This page contains information for healthcare professionals regarding histopathology specimen:
The department receives material from all major surgical and medical disciplines and general practice surgeries. There are facilities to process renal biopsies with off-site electronmicroscopy.
Muscle biopsies, after prior consultation with the laboratory, may be processed at King's College Hospital. Diagnostic material from paediatric neoplasms should be sent directly to the Pathology Department at St George's Hospital.
In general all specimens should be fixed in adequate volumes (ideally 10x the volume of the specimen) of 10% buffered formal saline and sent to the laboratory.
Failure to use adequate amounts of buffered formal saline will result in potential loss of morphology, the potential loss of diagnostic information within the specimen and will also hinder ability to perform subsequent special stains that may be required for diagnosis.
Skin biopsies requuired for immunofluorescence must be sent as soon as possible in normal saline solution.
The protocol for sending muscle biopsies can be obtained after direct discussion with the department (ext 2495 St Helier Hospital and ext 6093 at Epsom Hospital)
Testicular biopsies should be sent in Bouin's fixative obtainable from the laboratory
Lymph node and other specimens on which microbiological examination is required must be divided, and a portion placed in a sterile container and submitted to microbiology directly.
Lymph nodes removed from suspected lymphoma are to be submitted fresh and intact and sent immediately to the histopathology laboratory.
Please notify the laboratory well in advance of sending these specimens so that a pathologist and senior biomedical scientist can be on hand to process them.
Lymph nodes sent outside of laboratory hours are best sent in buffered formal saline.
Large bowel specimens should be sent fresh and intact in normal working hours. At other times to be submitted in adequate buffered formal saline.
Specimens should be sent in dedicated pots or containers with the lids tightly closed. These should be placed in a leak-proof plastic bag, preferably one having separate compartments, one for the specimen and one for the accompanying request card.
Both the specimen and the accompanying request card should have a minimum of the patient's age, hospital number, consultant's name, NHS number and relevant clinical details. If there is a discrepancy in this data or it is incomplete this is likely to result in a delay in the material being processed and a delay in diagnosis. The NHS number is required to help prevent the duplication of medical computer records which is a potential clinical risk.
Specimens should be sent to the laboratory as quickly as possible to prevent both deterioration and to assure rapid diagnosis. If there is a delay in the ability to send fresh material or material in normal saline for immunofluorescence, this should be kept in the fridge until transportation is possible.
If multiple specimens are removed, each is to be placed in a separate container and labelled with the usual demographic data and either a number or other distinguishing feature e.g. site. If a numbering system is used then the sites to which the numbers relate must be shown on the request form.
Turnaround time commitments are calculated from the date received not the date sent. These are normally:
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three working days for specimens labelled 'urgent' by clinicians or pathologists (urgency can also be added later at the pathologist's discretion);
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ten working days for 'non-urgent samples' and 'major resections'.
If clinicians phone for a case which is still within the turnaround time period they will be informed that the result will be on Clinical Manager by the expected turnaround time limit.
Only cases that have exceeded the turnaround time will be brought to the attention of the pathologist.
If a clinician is bringing a patient back or requires a result in less than ten days, this has to be mentioned in the request form at the time of ordering the test.
These should be discussed with laboratory staff (ext. 2495 St Helier Hospital and ext. 6093 Epsom Hospital) in the first instance and the request form marked appropriately. If there are special requirements with regards to speed of a result, these should be clearly stated on the request form e.g. result required by.
Please book frozen sections twenty four hours in advance (ext 2495 St Helier Hospital and ext 6093 Epsom Hospital) wherever possible and notify the laboratory if the time is changed or the opreation cancelled. Except in exceptional circumstances frozen sections can only be done between 09:00 and 17:00. If frozen sections are required on patients with AIDS or other infectious conditions please contact one of the consultant histopathologists.
Surgical resections, biopsies and specimens known or suspected to be high risk of infection (HBV, HIV, TB and CJD) require additional handling precautions.
Specimens such as complete lymph nodes and larger tissue resections are seldom completely fixed when they reach the laboratory. Such specimens from 'High Risk' patients should be left in fixative in a container until adequately fixed before processing. This may mean several days immersion and a judgment will be made in each case.
Frozen sections of unfixed material from high risk patients will not be prepared. In exceptional circumstances it may be possible to prepare frozen sections of unfixed material from such patients but only after prior arrangement with the histopathology laboratory and full discussion with consultant histopathologist.
Surgical specimens are stored for approximately six weeks after a report is issued. If new clinical information becomes apparent that might require further investigation of the unprocessed tissue, if available, these should be raised during this period. Diagnostic slides are kept for a minimum of ten years and tissue blocks for a minimum of thirty years.
Any specimen or report may be discussed with the consultant histopathologist
Please do not request results by telephone, except in emergencies. Only validated results of histopathological / cytopathological diagnosis are to be communicated to the requesting clinician or an authorised deputy, by a histopathology consultant or secretary (with specific authorisation for each case) and only if the identity of the enquirer is beyond doubt.
Results will only be faxed to 'Safe Haven' fax machines and will only be sent following the completion and return to the department, of a 'Safe Haven' confirmation form. The departmental secretaries will fax these forms on request. This confirmation will be kept on file for future reference so will only need to be completed once for any single fax number.
