Guidelines for Specimen Submission to Pathology Laboratory

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Guidelines for Specimen Submission to Pathology Laboratory

Pre-analytic phase 1. Specimen identification 2. Adequacy of clinical history 3. Specimen fixation 4. Specimen delivery 5. Accessioning errors Analytic phase Post analytic phase Turn around times

Surgical pathology Cytology Autopsy

These include; Prostate & Breast needle core biopsies, Urinary bladder biopsies, Bone and Soft tissue tumor biopsies, Oropharyngeal biopsies and other small diagnostically important biopsies Does not include skin biopsies, endometrial or cervical biopsies, endocervical curettages, or GI biopsies Ancillary special stains (most) and immunostains cannot be performed in a Stat manner. They are to be placed in pink cassettes to facilitate sorting in the histology laboratory

Include liver, heart, or lung transplant biopsies; biopsies of highly suspected neoplasms with emergent treatment requirements; and biopsies of other tissues where the diagnosis is critical for rapid treatment (infectious, etc.). RUSH specimens should be placed into green cassettes for immediate identification.

These cases are placed in white cassettes.

The clinical history must be accurate and complete. The referring attending physician s name and/or the name of the responsible physicians, as well as clinical service(pager numbers or fax or phone number ) List the specimen type (anatomic site) that corresponds to the specimen type listed on the specimen container If the patient has an infectious disease (i.e., HIV, Hepatitis B or C, tuberculosis) indicate this on the form List the differential diagnosis in the Pre-op diagnosis area

Specimens should be gently handled. The use of surgical instruments should be avoided (to prevent crushing or damaging the tissue). If a surgical instrument must be used when passing the specimen to the circulator, the Certified Surgical Technologist (CST) should use an atraumatic clamp or tissue forceps. When manually handling the specimen, avoid crushing the tissue with the fingers.

Specimens should be placed into the container with fixative as soon as possible. If this cannot be completed in a timely manner, the specimen should be placed in a sterile basin and kept moist with sterile saline or wrapped in salinesoaked sponges until the specimen can be passed off the sterile field to the circulator and placed in the container with fixative.

20cc pre-filled formalin containers small biopsies, skins, needle biopsies, small specimens 120 cc pre-filled formalin containers appendix, gallbladder, large biopsies, lipomas Small tubs appendix, gallbladder, small uterus, small ovarian cysts, large lipomas Medium tubs uterus, small colon resection, small placenta, small mastectomy Large tubs larger placenta, large colon, large breast

Place specimens in appropriately sized, tightly sealed, non transparent containers, with a volume of 10% formalin at least 10-20 times that of the tissue volume Please write the time the tissue is placed in formalin. Proper and timely fixation is a critical step in tissue preparation for diagnosis. Do not freeze fixed tissues

The following information should be written on the label in the operating room. A. Type of specimen B. Site of specimen including left or right side C. Two unique identifiers, eg patient name and hospital number D. Date and time specimen E. Type of preservative, if used F. Surgeon s name G. Suture tag if present and placement, eg 12 o clock position or lower left quadrant

The label should be placed on the side of the container and not the lid. Permanent black or blue ink should be used when writing the information on the label. Label each container with a biohazard/formalin warning label.

Place minute fragments (averaging 1 cubic mm or approximately one-half the size of a grain of rice) of fresh tissue in buffered glutaraldehyde, with a tissue volume: fixative volume of approximately 1:30

Several types of specimens( such as, Lymph node biopsies for lymphoma work-up; Lung resection specimens for tissue banking; Biopsies of tumors with unknown diagnosis) should be submitted to the pathology laboratory fresh (without formalin), in a sterile container, in order that special studies (i.e. cytogenetics, RNA analysis, flow cytometry) may be performed.

DNA analysis: Fixed or non fixed specimens, Paraffin blocks, or dried tissue. RNA analysis: Fresh tissue, blood or serum and If analysis is to be delayed, should be kept place in -80 degree Cytogenetic: Fresh tissue or blood ISH : Cytology slide, sectioned tissue from frozen or paraffin blocks

Tissue for cytogenetics can be collected from a fresh specimen in the Surgical Pathology Laboratory Choose villi and fetal parts for chromosome analysis study. Place in a sterile urine cup and cover with sterile saline or RPMI transport medium. Refrigerate until courier pickup. Do not freeze.

Place fresh tissue specimens(2 3 mm) in a sterile container(sterile urine cup) in the Operating Room, insert it upright in a sealable biohazard bag and place an infectious precaution sticker on the outside of the bag and sent directly to the main Clinical Laboratory with appropriate Microbiology or Virology Requisition forms.

Tissue should be obtained fresh and kept moist until it is quickly frozen. Skin specimens can be kept on normal saline, saline-moistened gauze in a small Petri dish for 24 hours but not longer before processing. For longer delay times the specimens should be put into Michel's transport medium.

Fixation in 10% buffered formalin: 8-24 hours Prolonged fixation in formalin > 2 weeks may interfere with certain immunohistochemical or molecular diagnostic assays

Bring specimens directly to the Surgical Pathology Laboratory. BM: Deliver the core biopsy in fixative, the aspirate in EDTA tubes and unstained aspirate smear and PBS slides to the surgical pathology laboratory.

Extra-Large specimens: (i.e. limb amputations) should be double-bagged into two large red biohazard bags, labeled on the outside with the patient s name, hospital number and should bring this directly to the Surgical Pathology Laboratory and place into the specimen refrigerator or in formalin.

