Cellular Pathology - University Hospitals Birmingham

Cellular Pathology is based across UHB sites at QE Hospital Birmingham, at Birmingham Heartlands Hospital, Solihull Hospital and at Good Hope Hospital.

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 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 https://www.ukas.com 10141 Schedule of Accreditation .

At the QE site the laboratory has recently updated equipment 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.  Other new tests to meet clinical requirements are regularly added to the testing repertoire.  Consequently not all platforms, special stains and antibodies have been assessed by UKAS and so will not currently be covered by published UKAS Accreditation scope to ISO15189.   

The Department is currently supporting the Trust with significant increases in clinical activity.  For some specialties reporting times have fallen bellow targets and so the Department is working with service users to minimise the impact of this.  The Department is prioritising clinically urgent requests and patients on cancer pathways, recruiting and working additional sessions.  The Department is also outsourcing reporting of some requests to two external specialist UKAS Accredited suppliers that hold contracts with the Trust.

Specialist Services  within Cellular Pathology (by site), QE=Queen Elizabeth, BHH=Birmingham Heartlands, SH = Solihull, GH=Good Hope

  • MOHS (QE, SH) -   microscopically controlled surgery used to treat common types of skin cancer. 
  • Neuropathological Smears (QE) -  rapid diagnostic service for intra-operative brain tissue specimens
  • Cytopathology (BHH,QE) - diagnostic cytopathology services for the Trust including fine needle aspirations, endoscopic brushings and washings, EUS-FNAs , serous fluids urines and CSF.  
  • Muscle Biopsy Service (QE) -  part of the investigation of a clinically suspected neuromuscular disorder when other less invasive tests have not provided a firm diagnosis.
  • Electron Microscopy Service (QE) - used routinely at magnifications of between 1500 and 70,000 times to examine the ultrastructure of cells and their surroundings.   
  • Andrology (GHH) - Diagnostic, Post Vasectomy and Retrograde  Semen analysis .  The service operates from a single site located on the 1st Floor of the Sheldon Unit at Good Hope Hospital.
  • Direct Immunofluorescence (BHH and QE) - Direct immunofluorescence is used for the detection of  tissue bound proteins such as antibodies and complement proteins. Two types of tissue, skin or renal, are processed, This method allows for the detection of tissue bound antibodies when there may be insufficient levels to detect in serum.  
  • Mortuary (QE, BHH, SH, GH) - Body storage available on all sites with 10 freezer storage spaces available on the Solihull sites.  Post Mortems can be carried out on the Heartlands and QE sites.    
  • Immunohistochemistry (QE,MSK, BHH) - carried out using different platforms and antibodies across the sites.  See attached UKAS scope for those antibodies accredited.  At present there are several antibodies that are not yet accredited but will be added to the scope in due course.      

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 users can make request via a theatre request book entry 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/gps/laboratory-information/ shows this request form together with specific request forms used within the Trust (QE site)  for liver and breast biopsy cases.  For Heartlands, Good Hope and Solihull users then request forms are available from the Department of via a request to This email address is being protected from spambots. You need JavaScript enabled to view it. 

TWO unique patient identifiers must be present on both the request form and specimen container i.e. a minimum of the PID, NHS number or the DOB together with the patient surname and forename/initial in order to be accepted by the department. Other missing data (e.g. full clinical details) may be clarified over the phone or by email as needed.

Sample pot requirements                                   

  • Patients full name  (or as a minimum; surname with initial) 
  • Hospital or clinic PID / NHS no. AND/OR Date of birth

Request form                                              

  • Patient’s full name.                                 

  • Date of birth.                                             

  • Hospital or clinic PID / NHS no.

  • Address

  • Location

  • Clinical details

  • Request form must be signed

  • Consultant / GP

If one or more than one specimen is taken from the same patient the specimen containers and request form must be clearly labelled with the sites of the spec and indicated as parts 1,2,3 etc.

