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 (at QE site 0121 371 13314 and at BHH site 0121 424 3188 ) 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.
Date of birth.
Contact number or bleep number.
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 15 to 30 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, 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. Mohs surgery is carried out at Solihull and QE Hospital sites.
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 15 - 30 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 (0121 371 3352) or a trimming room senior Biomedical Scientist (0121 371 3314) 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.
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.
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.
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 minutesbetween 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. The optimal size of diagnostic tissue requiring processing for electron microscopy is as follows: the largest dimension should be no greater than 5mm and the smallest dimension no less than 1mm. Any specimen with the smallest dimension less than 1mm may not survive tissue processing.
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.
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 or molecular pathology and this does add to reporting times for complex cases.
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 7 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, TATs may be longer with a small specialist EM team
- Muscle and nerve biopsies approx. 10 to 14 weeks.
For some complex cases outside, second opinions may be requested internally within UHB but also externally to support the diagnostic report and this may add to the number of days before a final diagnostic report is issued. List of key contacts we currently use for specialist second opinions and referral labs used for testing.
||Business Scope (test)
||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)
||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
||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