Cellular Pathology, QE Hospital Birmingham

 

The majority but not all of Cellular Pathology tests that are performed and equipment in use are accredited to internationally recognised standards for medical laboratories ISO 15189.  This is important for the Department and for service users as it provides assurance on quality and competence.   There is increasingly an integrated approach across the different UHB hospital sites e.g. Musculoskeletal Pathology and Heartlands Hospital based Cellular Pathology, where staff, equipment and testing may be shared to deliver the highest possible quality services to our service users. The full range and nature of accredited tests is detailed on the United Kingdom Accreditation Service website.  Select this link for the details:  http://www.ukas.com - Schedule of accredited tests for Laboratory 10141 .  The laboratory is currently modernising  H&E, special stains and immunohistochemistry staining platforms to support high quality diagnostic cellular pathology reporting and to ensure full traceability of samples within the laboratory.  Consequently not all IHC analysers, special stains and antibodies have been assessed by UKAS.  Others have been reviewed by UKAS early in 2020 and so again are not currently covered by UKAS Accreditation to ISO15189.   Should the laboratory demonstrate to UKAS that they satisfy ISO 15189 requirements for those new tests and platforms, then the UKAS website is updated to reflect that updated repertoire and further specific test details are also included below:

 

Specialist Services  within Cellular Pathology  Accredited Tests
MOHS Mohs, is microscopically controlled surgery used to treat common types of skin cancer. Yes
Neuropathological Smears The Department provides a rapid diagnostic service for intra-operative brain tissue specimens. Yes
Cytopathology  The Department provides the diagnostic cytopathology services for the Trust including fine needle aspirations, endoscopic brushings and washings, EUS-FNAs , serous fluids urines and CSF.  Yes
Muscle Biopsy Service Muscle biopsies are performed as part of the investigation of a clinically suspected neuromuscular disorder when other less invasive tests have not provided a firm diagnosis. Yes
Electron Microscopy Service The Electron Microscope Unit is used routinely at magnifications of between 1500 and 70,000 times to examine the ultrastructure of cells and their surroundings.   Yes

 

 

