The submission of a histology specimen constitutes a request for a consultant opinion. The specimen needs to be well preserved. It is essential that good clinical information is provided so that the histology can be interpreted within the clinical context.
Request Forms
See specimen acceptance policy
Write legibly, avoiding arcane acronyms what may be peculiar to your specialty.
Give contact details. These should be for the person who knows about the patient and wants to hear the report. (This is not necessarily the person who obtained the specimen.) Avoid giving communal "on call" bleep numbers.
Rather than simply repeating oneself under each heading, under Clinical Data give relevant medical history and the clinically suspected (differential) diagnosis. This should include all previous malignancies, whether in the same or any other organ system. Under Nature of Specimen, give the precise anatomical site of the specimen. If there are multiple specimens, there should be a one-to-one correspondence between the specimens listed on the card and the labelling of the specimen pots. State any markers, such as sutures, and their significance. Record any features of the specimen that are likely to be difficult to interpret after fixation, particularly for complex resections.
Specimens
Put the Addressograph on the pot, not on the lid. For multiple specimens, each specimen should go in a separate pot, which should be labelled with the anatomical site, exactly corresponding to the listed specimens on the request card.
Use a large enough pot so as not to distort the specimen; a fixed specimen may be difficult to remove from a small glass tube. Ideally, the volume of formalin should be at least ten times the volume of the specimen; for large specimens, the entire specimen should at least be covered. (Containers are available from the Histology Department's Specimen Reception.) In the event that a specimen cannot be placed in formalin immediately (e.g., passed at home, lungs requiring inflation by the histology department), place it in a refrigerator in a clean container.
Specimens should be sent to the Department as soon as practical after removal. If there is uncertainty about how to deal with any specimen, please telephone the laboratory for advice. It is strongly advised that for any cases which might need extra tests, such as immunofluorescence or electron microscopy, that a Consultant Histopathologist is contacted first. It is best to consult in advance of procuring specimen.
Disposal of specimens
Unless the Department is advised otherwise, all specimens are normally destroyed after approximately 4 weeks. Tissue blocks and slides are kept indefinitely (unless the patient directs otherwise).
Frozen Sections
Please telephone the laboratory reception (4801), giving a day's notice if possible. We may need such notice to ensure that the most appropriate consultant is available to deal with the specimen. A further telephone call to the laboratory should be made as the specimen leaves the operating theatre. If the frozen section is cancelled, please telephone to inform the laboratory. The specimen should be send fresh, not in formalin.
A preliminary report will be issued stating the frozen section diagnosis. Note that this will always be followed by a supplementary report giving the definitive diagnosis based on the formalin-fixed paraffin-embedded sections.
Urgent requests
Routine processing takes 48 hours, 72 hours or more for large or calcified specimens. Additional time is required for immunohistochemistry. If clinically indicated, please mark the request card "clinically urgent". Please indicate the nature and time of the deadline, such as a planned operation or outpatient appointment. It is possible with small biopsies to have a result available within 8 hours, but discussion between Clinicians and Histopathologists is needed for this service. Any reporting required outside usual working hours requires a clinician to talk directly with a consultant histopathologist.
In order to help the Trust to comply with the deadlines set under HSC205 for the treatment of cancers (62 days from the referral of a suspected cancer to treatment), we fast track such specimens. Please mark them "HSC205", preferably using the standard red disc. The HSC205 clock stops when the patient is treated, so do not mark the definitive surgical resection specimens as HSC205. We aim to issue at least an initial report for 95% of HSC205 cases within five working days of receipt.
Cardio-Thoracic Transplant Biopsies
The Transplant Biopsy On-call Service is available outside normal laboratory hours. Please contact switchboard.
Bone marrow trephines
The reporting of bone marrow trephines will be expedited in they are places in decalcifying fixative which comes in yellow-topped containers labeled "decal". Any clot formed from an aspirate and therefore free from bone should be placed in usual formalin fixative.
Carcinoma Data Sets
For major cancers, the Department uses the Data Sets recommended by the Royal College of Pathologists.
EGFR
Testing for EGFR (epidermal growth factor receptor) mutations are sent to the Regional Genetics Service, which quotes a reporting time from receipt of 10 working days. There is a standard request form. which needs to be completed by a clinician. Send the completed form to histopathology at Wythenshawe and we will arrange transfer of appropriate tissue material. This is usually formalin fixed paraffin embedded tissue from a tumour biopsy but other samples can be analyzed (please discuss with us).
Accreditation status of Regional Genetics Service
Lymphomas
Since 1st December 2007, all lymphomas are being reviewed by the Regional Haematolymphoid Service. This is expected to have a turnaround time of 7 to 10 days. Click here to see the Christie Histology Department's accreditation status.
Her2
Testing for Her2 on breast carcinomas is performed at the Christie Hospital.
Skin specimens
According to the volume of work received and the capacity of the laboratory, some non-urgent skin biopsies are forwarded to Pathlore for reporting. The returned reports are transcribed and the reports issued in the usual way.