Histopathology Department

Histology Laboratory Handbook

SECTION

Main laboratory

SOP NUMBER

HPSOPML021

AUTHOR

Helen Done

VERSION

013

DATE WRITTEN

19.2.2016

APPROVED BY

Vivek Mudaliar

DATE ISSUED

19.2.2016

INITIALS

HD

LOCATION OF HARD COPIES

Available on UHNM NHS Trust intranet site

The Royal Stoke Site Main laboratory (x2 copies)

Multiple Users on the County Hospital site

University Hospital of North Midlands NHS Trust

Histology Department

Pathology Directorate

Royal Stoke Site

Floor 2 Main Building

Newcastle Road

Stoke on Trent

Staffordshire

ST4 6QG

Tel: 01782 674932

This laboratory handbook is issued under the authority of

Dr Vivek Mudaliar, Consultant Head of Department

Contents

Location of Hard copies ... 1

Introduction ... 3

Telephone Numbers ... 4

Laboratory and Office ... 4

Medical Staff ... 4

Mortuaries and Post Mortem Room ... 4

Location ... 5

Opening hours: ... 5

Submitting specimens to Histology ... 5

Request forms ... 5

Specimen advice ... 7

Transport of specimens to the laboratory ... 10

Health and Safety advice for handling formaldehyde ... 10

Spillage advice ... 10

Routine Specimens ...11

Urgent Specimens ...11

Specimens sent ‘dry’ ...11

Frozen Sections ...12

Specimens requiring consent for examination and/or disposal ...12

OSNA ...13

Renal biopsy ...13

Biopsies for Immunoflourescence ...14

Neuropathology specimens ...14

Muscle biopsies ...14

Rectal biopsy for investigation of Hirschsprung’s disease ...15

Sural Nerve biopsies ...15

Gynae Cytology Preparation………16

Referral laboratories………. ……….16

Report Availability ...32

Further Information ...33

Post Mortem information ...34

Coroners Post Mortems ...34

Non Coroner’s Post Mortems ...34

Post Mortem Examination Requests ... 34

Consent ... 35

Introduction

The Histology department at UHNM holds both CPA and HTA accreditation and offers a comprehensive histology service to users. We receive over 35,000 requests each year from which we produce over 230,000 slides for microscopic examination.

The following sub-specialities of histology are covered by in-house pathologists:  Breast  Urology  Gynaecology  Upper GI  Lower GI  Respiratory  Renal  Lymphoma  Dermatology  Head and neck  Endocrine

 Soft tissue and bone  Post mortem Histology

The Consultant Histopathologists from The Royal Stoke Hospital Histology department contribute to all relevant multi-disciplinary team meetings.

Neuropathology specimens are referred to the Queen Elizabeth Hospital Birmingham neuropathology department.

Ophthalmology specimens are referred to the Royal Hallamshire Hospital Sheffield, Ophthalmology department. Occasionally a case of any sub-specialty may be referred to consultant pathologist at another centre. If this happens reference is made in the text of the histology report. An up to date list of usual referral centres is available from the Histology Office

As well as routine histological techniques the laboratory has a comprehensive special stain and immunocytochemistry repertoire available to aid pathologists in producing diagnoses.

The department also provides an Immunocytochemistry Her2 testing service with subsequent FISH testing being performed in house.

We provide an OSNA (One Step Nucleic Acid Amplification) service to the breast surgeons. Currently this is only available to the breast surgeons based on The Royal Stoke Hospital site.

We provide an Electron Microscopy service for renal and cardiac diseases.

The laboratory works to the University Hospital of North Midlands NHS Trust ‘Data Protection Policy’ to ensure the protection of personal information and the ‘Handling of complaints and concerns’ policy.