To ensure that amount of residual radiation is minimized before the specimen is processed The specimen should be: Placed in a formalin container and Labeled with the date that the specimen was removed. Placed in a secondary container Add 24 hours to the collection date and time, and list this on the secondary container as the date for examination

1. Absence of a Requisition Form 2. Absence of Two Patient identifiers on container and Requisition Form 3. Mislabeling of container or specimen designation that differs from the requisition 4. Missing specimen container 5. No tissue in the container 6. Requisition missing physician s name 7. No clinical history provided 8. Incomplete requisition (specimen sites not listed) 9. Inadequate amount of fixative 10. Container lid improperly sealed/fluid spill

To prevent specimens from being lost during the transport process, cases with deficiencies will not be returned Those specimens with mislabeling will require a clinical staff member come to the Surgical Pathology lab to correct the discrepancy For clinical specimens with deficiency in other causes, call the department and ask to fax the requisition Form with the required information Occasionally the specimen may have to be shipped back to the clinic for correction.

STAT specimens must be delivered directly to Cytology Lab.(e.g. BAL for Pneumocystis carinii). Results are reported via phone call within 2 hours of accessioning. Rush cytology specimens require expedited processing due to an urgent patient care situation. Routine specimens. Most routine specimens will have results reported within 2 business days

فرم درخواست سیتولوژی

Specimens should be sent to the cytology lab as quickly as possible after removed from the patient Keep specimens refrigerated if a time lapse of one hour or more is expected before delivery to the cytology lab. Specimens must be double-bagged. Insert completed requisition form into side pouch of bag. Make sure all lids are securely and properly tightened.

Cytology Specimen Collection Guidelines Specimen Fixative Quantity Storage Deliver To CSF None 3-5 ml Refrigerate Clinical Lab. Hematology (within 30 min) Ascitic (peritoneal) Fluid None 150 ml Refrigerate Cytology Lab. Bronchial Brushing Bronchial Washing CytoLyt Brush in 5-10 ml Fluid Refrigerate Cytology Lab None 20 ml Refrigerate Cytology Lab Sputum CytoLyt 5-10 ml Refrigerate Cytology Lab Cyst Aspiration None ---- Refrigerate Cytology Lab

Cytology Specimen Collection Guidelines Specimen Fixative Quantity Storage Deliver To Brushing Slides CytoLyt or Normal Saline Brush in 20 ml Refrigerate Cytology Lab Body Fluids (Pericardial, Pelvic, etc.) None 150 ml Refrigerate Cytology Lab Urine / Bladder Washings None 50-80 ml Refrigerate Cytology Lab Pleural Fluid None 150 ml Refrigerate Cytology Lab

Fixatives are always added in equal volume to the volume of specimen (i.e., for 5 ml of specimen, add 5 ml of fixative). The requisition MUST be marked to indicate the type of fixative (if any) that was used. If the slide is improperly stained based on incorrect information, it may be rendered unreadable.

Specimens from unknown clinics or facilities. Specimens without patient identification on the specimen container. Specimens and request sheets having different patient names. Specimens in leaking or unsealed containers. Specimens received with attached needles, in a Pleur-Evac container or greater than 500 ml in volume. Sputums not fixed in cytology fixative. If a concurrent sputum microbiology culture is required, two separate specimens must be obtained.

Call the clinic or nursing station, up to two times to report the problem. All rejected specimen and the reason for rejection and the ward or clinic contacted, are recorded in the computer system. Mislabeled specimens must be completed within 24 hours of discovery of the problem. Due to the fragile nature of the cellular material we will not attempt to recover a specimen that is over 7 days old.

Pathology Reports Provisional(Preliminary) report Addendum report Final report Revised(amended) report Corrected report گزارش اولیه)موقت( گزارش ضمیمه گزارش نهایی گزارش بازنگری شده گزارش اصالح شده Verbal reports may be available sooner.

The rapidity of reporting the diagnosis to clinicians Measured in working days from the time the specimen is accessioned to the time a verbal or written report is available.

Frozen section Less than 6 hours Fresh tissue Stat Within 6 hours of receipt In formalin /via phone call RUSH 24-hour or less In formalin Routin 2-4 day

Overnight fixation, One day Decalcification, One day Resubmission of tissue, one to two days Recut/deeper sections, one to two days IHC or other special stains, one to two days Electron microscopy, two to three days Intra-departmental consultation, one to two days

Biopsies: 2-3 working days Large cancer or non-cancer cases: 3-4 working days Decalcified specimen, within 4 working days Renal biopsy: 2-7 business day FNA with cell block, 2 days FNA without cell block, 1 day Gynecologic cytology, within 7 days

A total of 713 specimens were analyzed. 551 (77%) were verified within 2 days and 162 (23%) in 3 days or more. Lung, gastrointestinal, breast, and genitourinary specimens showed the highest percentage of cases being signed out in over 3 days. Diagnosis of malignancy, consultation with other pathologists, having had a frozen section, and use of immunohistochemical stains were significantly associated with increased turnaround time.

Average and range of TAT and percentage of cases Specimen type n Average TAT Range of TAT All specimens 713 2.07 1-14 Lung 28 2.82 1-6 Gastrointestinal 77 2.53 1-7 Skin 38 2.36 1-6 Breast 51 2.31 1-5 Head and neck 68 2.29 1-10 Genitourinary 32 2.25 1-4 Lymph nodes 17 2.05 1-4 Soft tissue 68 2 1-6 Gynecologic 55 1.9 1-5 Other 279 1.77 1-14

1. Correctly identify the patient. 2. Correctly identify and confirm the specimen by the surgical team. 3. Placing the specimen in an appropriate container and preservative. 4. Correctly label the specimen. 5. Complete the pathology requisition slip. 6. The requisition form must be labeled as Rush, Stat or Frozen. 7. Transport the specimen to the pathology department. 8. Turnaround time for routine specimens is usually depending on case complexity and whether special stains or studies are required. 9. Most routine specimens will have results reported within 2 business days.

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