Immunohistochemistry 
Assay Code Diagnostic purpose Accrediation status  Future progress
AAT Alpha-1-Antitrypsin deposits  UKAS Omnis  
ACTH         Adrenocorticotropin hormone
expressing cells
not on scope 2020 ETS
AE1         Classification of
epithelial tumours
 UKAS Omnis  
AFP Alpha-1-Fetoprotein expressing cells not on scope 2020 ETS
Alpha Dystroglycan   not on scope  
ALPHA-B-CRYST           not on scope  
Alpha-SARC       Alpha-Sarcoglycan Staining protein  UKAS AS 48  
Assay Code Diagnostic purpose Accrediation status   
AMACR        Racemase Alpha-Methylacyl-CoA Racemase not on scope 2020 ETS
AMYLOID A         Demonstration of
 Amyloid A
not on scope  
AR adenoca of prostate, breast and ovarian ca not on scope 2020 ETS
ATRX         Glioma identification not on scope  
BAPP        Anti-Alzheimer Precursor Protein A4  UKAS AS 48  
B-CAT         Beta -catenin expressing cells  UKAS Omnis  
BCL2        B-cells  UKAS Omnis  
BCL6        B-Cells  UKAS Omnis  
BOB1         B-cells  UKAS AS 48  
BSCYTO (MNF116)        Epithelial cells  UKAS Omnis  
C4d        not on scope  
C9           not on scope 2020 ETS
CA 125        Identification of
serous ovarian cancer
 UKAS Omnis  
CA19.9        Epithelial cells, Sialyl Lewis
containing glycolipids
 UKAS Omnis  
Calcitonin        Calcitonin Expressing cells not on scope  
CALPONIN         Calponin expressing cells  UKAS Omnis  
Calretinin        Identification of
malignant mesotheliomas
not on scope 2020 ETS
CD10        CD10 expressing tumours not on scope  
CD117         CD117 expressing cells. Mast Cells.
Cajal Cells
 UKAS Omnis  
CD123        CD123 expressing cells  UKAS Omnis  
CD138  B-cells. Plasma Cells  UKAS Omnis  
CD14        CD14 expressing cells  UKAS Omnis  
CD15        Hodgkin Cells. Reed-Sternberg
Cells.
 UKAS Omnis  
CD19        B-Cells  UKAS Omnis  
CD1a        Lymphoblasts. Langerhans Cells.
Thymocytes
 UKAS Omnis  
CD2           not on scope  
CD20        B-Cells  UKAS Omnis  
CD21        Follicular Dendritic Cells, B-Cells  UKAS Omnis  
CD23         Follicular Dendritic Cells, B-Cells  UKAS Omnis  
AE1         Classification of
epithelial tumours
 UKAS Omnis  
CD25 Identification of Interleukin 2 receptor not on scope 2020 ETS
CD3        T-Cells  UKAS Omnis  
CD30        CD30 positive carcinomas such as
embryonal carcinoma
 UKAS Omnis  
CD31        Endothelial cells  UKAS Omnis  
CD34        Vascular and Lymphatic Vessels.
Cells of myeloid lineage
 UKAS Omnis  
CD4            UKAS Omnis  
AFP Alpha-1-Fetoprotein expressing cells not on scope 2020 ETS
CD43         T-Cells, B-Cells  UKAS Omnis  
CD45 LCA        Tumours of
lymphoid origin
 UKAS Omnis  
CD5 4C7        T-Cells  UKAS Omnis  
CD56        NK Cells, T-Cells  UKAS Omnis  
CD57            UKAS Omnis  
CD68 PG-M1        Leucocytes  macrophages  UKAS Omnis  
CD68-KP1         Macrophages and Monocytes  UKAS Omnis  
CD7         Macrophages. Monocytes. Cytokeratin 19 expressing cells  UKAS Omnis  
CD79        T-Cells  UKAS Omnis  
CD8        B-Cells  UKAS Omnis  
CD99        CD99 expressing cells not on scope  
CDX-2        Adenoca in GI tract  UKAS Omnis  
CEA         Carcinoembryonic Antigen positive
cells
 UKAS AS 48  
CEA POLY         Carcinoembryonic Antigen positive
cells
 UKAS AS 48  
CG               Neuroendocrine Cells.  UKAS Omnis  
CK14
(CYTO14)
  not on scope 2020 ETS
CK19 epithelial tumours with CK19 expression not on scope 2020 ETS
CK8/18 cyto 8/18 expression  UKAS Omnis  
CMV CMV infected cells  UKAS Omnis  
C-MYC          not on scope 2020 ETS
Collagen IV   not on scope  
CRP          not on scope  
CRYPTO           not on scope  
CyclinD1 mantle cell lymphoma  UKAS Omnis  
CYTO 17           not on scope  
CYTO 19         CK19  positive Epithelial Cells not on scope 2020 ETS
CYTO 20        Epithelial Cells (colonic type)  UKAS Omnis  
Alpha-SARC       Alpha-Sarcoglycan Staining protein  UKAS AS 48  
CYTO 7        (CK7) Cytokeratin 7 expressing cells  UKAS Omnis  
CYTO 8 (CAM5.2)        shows simple epithelium  UKAS Omnis  
Cytokeratin AE1/AE3        Classification of   UKAS Omnis  
D2-40        Podoplanin epithelial tumours  UKAS Omnis  
DES         Smooth muscle cells. Striated
muscle cells. Reactive mesothelial
cells
 UKAS Omnis  
DOG-1 GIST  UKAS Omnis  
DYSFERLIN 1.40        Dysferlin Protein  UKAS AS 48  
DYSTRO C        Dystropin (C-terminus) protein  UKAS AS 48  
DYSTRO R        Dystrophin (Rod Zone) protein  UKAS AS 48  
EBV         EBV POSITIVE CELLS  UKAS Omnis  
ECAD      Ductal and lobular breast ca  UKAS Omnis  
EMA         Epithelial Cells.   UKAS Omnis  
EMERIN        Emerin Protein  UKAS AS 48  
EP4            UKAS Omnis  
ER alpha EP1        Assessment of oestrogen receptor status  UKAS Omnis  
