Histopathology
- sending us requests
Histology is the study of the microscopic anatomy of cells and tissues. It is commonly performed by examining cells and tissues under a light microscope or electron microscope, which have been sectioned, stained and mounted on a microscope slide. The ability to visualize or differentially identify microscopic structures is frequently enhanced through the use of histological stains.
Histopathology, the microscopic study of diseased tissue, is an important tool in anatomical pathology, since accurate diagnosis of cancer and other diseases usually requires histopathological examination of samples. Pathologists, are the personnel who perform histopathological examination and provide diagnostic information based on their observations.
Requests for investigations:
“Each request received by the laboratory is considered an agreement between the laboratory and the sender. The obligations of both parties to that agreement are detailed on this site. If an organisation external to the Newcastle upon Tyne NHS Foundation Trust, wishes to procure our services, to a value in excess of £10,000 per annum then a Service Level Agreement will be drawn up between the two organisations.”
- Urgent specimens
- Fixation and specimen dispatch
- Fresh biopsy material
- Infection
- Referral work and second opnions
- Turnaround Times
- GP Courier, sample tracking
- See also – Test Directory (for sample storage & minimum volumes required)
Request forms
The request form must be completed.
See request forms and policy here for:
- Histopathology Request Form for NuTH Users
- Histopathology Request Form for External Referrers
- Sample Collection and Acceptance policy – Incorrectly identified samples and/or inadequate request forms may result in specimen rejection
Full clinical details are required. Full patient identification must be provided. Please ensure that the Ward number and name of referring Consultant are included on the request form. If using a patient sticky label, please ensure that the contact Consultant’s initials are correct and legible – failure to do so can result in significant delays in receiving reports. Details should also be given of previous biopsy or cytology report numbers: these reports will be found in the patient’s case notes.
A useful poster for labelling tissue tissue specimens for Histopathology can be found here.
Urgent specimens
A telephone call must be made to the appropriate department (histology 0191 282 4445 or cytology 0191 282 4437) before an urgent specimen can be accepted by the laboratory. Urgent requests should be clearly marked on the form. The name and pager number or telephone extension of the person to whom results should be communicated must also be provided.
All ‘Cancer Waiting Time’ samples should be marked ‘CWT’ on the request form.
Suspected tuberculosis
If tuberculosis or other infectious condition is suspected the specimen must be sent fixed and double bagged, as described above. Biohazard labels must be affixed and be visible
See guide and policies here for:
- Patient identification prior to investigative testing
- Policy for the transport of clinical specimens
- Sample Collection and Acceptance policy
Advice about a proposed investigation maybe sought from the relevant Consultant Pathologist. Some specialised investigations such as electron microscopy will require the use of a non-standard fixative.
Requests for reports outside normal working hours should be directed to the on-call consultant pathologist. These individuals can be contacted via the main Trust switchboard or to the on-call biomedical scientist for Pathology. Separate on-call arrangements operate for neuropathology specimens, and the on-call neuropathology consultant should be contacted via the main Trust switchboard.
Fixation and specimen dispatch
Under normal circumstances tissue for routine processing must be immersed immediately in fixative (buffered formalin 10% solution) and never allowed to dry. There should be sufficient fixative to enable to specimen to float freely, so the size of the container must be adequate. Container lids must fit well and provide a complete seal. Small biopsies should not be crushed or squeezed. Pots containing fixative for small specimens are available in wards, clinics and theatres. They can also be obtained from Specimen Reception in Histopathology 0191 282 4565 in emergencies.
Occasionally special fixatives may be required (e.g. for electron microscopy). The advice of a pathologist or biomedical scientist should be sought. Some biopsy specimens (e.g. lymph nodes for suspected lymphoma) are required fresh, and delivery requirements for these should be discussed in advance.