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.   External requests for sample pots and request forms are through contacting the Department.  For Heartlands site please e-mail This email address is being protected from spambots. You need JavaScript enabled to view it., for QE site use This email address is being protected from spambots. You need JavaScript enabled to view it. and for QE ROH/Bone requests This email address is being protected from spambots. You need JavaScript enabled to view it.

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.

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.  Formalin is a hazardous reagent with any leakages put portering, transport and laboratory staff at significant risk.  Please ensure containers are closed or sealed with appropriate fitting lids.  If in doubt please seek advice from the Department.

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.  

In addition to clinically urgent cases there are UHB wide @FDS@ or Faster Diagnosis Specification stamps to fast track these patient cancer samples.  This is to support end to pathways and prevent patient breaches where possible through prioritisation.

Service Background

The Department of Cellular Pathology provides a diagnostic histopathology, cytopathology, andrology, muscle biopsy, electron microscopy, Mohs, 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 for Pathology Services and is led by a Clinical Service Lead Dr Bruce Tanchel.   A technical Service Manager, Head Biomedical Scientist, Martin Collard oversees the management of the Department. 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: https://www.ukas.com schedule 10141 .  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. 

Some non-gynae cytology remains available at the QE Laboratory site but the majority of cytology samples across UHB are transferred to the Heartlands Hospital site for processing and staining.  The routine histopathology repertoire includes specialist renal, liver, muscle and nerve processing and reporting and a well established electron microscopy service.  During 2022/23 the former Musculoskeletal Pathology laboratory moved across to the QE Cellular Pathology site and details of this major service change will follow as part of the project planning process.  This specialty within Cellular Pathology is referred to as the Bone and Soft Tissue Unit.

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 core laboratory sites are open Mon-Fri between 08:00 and 17:30 with QE Cell Path also open Sun 07:00-15:00 and Heartlands Cell Path Sat 09:00-12.45. A specialist/expert referral service is also provided to hospitals in the West Midlands, nationally and to international clients.

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.

Cellular Pathology currently employs 32 consultant pathologists who cover a broad spectrum of clinical specialities, MDTS and are also available to offer clinical advice and interpretation of results if required.  Consultants can be contacted for specialist clinical advice by contacting the Cellular Pathology Offices on the QE (0121 371 3326) and BHH (0121 424 3884) sites.

Personnel 

Contact the Cellular Pathology Department

Heartlands 0121 424 3190 =  This email address is being protected from spambots. You need JavaScript enabled to view it. 

QE 0121 371 5990 = This email address is being protected from spambots. You need JavaScript enabled to view it.

Bone and soft tissue tumour unit = This email address is being protected from spambots. You need JavaScript enabled to view it.

Clinical Service Lead - Cellular Pathology

Dr Bruce Tanchel

0121 424 2196 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 - QE)

Dr Gerald Langman (Post Mortem Licence - BHH/GH)

 

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

0121 424 3189 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  or This email address is being protected from spambots. You need JavaScript enabled to view it. 

8a Operational Managers /Deputy Head Biomedical Scientists  - cross site roles include:

Becci Taylor (Cytology Lead)

Saeeda Kauser (Digital Pathology Lead/ routine labs)

Gavin Rock (IHC/Special stains Lead)

Rizwan Qamar (Dissection/Bone & soft tissue tumours)

Bev Whitehouse (Electron Microscopy Lead)

 This email address is being protected from spambots. You need JavaScript enabled to view it. or specific contacts as below:

 

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

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

0121 424 0189  or This email address is being protected from spambots. You need JavaScript enabled to view it.

0121 371 3352  or rizwan.QamarThis email address is being protected from spambots. You need JavaScript enabled to view it.

0121 371 5720 or  beverley.whitehouse.uhb.nhs.uk

Mortuary Manager

David Budding retiring during Summer 2024

QEHB 0121 371 2520/2523 or BHH 0121 424 2197

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

Tissue Services (Human Applications)

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

Alexandra Martin (QE Based)

Joanne Small (BHH Based)

0121 371 5968 or This email address is being protected from spambots. You need JavaScript enabled to view it.

