspirating some cells with a needle and syringe – such as fine needle aspiration cytology. Cytopathology differs from surgical pathology by being “cell” based rather than “tissue” based, and may require only a few cells for correct diagnosis of the underlying disease. For this reason, cytopathologists undergo special and intense training in the interpretation of these cellular smears. Following this training they are eligible for subspeciality board certification in cytopathology. In addition to a college degree, specialized training in schools of cytopathology allow individuals to spend one year in an approved institution, studying the cellular diagnoses associated with virtually every organ system in the body. These individuals become registered cytotechnologists and work in approved laboratories.
The pap smear is one of the most important tests in all of medicine. It alone has caused a marked diminution in the number of cervical cancers diagnosed in modern times since it has been responsible for the early detection of abnormalities which could be treated before the process has had a chance to evolve into cancer. In many underdeveloped nations where education of individuals is lacking and cytology services are poorly available, there is still a high rate of cervical cancer noted in the general female population.
Much more is known about the etiology of cervical cancer and, although such entities as “genital warts” have been recorded in the annals of history as far back as the Roman times, it is now known that these warts are indeed transmitted as a venereal disease and care caused by the Human Papillomavirus. This virus is the major cause of cancer of the cervix and, though in most women this virus is self-limiting and does not cause long-term problems, in a small number of women infected each year, it does indeed cause cancer. Since many of these women may have abnormal, but not specific, pap smears, it becomes pertinent that genetic testing for Human Papillomavirus viral DNA be undertaken. Delta Pathology laboratories offers this procedure to the generalist and specialist so that they can use a combination of clinical features, pap smear results and the presence of the virus to determine what is the best treatment plan for each individual case.
In addition, cytopathology is frequently used to determine whether cancer cells are present in the sputum, urine, or other fluids that accumulate in the chest or abdomen. As many as half of the patients with lung cancer have cancer cells in the sputum and a diagnosis can be made with a simple non-invasive test such as a cytology smear rather than resorting to more invasive surgical procedures. Physicians combine the sputum examination with other procedures such as bronchoscopy or needle aspiration of the lung to properly diagnose lung cancer. If a patient has already been treated for cancer, examination of fluid from the chest or abdomen can show if the cancer has spread and whether the patient is in need of more treatment.
Dermatopathology is a subspecialty of pathology and dermatology that involves the histologic evaluation of diseases involving the skin and subcutaneous soft tissue. Dermatopathology is a recognized subspecialty by the ACGME and requires fellowship training in an accredited dermatopathology fellowship training program that includes at least six months of clinical dermatology as well as six months of dermatopathology. The American Boards of Pathology and Dermatology jointly bestow special certification in dermatopathology to those physicians who complete such fellowship training and then pass a specialty examination.
Skin diseases and their accurate diagnoses are an important part of the services that The Delta Pathology Group provides to its clients and patients. Expertise within dermatopathology assures special consideration by a specialty trained pathologist in the evaluation of difficult melanocytic lesions (i.e. nevi and melanoma), routine skin cancers (i.e. basal cell carcinoma and squamous cell carcinoma), as well as interesting inflammatory skin lesions (i.e. connective tissue diseases such as lupus erythematosus as well as allergic drug reactions). Biopsies are generally procured by a Dermatologist, Family Practitioner, or a General Surgeon. These biopsies are processed by our lab, and over 90% of the diagnoses are rendered within 24 hours upon receipt of specimen. Extensive intradepartmental consultation is routinely utilized. A network of national expert consultants are utilized for especially difficult or challenging cases.
Given the increased incidence of skin cancers and melanomas, our dermatopathology service has gotten busier as our aging population seeks increased medical care for skin lesions. Expert correlation of the tissues with the clinical information are utilized on a case per case basis.
FINE NEEDLE ASPIRATION : FINE NEEDLE ASPIRATION
Fine needle aspiration is one of the most sophisticated areas of cytopathology. While a patient’s history, physical examination and other tests may lead to a diagnosis of disease, cancer treatment is usually only done after a pathologist has made a definitive diagnosis on a tissue sample. Tissue may be obtained in the traditional way of biopsy before surgery or by frozen section done at the time of operation. Alternatively, fine needle aspiration cytology can be done before treatment is planned.
