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.