Here's a paradox for you. By and large, small companies are crushed underfoot by the titans of their respective industries. Yet almost all of those titans were once small companies themselves. Same goes for the companies we'll look back on as winners in 10 years; right now, they're probably just small fries. I'm not saying that Bio-Reference Laboratories (NASDAQ:BRLI) is on its way to eventual titanhood, but this little Northeastern lab company has put together a pretty good recent record of growth.

For the third quarter, Bio-Reference reported that revenues rose 19% on the strength of a 15% increase in patient count, as well as a 4% increase in revenue per patient. However, both the gross margin and operating margin for the period fell below year-ago levels, limiting increases in reported operating income and net income to only 4% and 7%, respectively.

There isn't anything especially novel about what Bio-Reference does. It operates as an independent clinical lab offering a range of testing services like Pap smears, cholesterol tests, urinalyses, and drug tests. Of course, Bio-Reference does also offer a range of esoteric tests (generally more expensive than regular tests), which made up about one-third of the business in this quarter. The company's unusual focus sets it apart from competitors -- it's basically a regional operator serving the New York City metropolitan area.

In addition to a growing business serving correctional facilities (which extends beyond its normal regional area), Bio-Reference competes with big boys like Quest Diagnostics (NYSE:DGX) and Lab Corp of America (NYSE:LH) by being more responsive to customers and offering customized services. I'd say that approach has worked thus far; revenue has more than doubled since 2000.

Can Bio-Reference be the next little company to come out of nowhere and make a name for itself? It's certainly not out of the question. The company has an appealing cancer and genomics business (GenPath), and it appears that medicine is continually moving toward more testing.

That said, it's not all smooth sailing. Medicare recently changed some its reimbursement policies for testing, and Bio-Reference has taken a hit from the lower reimbursement rate for flow cytometry. What's more, there are benefits to scale; the company has pretty thin margins relative to its larger competition. It may not be an obvious buy today, but for investors seeking successful yet unknown companies, Bio-Reference is certainly worth keeping an eye on.

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Fool contributor Stephen Simpson has no financial interest in any stocks mentioned (that means he's neither long nor short the shares).