ESA         epithelial marker  UKAS Omnis  
FACTOR 13a          not on scope 2020 ETS
FACTOR8           not on scope  
FSH         Follicular Stimulating Hormone
expressing cells
 UKAS Omnis  
Gastrin        Gastrin producing tumours not on scope 2020 ETS
Amylase   not on scope  
GCDFP-15        Identify breast mets not on scope 2020 ETS
GFAP         Identification of astrocytes  UKAS Omnis  
GH         Growth Hormone  UKAS Omnis  
Glucagon   not on scope  
GLUT/SYNTH        Glutamine Synthetase expressing
cells
 UKAS AS 48  
GLYCO C         red cell precursor marker not on scope 2020 ETS
GLYPICAN3        Glypican-3 expressing cells  UKAS Omnis  
GRANZ         Lymphocytes. NK cells. T-cells not on scope 2020 ETS
HAIRY CELL         Hairy Cell Leukemia  UKAS AS 48  
HBCAG           not on scope  
HBSAG            UKAS Omnis  
HCG           not on scope 2020  ETS
HEPATOCYTE         Hepatocyte Cells not on scope 2020 ETS
HSV HSV positivity  UKAS Omnis  
HHV8         Human Herpes viris (type 8) latent nuclear antigen  UKAS Omnis  
HIV         HIV + not on scope 2020 ETS
HMWCK basal cells and
squamous epithelium
 UKAS Omnis  
HSP 70          not on scope  
IDH        astrocytoma  UKAS Omnis  
IgA           not on scope  
IgD           not on scope  
IgG      not on scope  
IgG4         Ig4 expressing cells  UKAS Omnis  
IgM           not on scope  
Arginase Hepatobiliary Pathology not on scope  
INSULIN         Insulin producing cells  UKAS Omnis  
KAPPA         plasma cells  not on scope 2020 ETS
Ki-67        Proliferating cells  UKAS Omnis  
Lambda   plasma cells not on scope 2020 ETS
LH        Luteinizing Hormone expressing
cells
 UKAS Omnis  
MAP2   not on scope  
MAST  CELL        Tryptase Mast Cells not on scope  
MDM2   not on scope  
Melan-A        Melan-A expressing cells  UKAS Omnis  
Melanosome HMB45        Melanocytes  UKAS Omnis  
Merkel Cell   not on scope 2020 ETS
MESO         Mesothelial Cells  UKAS AS 48  
MHCf        Skeletal Muscle fast fibres  UKAS AS 48  
MHCs        Skeletal muscle slow fibres  UKAS AS 48  
MITO           not on scope  
MLH1        MutL Protein Homlog1 Expressing
cells
not on scope 2020 ETS
MSH2 FE11        MutL Protein Homlog2 Expressing
cells
not on scope 2020 ETS
MSH-6         MutL Protein Homlog6 Expressing
Cells
not on scope 2020 ETS
MUC 1            UKAS Omnis  
BAPP        Anti-Alzheimer Precursor Protein A4  UKAS AS 48  
Mum-1 B-cells in the light Zone of germinal centre / plasma cells  UKAS Omnis  
MYELIN PLP        Myelin PLP protein not on scope  
MYELOPX         Myeloid cells  UKAS Omnis  
MYO-D1        Myosin not on scope  
MYOGENIN         rhabdomyosarc  not on scope  
Myoglobin   not on scope  
NAPSIN A           not on scope 2020 ETS
NEU-N          Neurones  UKAS Omnis  
Neurofilament Protein        Neurones. Axonal processes  UKAS Omnis  
NSE           not on scope 2020 ETS
OCT 2   not on scope  
OCT 3/4 Octamer/binding Transcription
factor OCT3/4     
OCT3/4 expressing cells  not on scope 2020 ETS
MHC smooth muscle    UKAS AS 48  
P16         Heart and Neck/Gyane  UKAS Omnis  
p53        P53 protein  UKAS Omnis  
P62         P62 Protein not on scope  
#REF!   #REF!  
BCL2           UKAS Omnis  
PAX-5  (BSAP)      B-Cells  UKAS Omnis  
Pax-8    UKAS Omnis  
PERFORIN           not on scope  
PGP 9.5           not on scope  
PGR Assessment of progesterone
receptor status. Meningioma Cell
 UKAS Omnis  
PLA2R 1/300          not on scope  
PLAP         Placental Alkaline Phosphatase
(PLAP) Expressing cells
not on scope 2020 ETS
BCL6        B-Cells  UKAS Omnis  
PROLACTIN         Prolactin expressing cells  UKAS Omnis  
PRP1/10000          not on scope  
PSA Prostate luminal epithelial cells.  UKAS Omnis  
PSAP            UKAS Omnis  
S100         S100 protein expressing cells  UKAS Omnis  
SDHA 1/100        SDHA expressing cells not on scope 2020 ETS
SDHB        SDHB expressing cells not on scope 2020 ETS
SMA Smooth Muscle myosin / Myoepithelial cells   UKAS Omnis  
SMMYO    UKAS Omnis  
SNF5          not on scope  
SPECTRIN PARAFFIN           UKAS AS 48  
STAT 6  1/1000          not on scope  
BOB1            UKAS AS 48  
SV40           not on scope 2020 ETS
Synapto Neuroendocrine Cells.  UKAS Omnis  
TAU           not on scope  
TDT        Thymocytes not on scope 2020 ETS
THYROG         Thyroglobulin expressing cells not on scope 2020 ETS
B-SARC          not on scope  
TOXO           not on scope  
TSH         Thyroid Stimulating hormone
expressing cells
 UKAS Omnis  
TTF         Already using same Ab as HGS  UKAS Omnis  
UBIQ           not on scope  
VIMENTIN         Mesenchymal Cells not on scope 2020 ETS
WT1 Wilms’ Tumour 1 Protein (WT1)
expressing cells.
not on scope 2020 ETS

