Pathology tests database

Sample and container requirements

Minimum Dataset required for Cellular Pathology Requests Request forms must be clear and legible. Important information (e.g. clinical history, bleep number etc.) must be clearly indicated on the form and any priority or urgent cases must be marked, such as Faster Diagnosis specimen request forms must contain the FDS Specification stamp .The use of patient ID stickers is permitted however, the full patient sticker must be used NOT the smaller blood tube sticker. Any specimens received that do not meet the minimum dataset criteria will be returned to the requesting department. Trust users can make request via a theatre request book entry or by completing an internal UHB histopathology / cytopathology request form. GP and dental practices should complete the external request form which can be supplied on request from the Department and for internal service users this link http://www.uhb.nhs.uk/gps/laboratory-information/ shows this request form together with specific request forms used within the Trust (QE site) for liver and breast biopsy cases. For Heartlands, Good Hope and Solihull users then request forms are available from the Department of via a request to pathologystores@uhb.nhs.uk TWO unique patient identifiers must be present on both the request form and specimen container i.e. a minimum of the PID, NHS number together with the patient surname and forename/initial in order to be accepted by the department. To ensure that cases are not delayed within the laboratories please make sure that the request form is correctly completed and all sections are filled in properly. Once received urgent cases will be highlighted by the specimen reception and prioritised appropriately in the departmental workload. Request form Patient’s full name. Date of birth. Hospital or clinic PID / NHS no. Address Location Clinical details Request form must be signed Consultant / GP Sample pot requirements Patients full name (or as a minimum; surname with initial) Hospital or clinic PID / NHS no. AND Date of birth If one or more than one specimen is taken from the same patient the specimen containers and request form must be clearly labelled with the sites of the specimen and indicated as parts 1,2,3 etc. Due to the wide range of cellular pathology specimens several key container types exist as below. The size of the specimen container must be appropriate to the size of the specimen to allow adequate fixation. Tissue should be placed into appropriately sized containers which will allow for the specimen and at least ten times its volume in fixative (i.e. neutral buffered formalin) to be contained. DO NOT use containers which are too small to allow for this volume of fixative to be used or squash specimens into small pots. Specimens should be free-floating in fixative not pressed up against the sides of the container as this leads to distortion of the tissue and may make further processing unnecessarily difficult. Small specimens: Yellow Topped 60 mL Containers for biopsies and small resection e.g. skin ellipses, appendicies. Routine specimens: 350 mL White Topped “Honey Pots” - Suitable for larger specimens e.g. gall bladders, larger skin resections femoral heads These pots are also suitable for biopsy specimens where the tissue is adhered to glass microscope slides. Large resection specimens: Specimen buckets without fixative / dry - Fixative is supplied to theatres from pharmacy and is added to the container with the specimen prior to sending to the histology laboratory. e.g. bowel, heart, breast tissue. “Mega” Specimen Buckets: The buckets should be collected from cellular pathology in advance of the surgery taking place. Specimens MUST NOT be placed into yellow clinical waste bags or Griff Bins as these WILL NOT be accepted by the deaprtment. Examples include arge anatomical or specimen resections e.g. large sarcomas. Dry/Fresh Samples (Within Lab hours only): Specimen buckets, 60ml pots / Theatre Tissue Safe system. Dry samples sent to the lab e.g. frozen sections; MOHS samples: lymph nodes; Research projects/biobank samples Small Biopsy Specimens Specimens should be placed into 60 mL pre-filled containers of neutral buffered formalin. Wherever possible small or endoscopic biopsies should be placed into mini biopsy or microcassettes cassettes (small yellow cassettes) before being placed into the neutral buffered formalin pots. Supplies of cellsafe cassettes can be sourced from the Cellular Pathology Specimen Reception. Breast or other fine cores may be placed onto wet white cards/sponges before being placed into neutral buffered formalin pots. Please ensure the cores are stretched out linearly prior to fixation as knotted cores are not easy to separate out in the laboratory. Please note that biopsies are delicate and should be handled with care, avoid the use of forceps wherever possible to prevent trauma artefact to the tissue.

Minimum volume required

The size of the specimen container must be appropriate to the size of the specimen to allow adequate fixation. Tissue should be placed into appropriately sized containers which will allow for the specimen and at least ten times its volume in fixative (i.e. neutral buffered formalin) to be contained.