What is fine needle aspiration cytology? A doctor inserts a needle into a mass and extracts a small number of cells, which can be processed in different ways by a cytopathologist. Superficial masses can easily be aspirated in a doctor’s office. Deeper masses in the lungs, liver, or abdomen need special x-rays or ultrasound procedures to find the exact location of the mass, and are aspirated in the usual way.
Once a cytopathologist gives an exact diagnosis, the physician can plan the best treatment for a particular disease in each individual patient.
FLOW CYTOMETRY :
The Delta Pathology Group, L.L.P. uses the most current available dual laser flow cytometer and a comprehensive battery of monoclonal antibodies to test blood, bone marrow, tissues, and fine needle aspirates to detect the presence of leukemia and lymphoma cells. A more limited panel of monoclonal antibodies is used to define a patient’s immune status.
Based upon the current literature and standard practices of care, an extensive battery of monoclonal antibodies specific to cell surface and cytoplasmic proteins for T cells, B cells, myeloid cells, NK cells, and stem cells is maintained. The final test panel of monoclonal antibodies is dictated by the results of a preliminary flow cytometry screening panel, anatomic pathology results, and clinical data.
Patient specimens are processed to obtain suspensions of cells and, the cell suspensions are incubated with appropriate monoclonal antibodies. The flow cytometer instrument injects the antibody-labeled cell suspensions into a sheath fluid that is passed through laser beams traversing a quartz chamber. Cell size is defined by the degree of forward angle light scatter, and cellular granularity is determined by the degree of side angle light scatter. In addition, the flow cytometer can simultaneously measure the intensity of four different fluorochrome tagged monoclonal antibodies reacting with each cell that passes through the laser beams.
Based upon forward angle light scatter and side angle light scatter, or CD45 cell surface antigen density and side angle light scatter, or a combination of these two different gating parameters, a heterogeneous population of cells may be segregated into defined cell populations such as lymphocytes, monocytes, granulocytes, immunoblasts, and myeloblasts. Large lymphocytes may also be differentiated from small lymphocytes. Each segregated cell population (e.g., lymphocytes) may in turn be tested for the presence, absence, and level of positivity for a large battery of monoclonal antibodies.
Leukemias and lymphomas represent the monoclonal expansion of lymphoid, myeloid, or precursor stem cells in varying stages of development. Therefore, the patterns of reactivity to a panel of monoclonal antibodies assist in the detection and classification of neoplastic populations.
The World Health Organization has defined the reactivity of monoclonal antibodies used in flow cytometry and assigned a cluster designation (CD) number according to their patterns of reactivity. Delta Pathology’s flow cytometry laboratory section maintains a comprehensive battery of approximately 50 different CD markers.
Monoclonal antibodies designated CD2, CD3, CD5, and CD7 are associated with T cells; CD19, CD20, and CD22 are B cell markers; and CD13, CD14, and CD33 are myeloid associated markers. However, lineage specificity is not absolute for most CD markers; e.g., acute myeloid leukemia frequently expresses CD7 and/or CD19 and acute lymphoblastic leukemia may express CD13.
CD markers that are usually associated with a cell lineage may be lost in neoplastic populations, or the intensity of expression of CD markers may be increased or decreased. A lymphoma may express one CD marker pattern, and the leukemic phase of the neoplastic population may express a different pattern of CD markers.
Flow cytometry can often establish a diagnosis of leukemia/lymphoma in selected cases and in other cases flow cytometry can contribute to the diagnosis. But, in all cases flow cytometry is used in conjunction with anatomic pathology to arrive at a final diagnosis. Occasionally, however, populations will be detected by flow cytometry that would otherwise be missed by anatomic pathology alone.
The identification of a light chain restriction (kappa or lambda) defines monoclonality for B cell neoplasms, and the use of selected CD markers establishes a diagnosis or contributes to the classification of the neoplastic population. Examples below demonstrate the usefulness of flow cytometry in the characterization of some B cell disorders.
Chronic Lymphocytic Leukemia (CLL) is peculiar in that these neoplastic B cells express the T cell marker CD5. Typically, CLL also express dim CD20, dim or negative CD22, bright CD23, and negative CD79b. CD38 positivity in CLL is a surrogate marker for an unmutated germline configuration and a poor prognosis.
Mantle Cell Lymphoma (MCL), a more aggressive B cell neoplasm, may be difficult to distinguish morphologically from CLL, but flow cytometry can provide vital data in its characterization. MCL typically reveals CD5 positivity, bright CD20, CD22 positivity, bright CD79b, and CD23 negativity.