 

Special stain and Eynzme Histochemistry 
Protocol Diagnostic purpose Accredited Future progress
Alcian Blue acid mucins Yes  
Alcian Blue/PAS/d Acid and Neutral mucins Yes  
Congo Red   Amyloid Yes  
Elastic van Gieson Elastin Fibres Yes  
Gram/Gram Twort Gram positive and Gram negative
organisms/Fungi, Pneumocystis
Yes  
Grocott's Methenamine Silver Haematopoietic Tissue Yes  
Haematoxylin van Gieson Collagen, connective tissue Yes  
Long Giemsa Haematopoietic Tissue Yes  
Long Ziehl-Neelsen Lipofuscin No  
Martius Scarlet Blue Fibrin Yes  
Masson's Trichrome Collagen, connective tissue Yes  
Modified Giemsa Helicobacter-type organisms Yes  
Modified Masson Fontana Melanin Yes  
Modified Ziehl-Neelsen Mycobacterium Leprae No  
Mucicarmine Mucin No  
Orcein Hepatitis B Surface antigen
Copper associated protein
Yes  
Periodic Acid Methenamine Silver Glomerular Basement Membranes Yes  
Periodic Acid-Schiff Glycogen, neutral mucins, fungi,
glomerular Basement Membranes
Yes  
Periodic Acid-Schiff - Diastase Carbohydrate, fungal organisms/ glomerular basement menbranes  Yes  
Perls Iron Yes  
Reticulin Reticulin fibres at 3µm and 2µm Yes  
Rhodanine Copper Yes  
Toluidine Blue Mast Cell Yes  
Von Kossa Calcium Yes  
Warthin-Starry Spirochetes, Helicobacter pylori Yes  
Ziehl-Neelsen (Acid Fast Bacillius)  Acid-Fast Bacilli (Mycobacterium) Yes  
Cytochrome C Oxidase staining
PMU_S010
Marker of mitochondrial activity Yes  
Gomori Trichrome staining
PMU_S005
Abnormal Mitochondria Yes  
Haematoxylin and Eosin staining
PMU_S004
Basophilic and eosinophilic Yes  
Muscle Acid Phosphatase staining
PMU_S013
structures Yes  
Myosin Adenosine Triphosphatase
Staining pH 9.4 & pH 4.6
PMU_S012
Demonstration of lysosomes Yes  
Major Histocompatibility Complex
PMU_S055
Demonstration of fibre typing Yes  
NADH Staining PMU_S009 Upregulation indication of inflammatory response. Yes  
Periodic Acid – Schiffs (PAS)
Staining PMU_S007
Demonstrate abnormal mitochondria and fibre typing. Yes  
Phosphorylas staining Demonstrate muscle glycogen Yes  
Succinate Dehydrogenase staining Phosphorylase activity Yes  
Sudan Black staining Marker of mitochondrial activity Yes  

 

Minimum Dataset required for Cellular Pathology Requests

In order to process specimens it is essential that request forms are fully completed in a clear and legible format. The use of patient ID stickers is permitted however please ensure you use the full patient sticker NOT the smaller blood tube sticker. All specimens received into Cellular Pathology must meet the agreed laboratory minimum dataset; any specimens not meeting the criteria will be returned to the requesting department.Please ensure that any important information (e.g. clinical history, bleep number etc.) is clearly indicated on the form and ensure that any priority or urgent cases are marked as such.

  • Trust cases can be requested via a theatre book 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/laboratory-request-forms.htm shows this request form together with specific request forms used within the Trust (QE site)  for liver and breast biopsy cases.

Specimen Labelling and Multi-Part Cases

If more than one specimen from the same patient attributed to a case is sent they should be clearly indicated as part 1, 2, 3 etc. with an note on the request form detailing the site of the specimen.

Hazardous Specimens

Specimens arising from patients with known or suspected transmissible diseases (e.g. tuberculosis, viral hepatitis, HIV) must be clearly labelled as such to prevent unnecessary risk to laboratory staff.

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.  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.

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.

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. Once received urgent cases will be highlighted by the specimen reception and prioritised appropriately in the departmental workload.

UHB, Department of Cellular Pathology

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Cellular Pathology Service Background

The Department of Cellular Pathology provides a diagnostic histopathology, cytopathology, muscle biopsy, electron microscopy, molecular pathology, post mortem and mortuary service to internal users (other Trust departments e.g. surgery) as well as external users (GPs, dental and private practices). The Department also incorporates the Tissue services for the Trust; this department is responsible for managing and ensuring compliance of the licensable activities which falls under the HTA Human Application Sector, this includes procurement, testing, storage, traceability, disposal and distribution of human tissue and cells for therapeutic use.

Cellular Pathology Department operates within the Quality Management System of the Clinical Laboratory Services and is led by both a consultant medical Clinical Service Lead and a technical Service Manager. Cellular Pathology participates fully in UK NEQAS External Quality Assurance schemes where appropriate.  The Laboratory works to ISO 15189 requirements and is assessed by UKAS to evaluate compliance.  The vast majority of equipment, procedures and tests offered by the Department of Cellular Pathology are included in the UKAS scope of Accreditation seen here: http://www.ukas.com/.  Some non-accredited tests may also be used to support diagnostic tests and these are mainly reflected in stains, antibodies and associated platforms that are currently under assessment by UKAS for potential additions to the scope of laboratory testing.  Whilst there is no major change in tests performed in Cellular Pathology, there is however a major GenMed/Agilent modernisation of the laboratory equipment.  H&Es, stains and antibodies performed on these newer Agilent platforms are not currently accredited tests.  The repertoire and this website will be updated in terms of accredited tests following the outcome of the next UKAS assessment visits during January 2020.

Cellular pathology processes over 35,000 Histopathology 4,000 Cytopathology and approx. 50 post mortem cases/year.  Non-gynae cytology remains available at the QE Laboratory site but the Department is in the process of transferring processing and staining of most QE based cytology requests to the Heartlands Hospital site.  A further update on this change will follow during February 2021 after a review of the change in process has taken place to ensure reporting times and service are improved by the change.  The routine histopathology repertoire includes specialist renal, liver, muscle and nerve processing and reporting and a well established electron microscopy service.  During 2021 the nearby Musculoskeletal Pathology laboratory will move across to the QE Cellular Pathology site and details of this major service change will follow as part of the project planning process.