Special requirements

Hazardous Specimens Specimens presenting an infection risk (e.g. tuberculosis, viral hepatitis, HIV) must be clearly labelled as such to prevent unnecessary risk to laboratory staff. Urgent Biopsy Specimens (Rapid Paraffin Service) The Department (QE site only) provides a rapid paraffin service for clinically urgent biopsy specimens; a report can be issued on the same day that the specimen arrives in the department. It should be noted however that not all specimens are suitable for rapid processing. In general terms only liver, renal and cardiac biopsies are processed in this way. Other specimens may be suitable however advice should be sought from the Histopathology Manager (0121 371 3352) or a trimming room senior Biomedical Scientist (0121 371 3314) prior to sending other tissue types. Tissues for the rapid paraffin service must be received by the department no later than 13:30. Please ensure that the name and bleep number of the requesting clinician is clearly indicated on the request form to allow for the verbal report to be issued. Specimens received after 13:30 will not be processed urgently and will be placed onto the “normal” biopsy run later in the day thus same day reporting will not be possible.

Patient preparation

N/A

Sample viability

N/A

Turnaround time

Laboratory Turnaround Times The agreed routine TATs for each specialty is 14 days to first reported for 90% of cases. Targets for reporting are currently not being met, there are delays in non-urgent work currently and this is reflected in 50% of work reported within 14 days. . Some cases are more complex and require additional work e.g. immunohistochemistry or molecular pathology which increases the Turnaround time. Specific turnaround data is available to service users upon request. Cancer tracking patient TATs are also tracked and reviewed with service user representatives and the Trust's FDS or Faster Diagnosis Specification group. Urgent renal biopsy samples for example are routinely processed and reported on the same day. In addition the Department actively monitors outstanding cases, notifying reporting pathologists that cases are still unreported. This and actions to increase lab and consultant capacity continue to support the delivery of improved TATs for service users. Reporting Once specimens are reported and authorised by the laboratory they can be accessed on the intranet by appropriate staff. In addition a typed copy will be sent to the destination specified on the request form (FOR EXTERNAL USERS ONLY). If the specimen is needed for a particular MDT or clinic, then please state this on the request form. Urgent reports can be issued verbally if necessary to a suitable member of medical staff. Please put a mobile telephone number or a bleep number (that will be answered immediately) on the request form. Telephone reports will only be issued on request via telephone. Urgent Reporting Occasionally it may be necessary for a requesting clinician to highlight a specimen as clinically urgent. If an urgent report is required it should be clearly identified or indicated on the request form. Urgent requests should be sent to Cellular Pathology via the porters without delay. To ensure that cases are not delayed within the laboratory please make sure that the request form is correctly completed and all sections are filled in properly. In addition to clinically urgent cases there are UHB wide @FDS@ or Faster Diagnosis Specification stamps to fast track these patient cancer samples. This is to support end to pathways and prevent patient breaches where possible through prioritisation.

Reference range

N/A

Clinical guidance

Histology laboratory work involves the preparation and microscopic examination of tissue samples for morphological assessment by pathologists.

Notes

Specimen Containers When requesting stock a member of staff from the Cellular Pathology department will inform the requestor when they will be ready for collection by the portering staff. Consumables provided by the lab should be transported via the porters so please allow time for preparation and transport. External requests for sample pots and request forms are through contacting the Department. For Heartlands site please e-mail uhb-tr.histopathology@nhs.net, for QE site use uhb-tr.cellpath@nhs.net. Transportation of Specimens Specimens are collected at regular intervals from theatres and all relevant departments via portering services. Urgent and unfixed (dry/not in formalin) specimens should NOT be left until the next routine collection – telephone portering services and arrange for a member of staff to bring the sample(s) to the laboratory without delay. Please note specimens must be despatched to the Department within a secondary bag or secure transport box with sufficient absorbent material to absorb/contain any potential spillage. Formalin is a hazardous reagent with any leakages put portering, transport and laboratory staff at significant risk. Please ensure containers are closed or sealed with appropriate fitting lids. If in doubt please seek advice from the Department. Referral Laboratories and second opinions For some complex cases outside, second opinions may be requested internally within UHB but also externally to support the diagnostic report and this may add to the number of days before a final diagnostic report is issued. List of key contacts we currently use for specialist second opinions and referral labs used for testing is available upon request. Unaccredited testing The Department regularly reviews testing to reflect clinical service needs and advances in technology. Consequently, some testing and equipment has not yet been reviewed at UKAS assessment visit. The following testing and aspects of Cellular Pathology are not covered by UKAS 15189 accreditation: Digital Pathology The Department is performing extensive clinical validation towards going live with digital pathology in 2024. Slide scanners are used as part of a Sectra IDS7 software solution for viewing and reporting digital images. This will be subject to a UKAS 'Extension to accredited scope' application later. To enable this PACS reporting went live during 2024. Therefore some cases are reported using this system and this is not within our scope of accreditation. ?? MSC/Unaccredited antibodies