The expression of bright CD11c is observed in Hairy Cell Leukemia and Prolymphocytic Leukemia. Additional markers such as CD103, CD25, CD43, and CD79b assist in differentiating these two neoplasms.
CD10 positivity is most frequently observed in cases of Follicular Cell Lymphoma (FCL), Follicular Hyperplasia (FH), and Diffuse Large B Cell Lymphoma (DLBCL). CD10 positive FHreveals a bimodal CD20 positivity and the brighter CD20 population expresses dim CD10, whereas CD10 positive FCL and DLBCL cases reveal unimodal CD20. Cell size as defined by forward and side angle light scatter assists in differentiating FCL and DLBCL.
In all cases, flow cytometry data are analyzed by a hematopathologist and these data are collated with anatomic pathology results and clinical findings. A staff of laboratorians with specialty certifications in the areas of immunology, microbiology, histocompatibility, and immunogenetics perform flow cytometry patient tests, quality control and quality assurance.
GASTROINTESTINAL PATHOLOGY : GASTROINTESTINAL PATHOLOGY
The full range of gastrointestinal pathology interpretation is offered by The Delta Pathology Group, L.L.P. This includes routine H&E stains on specimens from the esophagus, stomach, duodenum, small bowel, large bowel, rectum, liver, gallbladder, and pancreas as well as histochemical and immunohistochemical staining of the tissues as indicated by the histology or clinical setting. Pathologists with a particular interest in gastrointestinal pathology will be reviewing the cases and extensive intradepartmental review of interesting cases is routinely performed. Correlation of the tissues with the clinical setting, imaging studies, and laboratory findings is also performed in conjunction with the physician in cases of interest.
GENITOURINARY PATHOLOGY : GENITOURINARY
Genitourinary pathology refers to a subspecialty of surgical pathology which deals with diseases of the kidney, ureter, urinary bladder, urethra, testicle, and prostate gland. The changes studied in this subspecialty may include congenital abnormalities, metabolic processes which bring on changes in these organs, infertility studies, infectious processes and both benign and malignant tumors. Recently, the advent of renal transplant surgery has initiated the addition of transplant pathology to the subspecialty. With the discovery of a simple serum test to screen for prostatic cancer (PSA) along with high profile celebrities offering testimony about their ordeals with this disease, we have seen an increase in the number of biopsies of the prostate gland to rule out malignancy. It is known that prostate cancer is the second leading cause of death in adult males, being second only to lung cancer. Thus, there has been a resurgence in awareness of diagnostic tools available to the urologist as well as treatment parameters, both surgical and non-surgical to lay personnel. Numerous studies over the recent years have shown how needle biopsies of the prostate are a relatively easy way to obtain tissue for study without placing a patient at the risk of general anesthesia and loss of time in the work force.
Today, multiple core biopsies of both sides of the prostate as well as “saturation” biopsies help the urologist to stage, grade, and determine the most effective treatment for the patient. Thus today, the urologic pathologist is seeing more biopsies of the prostate as well as the urinary bladder and kidney than ever before. Treatment in most instances is being effected and there is still hope for a cure. The urologic pathologist plays a vital role in the overall treatment plan of the patient by giving the urologist information concerning the cell type and aggressiveness and stage of the tumor in question based on the tissue submitted. We now have additional testing procedures such as immunoperoxidase stains and DNA ploidy studies of the tumor cells designed to give further information to the urologist and aid in the overall treatment plan of the patient.
GYNECOLOGIC PATHOLOGY :
The field of gynecologic pathology involves disease diagnosis of organs within the female genital tract. These include: the uterus, ovaries, fallopian tubes, uterine cervix, vagina, vulva and adjacent tissues. The Delta Pathology Group, LLP provides a full array of diagnostic expertise in the field of gynecologic pathology. Tissue examination for the diagnosis of benign and malignant diseases of the female genital tract is performed daily. Correlation of abnormal cytologic findings on Pap smear with biopsy material is an important component of patient care related to the early detection of cervical abnormalities including premalignant and malignant processes (dysplasia and carcinoma).