The Department provides a comprehensive pathology service to the Trust, South Birmingham Community and Mental Health Trusts, Private Hospitals, General Practitioners and General Dental Practitioners.  The Department is open Mon-Fri between 08:00 and 18:00 and on Sunday 07:00-11:00. A specialist/expert referral service is also provided to hospitals in the West Midlands, nationally and to international clients.

Laboratory Personnel - Department of Cellular Pathology at QEHB. These are as follows and will be further updated with an integrated cross site UHB Cellular Pathology structure in due course::

 
Clinical Service Lead - Cellular Pathology  
Dr Shalini Chaudhri (Consultant Pathologist)

0121 371 3347 (DDI: 13347) or  This email address is being protected from spambots. You need JavaScript enabled to view it.

Human Tissue Authority Designated Individual  
Dr Rachel Brown (Post Mortem Licence)

0121 371 3339 (DDI:13339) or This email address is being protected from spambots. You need JavaScript enabled to view it.

Cellular Pathology - Head Biomedical Scientist  
Martin Collard

0121 371 3343 (DDI: 13343) or This email address is being protected from spambots. You need JavaScript enabled to view it. 

Deputy Head Biomedical Scientist  
Daniel Kearns

0121 371 3352 (DDI: 13352) or This email address is being protected from spambots. You need JavaScript enabled to view it.

Deputy Head Biomedical Scientist  
Becci Taylor

0121 371 3336 (DDI: 13336) or This email address is being protected from spambots. You need JavaScript enabled to view it.

Electron Microscopy / Muscle Service  
Dr Liz Curtis Clinical Scientist 0121 371 5721 / 5720 (DDI: 15721 / 15720) or This email address is being protected from spambots. You need JavaScript enabled to view it.
Ferhana Maqsood (Muscle Service) 0121 371 5720 (DDI: 15720)
Mortuary Manager  
Peter Cockcroft (new cross site role from June 2020, following retirement of previous post holder)

0121 424 2197 or This email address is being protected from spambots. You need JavaScript enabled to view it.

or via Histopathology Manager (above)

Tissue Services  
Julie Dulson

0121 371 6838 (DDI:16838) or This email address is being protected from spambots. You need JavaScript enabled to view it.,uk

Quality Lead  
Vacant 

Vacant as of Dec 2020 and covered by This email address is being protected from spambots. You need JavaScript enabled to view it. until further notice.

Health and Safety  
Lee Robertson

0121 371 3314 (DDI: 13314) or This email address is being protected from spambots. You need JavaScript enabled to view it.

Training Lead

0121 371 3314 (DDI: 13314) or This email address is being protected from spambots. You need JavaScript enabled to view it.

 Specimen Reception   Ext. or external 0121 371 5990 
 Departmental Direct line   0121 371 6516 
 E-Mail   

Service Background

The Department operates within the Quality Management System of the Clinical Laboratory Services and is led by both a consultant medical Clinical Service Lead and a technical Service Manager. Cellular Pathology participates fully in UK NEQAS External Quality Assurance where appropriate.

Consultant Pathologists

Cellular Pathology currently employs 18 consultant pathologists who cover a broad spectrum of clinical specialities and are available to offer clinical advice and interpretation of results if required.

 

General  Specimen Requirements

Due to the wide range of cellular pathology specimens several key container types exist as follows :

 

Specimen Type

Container

Small specimens

 Biopsies and small resection e.g. skin ellipses, appendicies.

Yellow Topped 60 mL Containers 

Large specimens

 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

350 mL White Topped “Honey Pots”

Large resection specimen’s

e.g. bowel, heart, breast tissue.

 

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.

“Mega” Specimen Buckets

Large anatomical or specimen resections e.g. large sarcomas.

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 opened by laboratory staff and should ONLY be used for the incineration of clinical waste.

Dry Samples (Within Lab hours only)

Dry samples sent to the lab e.g. 100k Genomic Project, frozen sections; MOHS samples: lymph nodes; Research projects

Specimen buckets, 60ml pots /

Theatre Tissue Safe system for 100k genome samples

Cytopathology Specimens

Urine

Whole volume urines

Jerry can +/- cytospin collection fluid or a universal container.

Smears kits

 

Microscope slides; slide carriers; spray fix and cytorich red needle wash containers.

Serous Fluids/ Sputum/ respiratory fluids

 

Universal Containers

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. 

Please note many of the technical preparation aspects of cytology may take place at the Heartlands Hospital Cell Path Laboratory.

Intra-operative Frozen Sections

The department provides a rapid diagnostic service for intra-operative tissue specimens. Requests for frozen section should be telephoned to the histopathology laboratory (DDI: 13314) in advance of the procedure being undertaken, preferably on the day prior to surgery. Where this is not possible, e.g. an incidental finding during surgery, the request should still be telephoned to the laboratory prior to the sample leaving theatre. When calling the laboratory please ensure that you have the following information available as it will be asked for by the person receiving the call: 

  • Patient’s full name.

  • Registration number.

  • Date of birth.

