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My lab: diagnostic cytopathology and molecular

Specialist Biomedical Scientist Beth Carroll gives a guided tour of her laboratory in Cornwall.

I work as a Specialist Biomedical Scientist at the Royal Cornwall Hospital NHS Trust (RCHT), rotating between diagnostic cytopathology and molecular cell biology.

We work collaboratively in the laboratories and with our trust’s clinical teams to improve patient care, getting the most from even the smallest samples.

Giemsa and PAP staining techniques enable quick evaluation of routine diagnostic cytology samples, which include a range of bodily fluids.

It is often necessary to make an induced clot block from certain specimens, so that immunocytochemistry and/or molecular testing can be carried out to aid diagnosis or treatment.

We have an established biomedical scientist-led, rapid on-site evaluation (ROSE) service for endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS), and head and neck procedures, with seven clinics running per week. A trained biomedical scientist is present in the clinic to determine sample adequacy/volume for diagnosis and subsequent specialised testing, such as flow cytometry, in real time with diagnostic material being taken all in one appointment. This is cost-effective best practice that saves time, preventing multiple appointments for the patient. We currently have four fully trained staff who perform ROSE and I am looking forward to commencing my own training very soon.

At the beginning of this year, “Remote ROSE” was rolled out to external hospitals served by RCHT. A biomedical scientist located at the main RCHT site can perform ROSE on slides made by a trained clinical imaging assistant at another location. The idea is to allow more patients to locally access this service, increase the number of fine needle aspirates (FNAs) taken with ROSE, and to promote training and development of new specialised skills within the profession.

We have an extremely effective immunocytochemistry service, with most antibodies being available in house, aiding faster turnaround times and enabling full optimisation and diagnostic potential from cytology samples.

We carry out in-house molecular testing, primarily to aid rapid treatment options. This utilises fully automated real-time PCR, with results being available in as little as three hours. Current tests we perform are BRAF, EGFR, and KRAS for melanoma, lung, and colorectal adenocarcinomas. These tests are generally performed using formalin-fixed paraffin-embedded (FFPE) histological tissue/cytology clot samples, however, following the KEBI study run at RCHT in 2022, we now use liquid-based cytology (LBC) samples for both EGFR and KRAS testing in lung pathology. New testing kits are being developed all the time and our department is enthusiastic about the validation and implementation of any that will enhance patient treatment pathways.

In addition to in-house testing, we work closely with the Southwest Genomic Laboratory Hub (SW GLH) in Bristol, to where we refer cytological clots and histological tissue for a range of genomic testing. These tests are important for patient diagnoses, as well as determining eligibility for specific targeted therapies, known as “personalised medicine”.

I am proud to be part of such an innovative and collaborative team.  Although we are behind the scenes to many in the hospital, the team is integral to the diagnosis and treatment plans for so many of our patients in Cornwall.

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