0121 424 0193 or This email address is being protected from spambots. You need JavaScript enabled to view it.

Training Lead

Tracy Bright (QE Based)

Olukemi A Johnson (Heartlands based)

 

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

0121 424 1191 or This email address is being protected from spambots. You need JavaScript enabled to view it.

Health and Safety Lead

Rizwan Qamar

Joanne Small

 

0121 371 3314 This email address is being protected from spambots. You need JavaScript enabled to view it.

0121 424 0193 or This email address is being protected from spambots. You need JavaScript enabled to view it. 

Muscle Service

Ferhana Maqsood

 

0121 371 5720 This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Specimen requirements

Due to the wide range of cellular pathology specimens several key container types exist as below.  The size of the specimen container must be appropriate to the size of the specimen.

Specimen Type

Container

Small specimens

Yellow Topped 60 mL Containers for biopsies and small resection e.g. skin ellipses, appendicies.

Routine specimens

350 mL White Topped “Honey Pots” - 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. 

Large resection specimens

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.  e.g. bowel, heart, breast tissue.

“Mega” Specimen Buckets

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

Dry Samples (Within Lab hours only)

Specimen buckets, 60ml pots / Theatre Tissue Safe system.  Dry samples sent to the lab e.g.  frozen sections; MOHS samples: lymph nodes; Research projects/biobank samples

Cytopathology Specimens

Urine

A universal container. 

Smears kits

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

Serous Fluids/ Sputum/ respiratory fluids/CSFs

Universal Containers.  Do not use glass 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 (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.

  • 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 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

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.

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  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.

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 at Heatlands or QEHB sites.  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. 

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.  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.  

Please note that we support the service by outsourcing when required to the specialist EM facility at Leicester Royal Infirmary.  It is fully accredited by United Kingdom Accreditation Services (UKAS) ISO 15189, reference number 8608.

Advice on the service or requirements can be obtained from the EM lead biomedical scientist This email address is being protected from spambots. You need JavaScript enabled to view it. or from the electron microscopy laboratory team on 0121 371 5720.

 

 

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.  7, 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 routine TATs for each specialty is 14 days to first reported for greater than or equal to 90% of cases, within tolerance = 75% - 90% reported in 14 days.  Targets for reporting are not consistantly 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.  

Cancer tracking patient TATs are also tracked and reviewed with service user representatives and the Trust's FDS or Faster Diagnosis Specification group.  For example breast cancer tracking patient samples for Cellular Pathology remained strong at 90-100% reported within 10  days.  Urgent cytology is typically 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 delays in non-urgent work currently and this is reflected in 50% of work reported within 14 days.  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 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.

Referral Laboratories and second opionons

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. 