  • Contact number or bleep number.

  • Patient’s consultant.

  • Tissue type / nature of specimen.

  • Expected date and time of delivery to the Lab.

Tissue taken for frozen section should be placed into a suitably sized container without any form of fixative (i.e. dry) and sent in a secondary bag/container to Cellular Pathology without delay.  The transport of the fresh material is arranged by the requesting clinical team, typically using a UHB Hospital porter.  Theatre books should be used to record the audit trail from theatre and safe receipt in the laboratory.  The process from specimen receipt in the laboratory to verbal report issued takes no longer than 15 minutes however this time may be shortened or lengthened slightly based on the nature of the sample received.  High risk biohazardous tissues are not suitable for frozen sectioning unless absolutely clinically required. Examples of these include tuberculous lesions, specimens from patients with viral hepatitis and specimens from patients who are HIV positive. If there is any doubt as to whether the specimen is suitable or not please contact the laboratory and ask for the advice of a Consultant Pathologist.

MOHS

Mohs, is microscopically controlled surgery used to treat common types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the fresh tissue is snap frozen and sectioned for microscopic examination. The examination informs the decision for additional tissue removal.

The process from specimen receipt in the laboratory to verbal report issued takes no longer than 15 minutes per sample block however complex specimens with multiple samples will take additional time.

Mohs clinics are booked with the Department to ensure that there are clinical and technical staff  are available to complete the test.

Neuropathological Smears

The Department provides a rapid diagnostic service for intra-operative brain tissue specimens. Requests for neuro smears should be telephoned to the laboratory in advance as per intra-operative frozen sections.

Tissue taken for neuropathological smears should be placed into a sterile universal container (UC) without any form of fixative (i.e. dry) and sent to Cellular Pathology without delay. These specimens are often tiny and so any delay in receipt may lead to artefactual damage which can be detrimental to any further laboratory processing.

The process from specimen receipt in the laboratory to verbal report issued takes no longer than 15 minutes however this time may be shortened or lengthened slightly based on the nature of the sample received.

Small Biopsy Specimens

The department provides both a routine and urgent diagnostic service for 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 white cards 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.

Urgent Biopsy Specimens (Rapid Paraffin Service)

The department 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 (DDI: 13352) or a trimming room senior Biomedical Scientist (BMS 2 or above) (DDI: 13314) 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.

Resection Specimens

The department provides a routine and urgent diagnostic histopathology service for larger surgical resection specimens. 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.

Cytopathology

The Department provides the diagnostic cytopathology services for the Trust including fine needle aspirations, endoscopic brushings and washings, EUS-FNAs , serous fluids urines and CSF.  Routine specimens should reach the laboratory before 16:30 so that they can be processed within normal working hours. Specimens collected out of laboratory hours should be stored refrigerated until the next morning on which the laboratory is open.  Cytology sample that do not meet the minimum data requirements on request form or sample, are processed, to ensure that sample integrate is maintained. Details of missing data are added to the report.  Request for Consumables and Request Forms

Sample containers for use in cytology and request forms can be order by contacting the Cytology Department; they can be collected from the Cellular Pathology reception or the main pathology Reception CLS level-1 QEHB.  Cytology samples which do not meet the MDS will not be returned.  They will be processed in order to preserve the diagnostic material while attempts are made to contact the sender.  These samples will not be reported until adequate labelling of specimen and request form has been undertaken.Minimal delay between collection and receipt by the laboratory is necessary in order to prevent degeneration of cellular components and consequent loss of diagnostic value. All cytological specimens are potentially biohazardous and must be transported in leak proof containers enclosed in sealed bags. Specimens sent to the laboratory via the SDS should be placed in specimen bags and lids on the all containers should be securely closed.Urgent Cytology for Cyclo and Tacs should be available for reporting within 24 hours in line with KPI.

Specimens from patients with known or suspected tuberculosis, HIV, viral hepatitis or other transmissible disease should be labelled clearly.  Cytology DO NOT except or handle any specimens that are ? prion disease or CJD.

Specimens should be received as either pre-prepared slides, fresh unfixed samples in white- topped universal containers, or suspended in CRR.  Equipment used to collect the specimen such as brushes or drains are inappropriate.

Sputum - A series of three early morning ‘deep cough’ specimens should be collected on three consecutive days for maximum sensitivity. Post physiotherapy and post bronchoscopy specimens are suitable but should be clearly identified as such.

Serous Fluids - 50mls or the whole volume if less is aspirated should be sent in sterile universal containers. Include any tissue fragments or clots. Do not add fixative of anticoagulant. Drain bags are not suitable for transporting specimens and should NOT be sent.

Cerebrospinal Fluid (CSF) - Rapid processing is essential to preserve cells in CSF. These specimens should be sent to the laboratory within one hour.  ALL CSF SPECIMENS SHOULD REACH THE LABORATORY BY 16:30 AT THE LATEST TO ALLOW PREPARATION.

Urine - A representative aliquot of a maximum of 25ml of urine is sufficient for cytology processing, Ensure that this is not the first sample of the day.  Catheter urine and bladder washings are also acceptable but please mention this on the request form. Mid-stream urine samples are not suitable for cytology because they contain few cells.

