Guideline for the Handling of Pathology Lung Tissue Specimens

Transcription

1 Guideline for the Handling of Pathology Lung Tissue Specimens Version Date Summary of Change/Process Produced by Simon Trotter and circulated to Lung Network Site Specific Group for reviewing With amendments by Lara Barnish Reviewed and updated by Simon Trotter in preparation for discussion at the Lung Network Site Specific Group Reviewed, updated and agreed by Lung Network Site Specific Group Reviewed and endorsed by Guidelines Sub Group Date Approved by Network Governance September 2011 Date for Review September 2014 Page 1 of 5

2 1. Scope of the Guideline This guidance has been produced to support the tissue pathways for pulmonary pathology. 2. Guideline Background The information below follows the minimum data set for lung cancer issued by the Royal College of Pathologists: ( 8.pdf) Guideline Statements The members of the network site specific group for pathology have agreed to follow the guideline published by the Royal College of Pathologists in May pdf, with the additional supplementary statements contained in section All patients 3.1 The correct and complete patient demographics should be given on the clinical request form and a full clinical history including the site of the biopsy and the relevant clinical findings. In addition, any pertinent previous histology should also be provided, particularly if the patient is referred from another unit. 3.2 Handling of bronchial biopsies In general biopsy tissue for histological examination should be directly placed into buffered formalin. Specimens for the following should be sent directly to the laboratory: bacterial, mycobacterial, virus or fungal cultures At receipt by the laboratory the size and number of fragments sampled should be documented. Routine processing is then undertaken and 3 levels through the paraffin block are provided for the pathologist. 3.3 Reporting of bronchial biopsies Ideally reporting bronchial biopsies should be undertaken by a pathologist with an interest in lung cancer. Page 2 of 5

3 3.3.2 If tumour is present and is a primary lung carcinoma, differentiation between a small cell and non-small cell carcinoma is necessary. Confirmation of a small cell carcinoma may require immunohistochemistry using neuroendocrine markers and this is particularly relevant in cases where there is cellular crushing. Recent guidance now instructs pathologist to perform immunocytochemistry and histochemistry (TTF-1, P 63, and PAS staining after diastase digestion) on all undifferentiated non-small cell carcinomas to identify if there is adenocarcinomatous or squamous differentiation. This is important for treatment management particularly selecting those patients for EGFR mutational analysis. 3.4 Reporting of pleural biopsies Tissue biopsy where malignancy is seen will frequently require immunohistochemistry. A multitude of publications have described optimal panels of immunocytochemistry to differentiate between a mesothelioma and metastatic adenocarcinoma. Pathologists will have their own preferences and this is left to individual practice. 3.5 Reporting of resected tissue samples Lung specimens removed for cancer reporting are dealt with following the Royal College of Pathologists guidelines (see above). Staging with TNM version 7 is mandatory. 4. Second opinion 4.1 A second opinion on a tissue sample may be required in cases where interpretation is problematic and there is diagnostic uncertainty. This may be sought by either the local clinician or the pathologist. Referral to one of the lung pathologists at Heartlands hospital is advised in these circumstances and is best handled by the pathology department at the referring hospital. This will allow appropriate packaging and tracking of samples through the postal system. All cases should be accompanied by correspondence giving as much information as possible. 4.2 The lung pathologists based at Heartlands hospital are: Dr Simon Trotter (Lead) Dr Gerald Langman Dr Prabha Naidoo 4.3 In rare cases where a third opinion is needed after review, the material will be forwarded to Professor Andrew Nicholson (or his deputy) at the Royal Page 3 of 5

4 Brompton Hospital. The original referring hospital will be contacted if this is considered necessary. 5. EBUS The best method of processing EBUS sample has not been universally agreed. At Pan Birmingham Cancer Network, EBUS samples are processed as histological cores which enables good and interpretable material. This also permits the reliable use of immunocytochemistry if necessary. 6. Cytology Respiratory related cytology material for lung cancer incorporates: bronchial washings, bronchial brushings, bronchial trap, pleural fluid and sputum cytology. Laboratories will have their own standard operating procedure for processing these. Several units will now use liquid based fixation cytology and this can also be advantageously used for sputum samples after mucolytic treatment in the laboratory. It should be remembered that cytology wet specimens are kept for a finite period of time and it will not be possible to retrospectively request immunocytochemistry or other investigations (apart from EGFR) on cytology material. Monitoring of the Guideline Implementation of the guidance will be considered as a topic for audit by the NSSG in References Page 4 of 5

5 Approval Signatures Pan Birmingham Cancer Network Governance Committee Chair Doug Wulff Pan Birmingham Cancer Network Manager Karen Metcalf Network Site Specific Group Clinical Chair Arvind Rajasekaran Page 5 of 5