SPECIALTY NAME ADDRESS ISSUE DATE ACCREDITATION  ISO15189
Lymphomas Dr Stefan Dojcinov University Hospital of Wales (Cardiff and Vale University Health Board) 16/04/2021
Lymphomas Dr Danial Royston John Radcliffe Hospital Oxford 06/04/2021
Lymphoma (skin) Dr John Robert Goodlad Greater Glasgow and Clyde. 04/04/2023
Dermatopathology Dr Catherine Stefanato St Thomas's Hospital London (Viapath Analytics LLP) 05/04/2023
Dermatopathology Dr Alan Evans Ninewells Hospital Dundee (NHS Tayside) 25/01/2022
Dermatopathology Dr David Slater Royal Hallamshire Hospital, Sheffield (Sheffield Teaching Hospital NHS FT) 13/01/2023
Dermatopathology Dr R Carr Warwick 10/06/2022
Thyroid Dr Lia Menasce Christie Hospital Manchester (Central Manchester University Hospitals NHS FT 06/09/2021
Breast   Dr Andrew Lee University Hospital Nottingham (Nottingham University Hospitals NHS Trust Queens Medical Centre 22/03/2022
Gastro-Intestinal Prof. Neil Shepherd Cheltenham General Hospital (Gloucestershire Hospitals NHS FT) 04/01/2023
Bowel Screening Dr Adrian Bateman Southampton General Hospital 30/09/2022
Neural Prof Tuomo Polvikoski Royal Victoria Infirmary (Newcastle). (Newcastle Upon Tyne NHS Foundation Trust) 13/08/2021
Hydatidiform mole Dr Neil Sebire Charing Cross Hospital (UCL Hospitals NHS Foundation Trust) 03/03/2023
Lung Prof Andrew Nicholson Brompton Hospital London 09/03/2023
Haematopathology  Dr Alan Ramsay University College London NHS foundation Trust 06/06/2022
Haematopathology and Gynaecological pathology Dr Jayashree Pawade Southmead Hospital, Bristol  26/06/2019
Gynaecological pathology Dr Glenn McCLuggage ROYAL GROUP OF HOSPITALS Belfast 11/03/2022
Haematopathology  Dr Dogan NY USA Ahmet Dogan, MD, PhD
Chief, Hematopathology Service, Departments of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
1275 York Avenue, Dept of Pathology, Suite C-563
Attn: Ahmet Dogan, Jeeyeon Baik, New York, NY 10065
 
Dermatopathology Dr David Cundell  Royal Wolverhampton NHS Trust 16/02/2022
lower GI/bowel screening. Prof Marco Novelli UCL University college London 06/06/2022
Dermatopathology Eduardo Calonje St Johns Institute of Dermatology, St Thomas' Hospital 05/04/2023
       
Referal for Second opinion  Department of Histopathology Charing Cross Hospital LONDON 03/03/2023
BMT histology reporting Dr Andrew Jack HMDS St James Institute of OncologyBexley WingSt James University Hospital (leeds teaching Hospitals NHS Trsut) 03/02/2023
Muscle pathology Dr Chris Kettle Newcastle upon Tyne Dental HospitalRichardson Road 24/05/2021
Referal for Second opinion  Dr Madhuri Deolekar  Deartment of Histopathology Royal Blackburn Hospital Blackburn VV2 3HH 21/03/2023
Renal Histology  Dr Ian Roberts Oxford University Hospitals NHS TrustJohn Radcliffe HospitalHeadley Way 20/03/2023
Muscle histology Dr Lucy Feng Dubowitz Neuromuscular Centre, Dept of Neuropathology, Institute of Neurology, Queen Square, London WC1N 3BG Acadamic
Dental Histology Dr Paul Matthews University Hospitals Coventry and Warwick NHS TrustClifford Bridge Road 10/06/2022
Dental histology (slide reporting) Dr Phil Sloan Newcastle Royal Victoria InfirmaryQueen Victoria Road 13/08/2021
ENT histology Dr Richard Allibone Nottingham University Hospitals NHS TrustQueens Medical Centre CampusDerby Road 22/03/2022
Skin Dr Richard Carr Coventry and Warwickshire Pathology Network, Department of Histopathology, Warwick Hospita, Warwick CV34 5BW 10/06/2022
Referal for Second opinion  Dr Candice Roufosse
Histology Department 
North West London Pathology Charing Cross Hospital 03/03/2023
Referal for Second opinion  Prof Emad Rakha Nottingham City Hospital Campus 22/03/2022
Dental histology  Prof Paul Speight Emeritus Professor in oral and maxillofacial pathology School of Clinical DentistryUniversity of Sheffield19 Claremount Crescent  
Referral for second opinion (Neuropathology) Profesor Safa-Al-Sarraj  King's College Hospital, Denmark Hill, London
 SE5 9RS
04/10/2022
Paediatric Neuropathology  Prof Thomas Jacques Great Ormond street hospital  19/12/2022
Gynae Raji Ganesan Birmingham Women's hospital 22/11/2022
Referral for second opinion (Neuropathology) federico Roncaroli Salford Royal Hospital 20/10/2022
Referral for second opinion (Neuropathology) Professor Sebastian Bradner UCL Institute of Neurology 06/06/2022
Referral for second opinion (Neuropathology) Dr Zane Jaunmuktane UCL Institute of Neurology 06/06/2022
Referral for second opinion (Neuropathology) Prof Marai thom UCL Institute of Neurology 06/06/2022