See guide and policies here for: (under ‘ Policies’)
- Patient identification prior to investigative testing
- Policy for the transport of clinical specimens
- Sample Collection and Acceptance policy
It is usually preferable not to open or slice large surgical resection specimens; injudicious opening may cause severe tissue distortion. Every effort must be made to ensure dispatch of specimens to Pathology as soon as possible after surgical removal (please do not batch). Non-urgent specimens in fixative can be delivered by the routine portering services. Non-urgent fresh tissue specimens must be stored in a fridge at 4oC until it is possible to deliver them within normal working hours.
Fresh biopsy material
On occasion it is necessary or desirable to send fresh tissue , e.g. frozen section requests, spleens, some breast specimens and lymph node specimens. The Histopathology Department must receive warning of intent to send such material, and no specimen should be dispatched without prior discussion with a member of the pathology staff
(Specimen Reception 0191 282 4565 or General Office 0191 282 4445).
The specimen must be placed in a clean, dry container and sealed with a well fitting lid. Extreme care must be taken to avoid contamination of the outside surfaces of the container.
The container should then be placed in a plastic bag and sealed. If there is a risk of infection, they should be placed in a second bag, sealed and labelled with a Biohazard sticker.
The request form must be kept separate from the specimen, i.e. NOT in the plastic bag(s), but must accompany the container to the laboratory. Request forms must be kept free of any possible risk of contamination
Infection
Requests for reports on specimens from patients known to have, or suspected of having Transmissible Spongiform Encephalopathy (TSE),Tuberculosis (TB), Human Immunodeficiency Virus (HIV), hepatitis infection, Viral Haemorrhagic Fever (VHF) or any other category 3 or 4 pathogen must be clearly labelled as such and sent fixed and double bagged, marked with a biohazard label on both the request form and specimen container.
Please note: Histology is not usually the primary method for establishing nature of infection and sample handling may differ for other Pathology disciplines (e.g. Fresh samples are needed for TB culture to be referred directly to Microbiology). Please ensure you send samples suitably for the required lab investigation.
Referral work and second opinions
Although the vast majority of tests are performed ‘in house’ it is sometimes necessary for us to refer ‘rare’ requests to other specialised centres. On occasion, we will send a difficult or rare case to an expert in a particular field of histopathology for a second opinion. Reference to this will be included in the final report, when applicable.
In both instances we will secure regular assurances from the referral laboratories on their quality systems and performances to ensure that they meet high expected standards.
Where possible we will only use laboratories who are accredited with UKAS.
More information can be found in our Quality statement, found in the Quality section of the website (accessible via the top navigation bar)
During exceptional times, when the demand on our service exceeds our capacity, we outsource some non-urgent cases to Source Bioscience for reporting.
Turnaround times
We aim to ensure that each laboratory result is available at the time when it is needed for clinical decision-making. Our current turnaround times can be found in the Downloadable Documents here (under Guidance Documents – “Cellular Pathology turnaround times”)
Following the recent change in guidance from the Royal College of Pathology we are undertaking a consultation process to set locally agreed targets and these performance targets will be amended once they have been agreed with our clinical users.
Those cases requiring specialty tests/opinions may take longer than the defined time and a preliminary report may be released in this instance.
Urgent requests should be discussed with the reporting team, by telephoning 0191 2824445, prior to being sent.
GP Courier, sample tracking
Cellular Pathology offers a specimen tracking system to help ensure the safety of patient samples, for both cytology and histology, collected from the GP surgeries we serve in Newcastle upon Tyne. Operated by our courier partners, 1NE logistics
The system consists of a 3-part record form, on which the individual samples are listed, and a bar-coded specimen transport bag (white). Using the bar-code the transport bags are tracked from collection to delivery at the lab and safe receipt of the samples is confirmed to the sender.
Specimen Tracking Form Information Sheet
Specimen Tracking Form Information Sheet
A slightly different system has to be used for Northumberland GP’s referring samples for Cytology. These surgeries are served by a courier operating for Northumbria Healthcare. Our numbered specimen transport bags (pink) identify cytology samples for the RVI and these are collected from North Tyneside Hospital daily. A similar specimen tracking form identifies samples submitted and safe receipt at the lab can again be confirmed to the sender.