Endoscopic Brushing - Immediate fixation is important and all slides must be labelled with PENCIL with the patient’s name and hospital number before the smears are made.

Fine needle aspiration - Unless the clinician is experienced in this procedure, including making good quality smears, it is recommended that they contact the laboratory for advice before beginning the procedure. Smears should be made and the needle rinsed out in cytorich red fluid. For ENT specimens in particular it is important that smears are sent as well as needle washings. Only prepared smears and needle washings are accepted. The sending of needles sheathed or otherwise is strictly forbidden.

EUS-FNAs - Please send all the specimen in cytorich red fluid

Cervical Smears - Cervical smears are NOT accepted in nor prepared by cytopathology at QEHB. Please send any cervical smear specimens to the Cytopathology Laboratory at Wolverhampton's Black Country Partnership Laboratories.

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.

Muscle Biopsy Service - specific requirements

Muscle biopsies are performed as part of the investigation of a clinically suspected neuromuscular disorder when other less invasive tests have not provided a firm diagnosis.  The Muscle Biopsy Service receives muscle and nerve samples from the whole of the West Midlands region and occasionally from elsewhere in the UK.

This Department offers the following investigative techniques:

  • Muscle Histochemistry methods on frozen sections
  • Muscle immunocytochemistry on frozen sections.
  • Electron Microscopy.
  • Histology and Muscle immunocytochemistry on paraffin wax sections.
  • Arrangements can be made to send tissue away for DNA analysis.

 If required samples can be referred to specialist centres for further investigation

  • Metabolic tests.
  • Mitochondrial Assays and MtDNA.
  • Protein analysis for adult Limb Girdle Muscular Dystrophies.
  • Rare paediatric dystrophies

If a member of the muscle biopsy team is required to collect a nerve or muscle biopsy from QEHB theatres there should be a delay of no longer than 30 minutes between the biopsy being taken and the sample are being placed into fixative for electron microscopy.

For QEHB service users - Please call the lab to request collection as soon as possible once the specimen is available.  Prior to collection muscle should be kept in a dry universal container on water ice (ice can be supplied by the Muscle Lab) and the nerve should be kept in a dry universal container at room temperature.  A copy of the Muscle Biopsy request form noting the time the biopsy was taken should be completed by the requesting clinician. 

For external service users - Medical or secretarial staff from the requesting centre liaises directly with the Muscle Lab to book a biopsy.   A Senior Biomedical Scientist will travel to the hospital to collect the biopsy which is received fresh.  Clinical details are preferably received in advance of the biopsy from the requesting medical staff but relevant information may be transcribed from the patient’s notes onto the Muscle Biopsy Request Form by the Scientist collecting the biopsy.  The Scientist decides which tests will be required on the basis of this information.  The biopsy is cut up and fixed for certain tests on site, the rest of the specimen is brought back to the lab on ice and some is frozen in liquid nitrogen and the remainder allocated for further tests. 

Muscle Biopsy Service :

Cases can be requested as urgent at the time of the biopsy or by email/telephone; the pathologist will relay results back to the clinician via email/telephone.  

  • Muscle report  – 4 weeks from receipt to report authorisation.
  • Nerve reports – 4 weeks from receipt to report authorisation.
  • The current turnaround time for cases referred by the Department to specialist centres is 2-3 months depending on tests requested.

Electron Microscopy Service - specific requirements

The Electron Microscope Unit is used routinely at magnifications of between 1500 and 70,000 times to examine the ultrastructure of cells and their surroundings.  The EM unit receives approx. 800 samples a year, the majority of which are renal, but about 100 muscle and 30 nerve biopsies are also collected.  Other specimens include cardiac biopsies, occasional skin biopsies and tumour samples.

Specimens from outside the department requiring EM should be sent in a small sample container (e.g. bijou or Eppendorf tube) containing at least 2 mL of an EM fixative.  A glutaraldehyde based fixative such as 2.5% glutaraldehyde in phosphate buffer is ideal but 10% buffered formalin is also acceptable.  In larger tissue samples individual pieces should be no larger than 3 mm cubed and should be completely submersed in fixative.

For QEHB service users - Renal biopsies are delivered to the Cellular Pathology Specimen Reception and EM samples are taken in the EM Lab. 

For External service users - package specimens for EM in firmly closed leak proof containers, together with sufficient absorbent material to contain any liquid, in sealed bags. The sealed bags are placed securely in a small padded envelope with the address label as given above under key information.  The EM unit makes use of the Histology request form for both internal and external users.   A copy of the light microscopy report is also required. 

 Advice can be obtained from Dr Liz Curtis on 0121 371 5720 This email address is being protected from spambots. You need JavaScript enabled to view it. and the Biomedical Scientist team within the Elelctron Microscopy Laboratory.