 

 

Andrology

The laboratory's priority is to provide a comprehensive semen analysis service for Consultants, Urologists and General Practitioners from the Birmingham and Solihull area. This includes semen analysis (Diagnostic Semen Analysis), post-operative analysis of semen following a vasectomy operation (Post Vasectomy Semen Analysis) and Retrograde analysis of urine.

The laboratory operates on a clinic based service and has a maximum capacity of 2000 appointments available per annum. This covers the annual workload of routine diagnostic semen analysis, post-vasectomy samples and retrograde ejaculation analysis. Routinely patients will be given an appointment to attend the Andrology Department for on-site sample production in a designated private clinic room, however in exceptional circumstances samples may be produced off site if then able to be delivered to the laboratory within an appropriate time interval. 

The UHB Andrology Laboratory has fully trained scientists who are highly proficient in performing quality diagnostic semen analysis in line with World Health Organisation (2021) and the 2016 Laboratory Guidelines for post vasectomy semen analysis. The laboratory regularly performs internal quality control, participates in the UK National External Quality Assurance Reproductive scheme for Andrology (UKNEQAS) and liaises with other accredited laboratories for comparison of tests not covered within the UKNEQAS scope.

A laboratory referral can be made via:

Paper copy referral forms sent to Appointment Centre via post/e-mail

Electronic Referral Service (e-RS) with an attached referral form 

A copy of the referral form can be obtained by;

Contacting the laboratory directly on 0121 424 9717 Or by downloading from here Andrology Referral Form Or by GP’s accessing the word version at: https://www.uhb.nhs.uk/gps/referrals/andrology.htm

Off-site production can be arranged by the patient by telephoning the laboratory on 0121 424 9717 or by e-mailing This email address is being protected from spambots. You need JavaScript enabled to view it. (if you e-mail you are accepting that the connection is not secure and potentially not confidential – laboratory staff will minimise data transmission but cannot guarantee security). Please note that retrograde urine production must be on-site at Good Hope Hospital.

 Turnaround Time: 7-10 days (electronic reporting may be more rapid). Paper copies sent out following result authorisation.

Anti-sperm antibodies (ASAB) are not tested at this laboratory. Agglutination is described if noted.

Please see user handbook for additional information including contact details.

Accreditation information can be found under Cellular Pathology (UKAS 10141): https://www.ukas.com/download-schedule/10141/Medical/

 Post-vasectomy Semen Analysis (PVSA)

The laboratory undertakes examination procedures in line with the following guidelines: 2016 PVSA Guidelines. This will give clinicians information regarding clearance criteria. 

 Results are available to Hospital clinicians via PICS, Clinical Portal, and ICE.

 GP’s can access patient results through their own electronic result systems.

 Key details of the service:

Operates Monday to Friday 08:00am to 16:00pm
Undertakes Diagnostic semen analysis, Post vasectomy semen analysis and Retrograde examination (urine)
Appointment based with on-site private room for sample production
7-10 day turnaround time (electronic and paper copy reporting)
Patients are booked within 7 weeks from referral, unless clinically indicated or by patient choice
The User Handbook can be accessed here: Andrology User Handbook
 

Andrology - Measurement Uncertainty

Following on from our recent UKAS assessment, we were advised that we need to demonstrate that the clinical impact of the Measurement of Uncertainty on clinical decision values has been assessed and considered in relation to patient outcome. This must include an explanation of any effects this could have to the decision limits and how they should be interpreted.