Co-ordination of efforts between cytopathologists and surgical pathologists within the group allows for timely and accurate assessment of tissue and cytology in order to provide maximum information to the patient and clinician. Additionally, pathologists at Delta work with gynecologists and gynecologic oncologists, evaluating tissues removed at surgery to provide accurate data for the appropriate diagnosis and staging of patients with malignancy. This allows for selection of proper therapeutic regimens to provide patients with the greatest possible benefits and chances for cure.
Hematopathology is the study of diseases that involve the blood, bone marrow, and lymphoid tissue that include myelodysplasia, leukemia, and lymphoma. The diagnosis of hematopoietic neoplasms requires the integration of numerous pieces of data to arrive at a final diagnosis. Although routine histologic examination remains the most important technique for establishing a diagnosis, numerous ancillary studies are now available to assist with the diagnosis. These exciting new techniques include immunophenotyping by flow cytometry, molecular diagnosis, conventional cytogenetics, and fluorescent in situ hybridization (FISH). These techniques require a fresh tissue sample, so it is very important to anticipate what ancillary studies might be needed. Hematopathology is a recognized subspecialty and requires fellowship training in an accredited hematopathology fellowship training program for at least one year. A special certification is given to qualified physicians after passing hematopathology boards given by The American Board of Pathology. Delta Pathology offers expertise in hematopathology and a complete diagnostic service including state of the art 4-color flow cytometry.
Flow cytometry is a reliable and rapid technique for immunophenotyping hematopoietic cells. Large numbers of cells can be analyzed quickly due to the lack of cohesiveness of hematopoietic cells. Hematopoetic cells express a large number of cell surface antigens and flow cytometry detects normal and abnormal patterns of antigen expression. Flow cytometry is a necessity in the diagnosis of leukemias and extremely helpful in the diagnosis of lymphomas.
Molecular diagnostic tests include Southern blot, PCR, and RT-PCR. These techniques are able to detect a clonal, or neoplastic, population of lymphoid cells that have the same antigen receptor gene rearrangement or chromosomal translocation. These tests are very sensitive and can detect a minor neoplastic cell population. These tests are not necessary for the diagnosis of most hematopoietic neoplasms, but can be of great value in difficult cases.
Conventional cytogenetics uses chromosome metaphase spread analysis to detect structural and numerical chromosomal abnormalities. The most well known translocation that people associate with this technique is t(9;22) or the Philadelphia chromosome that is the diagnostic hallmark of chronic myelogenous leukemia. Cytogenetic analysis has become an integral part of the diagnosis in acute leukemias and myelodysplastic syndromes.
FISH is used to detect structural and numerical chromosomal abnormalities within intact cells or metaphase spread samples. Fluorescently labeled probes consisting of specific single stranded DNA sequences can bind complementary denatured DNA segments to detect specific chromosomes or gene sequences. It is very useful in detecting chromosomal translocations especially in cases of masked or cryptic translocations sometimes encountered using conventional cytogenetics.
Immunohistochemistry is the application of immunologic principles and techniques to the study of cells and tissues. No other process in the last 50 years has revolutionized the field of pathology to a greater extent as this technique. Tests employing monoclonal and polyclonal antibodies reactive with a wide variety of antigens expressed by lymphoid and non-lymphoid neoplasms are available and offered at Delta Pathology. These tests are performed on sections of routinely processed tissue. They can also be performed on cytologic preparations. Different panels can be performed to distinguish lymphoma from carcinoma and to determine different immunological classifications of lymphoma. These tests are also useful in determining the site of origin of a metastasis in cases where the primary tumor site is unknown.
MOLECULAR PATHOLOGY : MOLECULAR PATHOLOGY
Molecular pathology is an emerging specialty within the field of anatomic and clinical pathology that uses DNA analysis and specialized molecular techniques for the accurate classification and diagnosis of malignancies and infectious diseases. Molecular pathology, within our laboratory, currently encompasses a state of the art, in-situ hybridization lab that characterizes viral serotypes (i.e. HPV, HSV, CMV), as well as flow cytometry (i.e. immunophenotyping of blood disorders). Our laboratory is committed to procuring the latest technologies, and we are looking forward to expanding our diagnostic capabilities in this emerging area very soon.