Laboratory Turnaround Times

The Department monitors turnaround times on a regular basis and reviews significant delays or service issues within the Trust's Divisional Diagnostic Performance monthly meetings.  10 and 14 day Cellular Pathology turnaround target reporting times are reported to Trust service users, broken down by clinical specialty for biopsies and for cancer tracking cases for each month.  Specific turnaround data is available to service users upon request in addition to UHB internally available histopathology intranet dashboards.  The agreed TATs for each specialty is:

14 days to first reported. Target is greater than or equal to 90%, within tolerance = 75% - 90% reported in 14 days. 

Targets for reporting are predominantly met but of note is some more complex haematopathology and urology cases  may require additional work e.g. immunohistochemistry and this does add to reporting times.

Cancer tracking patient TATs are also tracked and reviewed with service user representatives.  For example breast cancer tracking patient samples for Cellular Pathology remained strong at 90-100% reported within 10 and 14 days.  Urgent cytology is reported the same day where IHC is not required.  Routine cytology reporting such as urine cytology may be reported outside of the 14 day target but within 28 days.  Urgent renal biopsy samples for example are routinely processed and reported on the same day.  There are no significant delays in service across the service currently.  Frozen sections/neuro smears are reported within approx. 15-30 minutes from receipt.

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.

Muscle Biopsy Service :

  • Histochemistry results is five to seven working days
  • The current turnaround time for cases referred to specialist centres is 2-3 months depending on tests requested.

Electron Microscopy :

  • Renal and cardiac turnaround times are approx. 10 to 14 days
  • Muscle and nerve biopsies approx. 10 to 14 weeks.

 

For some complex cases outside, second opinions may be requested to support the diagnostic report and this may add to the number of days before a final diagnostic report is issued.   List of contacts we currently use for specialist second opinions and referral labs used for testing. 

Supplier Name Address Business Scope (test)
NEWCASTLE-U-TYNE Cellular Pathology Department Royal Victoria Infirmary Queen Victoria Road Muscle biopsy testing and  second opinion
Guys and St Thomas' Hospital 5th Floor Tower Wing Guys Hospital Thomas Street Genetics centre for muscle biopsies
Erasmus MC Rotterdam Erasmus MC Rotterdam Provide the following tests:  Muscle Histochemistry  (Cell Path)Glycogen De branching Phosphorylase Phosphofructokinase Phosphorylase b kinasea-1, 4 glucosidase Glycogen Phosphoglycerate Mutase Phosphoglycerate Kinase Carnitine palmitoyltransferase IIAMP deaminase
Dr Andrew Jack HMDS St James Institute of Oncology Bexley Wing St James University Hospital Second opinion for BMT histology reporting
Dr Lucy Feng Great Ormond Street Hospital (Dubowitz Centre)Great Ormond Street Second opinion  for Muscle histology
Dr Chris Kettle Newcastle upon Tyne Dental Hospital Richardson Road Second opinion for Muscle pathology
Prof Paul Speight School of Clinical Dentistry University of Sheffield19 Claremount Crescent Second opinion for Dental histology (slide reporting)
Dr Richard Allibun Nottingham University Hospitals NHS Trust Queens Medical Centre Campus Derby Road Second opinion for ENT histology (slide reporting)
Dr Phil Sloan Newcastle Royal Victoria Infirmary Queen Victoria Road Second Opinion for Dental histology (slide reporting)
Dr Ian Roberts Oxford University Hospitals NHS Trust John Radcliffe Hospital Headley Way Second Opinion for Renal Histology (slide reporting)
Leicester Royal Infirmary  (EM Reporting) Electron Microscopy Department Cellular Pathology University Hospitals Leicester NHS Trust Partial processing and TEM image production of EM samples. From Resin embedded samples to EM images returned to UHB for interpretation and reporting.
Dr Paul Matthews University Hospitals Coventry and Warwick NHS Trust Clifford Bridge Road Second Opinion for Dental Histology (slide reporting)
Derek Burke Great Ormond Street Hospital (Biochemistry)Great Ormond Street Glycolytic tests (muscle)
Dr Ivan Robinson Derby Hospitals NHSFT Royal Derby Hospital Utoxeter Road Second Opinion for ENT histology (slide reporting)
Prof Robert Taylor Newcastle NCG Rare Mitochondrial Disease Service4th Floor The Medical School Framlington Place Newcastle University Second Opinion for Muscle pathology
University College London Medical School Centre for Amyloidosis & Acute Phase Proteins Division of Medicine (Royal Free Campus)University College London Rowland Hill Street London  NW3 2PFUK Centre for amyloidosis and acute phase proteins
Birmingham Women's Healthcare NHS Trust Metchley Park Road Edgbaston Regional cytogenetics department
HGS   Heartlands, Good Hope and Solihull (University Hospitals Birmingham NHS Foundation Trust ) Heartlands Hospital UHB Cellular Pathology  - Staining   IHC and Special Stains
Hallwang Clinic Silberwaldstraße 34D-72280 Dornstellen Hallwangen Private oncology testing
Leeds Teaching Hospital Dr Preetha Chengot Dept. of Cellular Pathology Leeds Teaching Hospitals Block 32 Chancellor Wing St James University Hospital Beckett Street Referral lab for the processing of ground sections on teeth Amelogenesis imperfecta

 

 

UHB, Department of Cellular Pathology

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