 

Application of the CV to the clinical relevance of Diagnostic Semen Analysis (DSA)

The Coefficient of Variation (CV) was calculated for each parameter for DSA and used as the measurement of uncertainty associated with each parameter. Each parameter’s CV is as follows:

Parameter

CV

Motility

7.32

Concentration

8.89

Morphology

17.02

Vitality

2.31

 The uncertainty is calculated by dividing the analysis result by 100 and multiplying by the associated CV. The range is calculated by +/- the uncertainty from the result.

 The uncertainty could influence the fertility pathway for patients who have received results close to the clinical decision values for each specific parameter. Examples include:

Motility – Uncertainty = 2.2%

This informs us that if the laboratory reports a motility result of 30% then it will have a range of 30% ± 2.2 (27.8 – 32.2%).

Concentration – Uncertainty = 1.4 x 10⁶/ml

This informs us that if the laboratory reports a concentration result of 16 x 10⁶/ml then it will have a range of 16 x 10⁶/ml ± 1.4 (14.6 – 17.4 x 10⁶/ml).

Morphology – Uncertainty = 0.7%

This informs us that if the laboratory reports a morphology result of 4% then it will have a range of 4% ± 0.7 (3.3 – 4.7%).

Vitality – Uncertainty = 1.2%

This informs us that if the laboratory reports a vitality result of 54% then it will have a range of 54% ± 1.2 (52.8 – 55.2%).

Clinical impact of measurement of uncertainty will be communicated to users with annual website updates. Internal users of the service will be emailed directly (fertility and urology).

 

Clinical Impact of Measurement Uncertainty

Measurement uncertainty, either for one reported parameter or as a combination of multiple reported parameters could have a clinical impact. For example, if a concentration of 15 x 10⁶/ml is reported (oligozoospermia), given a UoM of 1.4 x 10⁶/ml, this sample could have a concentration of 16 x 10⁶/ml (normozoospermia).

For some users, a diagnosis of oligozoospermia, even at the borderline level of 15 x 10⁶/ml, could lead to the recommendation of an assisted reproductive technology such as intracytoplasmic sperm injection (ICSI) to promote the chance of fertilisation, when conventional IVF, or even natural conception, might be possible. 

We inform our users of this uncertainty and emphasize that the reports can be used to guide clinicians to determine how to proceed with further investigation and management of a subfertile couple. We stress that all reported parameters should be considered holistically.

Furthermore, as per WHO 2021 guidance, we inform users that many known and unknown female factors hamper the value of using only semen examination parameters to predict the prognosis for the couple of spontaneous or assisted fertilization.

The decision limits that we provide on our reports are derived from WHO 2021 and are derived from data characterizing the semen characteristics of a reference population (men whose partners had a time to pregnancy of 12 months or less). The data uses a diverse international populations, noting that the percentiles used do not represent distinct limits between fertile and subfertile men.

We highlight that a semen analysis is never prognostic of fertility, as it is the fertility potential of the couple that defines them as fertile or subfertile.

  

Unaccredited testing

The Department regularly reviews testing to reflect clinical service needs and advances in technology.  Consequently, some testing and equipment has not yet been reviewed at UKAS assessment visit.  The following testing and aspects of Cellular Pathology are not covered by UKAS 15189 accreditation:

Sputum Analysis - Differential cell count performed on induced and non-induced sputum samples. A developmental diagnostic tool to deliver accurate severe asthma diagnosis and phenotyping.  This will be a step towards patient tailored medicine delivery in severe asthma and will enhance our Trust position as a leading national centre in the management of severe asthma.

Digital Pathology - the Department is performing extensive clinical validation towards going live with digital pathology during 2024.  Hamamtsu S60 and S360 slide scanners are used as part of a Sectra IDS7 software solution for viewing and reporting digital images.  This will be subject to a UKAS 'Extention to accredited scope' application later in 2024.

 

 

UHB, Department of Cellular Pathology

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