PEDIATRIC PATHOLOGY : PEDIATRIC PATHOLOGY
Pediatric pathology includes diseases unique to the perinatal period, infancy, and childhood. Perinatal diseases encompass disorders of the placenta and fetus as well as maternal maladies associated with pregnancy. Many disease processes and tumors that occur in children are unique to younger patients; however, some diseases that occur in both children and adults manifest themselves quite differently in childhood. Children can present with both acquired disorders and congenital problems.
QUALITY CONTROL :
It is imperative to assure uniform agreement in diagnoses of surgical pathology specimens. In order to accomplish this, Delta Pathology has initiated several programs and policies.
Cases are reviewed at a daily sign-out conference and, if a significant discrepancy exists among pathologists in the group regarding the diagnosis, outside written consultation is obtained.
In an effort to provide a systematic approach for quality assurance, a percentage of cases is reviewed randomly by another pathologist, regardless of complexity of the diagnosis.
In addition, 100% of frozen section diagnoses are reviewed and compared with final diagnoses. Likewise, all cases reviewed by other institutions are evaluated for correlation.
In terms of ongoing education, all members of the group participate in programs of Performance Improvement and Check Samples sponsored by The College of American Pathologists by whom The Delta Pathology Group, L.L.P. is accredited. Additionally, all members of the group are encouraged to obtain Continuing Medical Education in their area of subspecialty and expertise.
In the department of Cytopathology, considerable thought has gone into providing the highest quality control, quality assurance, and quality improvement in the area of pap smear testing. For instance, each pap smear is subjected to multiple checks to assure the patient of the highest quality testing at all times. The competency of testing personnel is assured by a re-screening of a percentage of the screener’s slides by a second screener. Each month, an evaluation of each technologist is made, printed, and studied for any trends. Monthly, each cytotechnologist’s performance is evaluated and compared to quality assurance standards. A remedial action policy defines corrective action taken if scores are not consistently in the optimal range. In addition, workload limits are placed on each technologist daily to assure that fatigue does not become a factor in screening procedures.
Delta Pathology’s quality control practices mandate that a minimum of 20-25% of each cytotechnologist’s negative pap smear diagnoses be re-screened by another cytotechnologist or pathologist. Delta Pathology has also invested in the AutoPap Primary Screener as well as the Thin Prep technique, further adding measures to assure quality results and diagnoses.
In addition, diagnostic correlations, tissue-pap correlations and follow up of high grade and malignant paps are routinely performed. Since Continuing Education is a vital part of our overall quality program, our department participates in glass slide assessment tests as well as attending regional and national cytology meetings and workshops.
Finally, the laboratory participates in a very comprehensive accreditation program directed by The College of American Pathologists. This evaluation occurs every two years with a self evaluation in between inspections.
In summary, these programs together with daily concentrated diagnostic work help to assure accurate and reliable diagnoses for the patients of The Delta Pathology Group.
SPECIMEN PROSECTION :
Every surgical pathology specimen that is received in the Delta Pathology laboratory is carefully accessioned, inspected and given a unique identifying number, which will forever be associated with that specimen. Each specimen’s characteristics visible to the naked eye or by “gross examination” are recorded as part of the “gross description” portion of the surgical pathology consultation report. Parameters such as size, weight, color, and texture are noted and many specimens may have quite detailed descriptions as surgical specimens may range from tiny endoscopic or needle biopsies to entire organs. Often the gross appearance of a specimen is a vital part of the information needed by your physician to evaluate a patient’s condition. It can be a very valuable tool for the consulting pathologist to use to decide how best to diagnose and evaluate a disease process or neoplasm. The gross description also includes the number and types of samples submitted for microscopic examination and serves as a written archive for any subsequent consultant or physician involved in that patient’s care.
TRANSPLANTATION PATHOLOGY : ORGAN TRANSPLANTATION
Organ transplantation is regularly performed in our area. Kidney, heart, and liver transplants are common. Lung and pancreas transplants are also occasionally performed. In evaluating a patient for transplant, Delta Pathology processes samples of the diseased organ so that the surgeon can determine suitability of the candidate. Following transplantation, the status of the transplanted organ is followed by a number of methods, including tissue samples taken by biopsy at prescribed intervals. Routine microscopic studies are performed. CD8 studies by flow cytometry, to assess immune status, are also offered. The reactions seen in these studies assist the treating physician in determining the need for anti-rejection therapy and in planning the therapy required. Delta Pathology has been a part of this team from the beginning of transplant surgery in this region. We process routine studies and perform emergency processing when necessary.