Telephone Numbers

When dialling from outside the hospital dial 01782 (if outside Stoke-on-Trent) and put 6 in front of the extension number noted below e.g. 01782 674899)

Royal Stoke Histology Laboratory and Histology Office

Report enquiries (Histology Office) x74298

Technical enquiries (Histology main lab) and frozen section (Histology main lab) x74932

Specimen enquiries (Histology lab specimen reception) x74899

Lead Biomedical Scientist for Histopathology x74237

Lead Biomedical Scientist for Her-2/FISH testing & clinical trials x74278

UHNM Pathology Stores Manager x74851

Fax (Histology Office) 0844 2448564

The Royal Stoke Switchboard 01782 715444

Royal Stoke Mortuaries and Post Mortem Room

Mortuary Manager x72088

Mortuary reception x72085

County Specimen Reception

Specimen reception (Jane Connolly) 01785 257731 x4704

Mortuary body store 01785 230470

Other Histology related services

Royal Stoke Supplies and Procurement (Histology request form and specimen bag requests) x72672

Consultant Histopathologists

Dr. B Latifaj x74841

Dr. N Cooper x74840

Dr. D Gey van Pittius x74836

Dr. V Smith x74835 Dr. M Stephens x74842 Dr. C Howitt x74838 Dr L Hammond x74837 Dr. G Douce x74843 Dr. K Kalyanasundaram x74839 Dr. V. Mudaliar x74293 Dr. E Sheldon x74246 Dr. H Ali x74288 Dr. S Harris x74288 Dr. P Simcock x74246 Dr. S Sundararajan x74835

Location

The Royal Stoke Hospital Histology Department is situated on the second floor of the University Hospital of North Midlands NHS Trust main building.

The Royal Stoke Mortuary is situated on the lower ground floor of the University Hospital of North Midlands NHS Trust main building.

The County Body Store is located at County Hospital.

All visitors to the department must report to the relevant reception desk and sign in and out of the building. Please note there is no longer a Histology department at County Hospital.

Opening hours:

Monday to Friday

Office (reports) 08:00 to 17:30 Histology Laboratory 08:30 to 17:30

Mortuary 08:00 to 16:00

Saturday and Sunday

All departments listed above closed

Outside Normal Working Hours

There is a pathologist on call outside normal working hours who can be contacted via The Royal Stoke Hospital switchboard for clinical advice in emergencies only.

There is no formal on call for technical support for frozen sections (only available for Royal Stoke based clinicians). This may be available on a ‘good will’ basis however it cannot be guaranteed and requires prior conversation.

Submitting specimens to Histology

Histology Request forms

It is imperative when sending any specimen to the Histology Laboratory that it should be accompanied by a correctly filled out request form. All sections of the form should be completed as shown on the provided example (see below). Failure to do so WILL result in rejection and the returning of the specimen to the requesting Clinic/ward/GP practice for amendment.

If Microbiology and/or cytology are required, separate specimens and separate forms MUST be submitted as the specimen(s) will be dealt with in different laboratories which are in different locations.

Request forms and specimen bags can be requested from The Royal Stoke Hospital Procurement and Supplies department (contact number as shown on page 4).

It is vital that forms are correctly filled out and more importantly, legible. Clinical details are a vital part of the Histology request. Please provide legible and relevant information in this field along with any information regarding danger of infection status if known or suspected.

The minimum data set for completion of the request cards and specimen post must be followed. This can be found in UHNM Policy Number C49 – ‘Policy for Requesting Patient Investigations and Referrals and the Reporting and Interpretation of Results’.

Please note the following;

 County sourced specimens MUST have the NHS number noted on the form.

 Please ensure the resection or main specimen is labelled as “A” on the request card. The proceeding specimens should then be labelled as ‘B’, ‘C’, ‘D’ etc.

 Please note if the patient is on a cancer pathway.

 Reports may be delayed if notes have to be retrieved by pathologists in cases where clinical

information provided on the requests card is deficient.

The Histology Laboratory runs a very strict zero tolerance approach to ALL Histology requests. Specimens WILL be returned if the correct format is not followed and appropriate information is not provided.

This zero tolerance approach is designed to ensure the correct and accurate receipt of specimens and request cards, to sufficiently fulfil the laboratory requirements for safe and reliable testing. Failure to follow this procedure will result in delayed testing and ultimately delayed receipt the final report and results.

To ensure your request card is accurately filled out, please study and follow the template/s and example provided over page. The example test required is in blue text.

All patient and requestor details shown in red must be completed and correct to ensure acceptance.

Please ensure the name of the consultant is shown in the consultant field and not the requesting clinician. This will also cause rejection of the specimen.

REPORT ENQUIRIES Histology 01782 67428 Cytology 01785 674229 SPEC. ENQUIRIES Histology 01782 674899 Cytology 01782 674229

PATHOLOGY LABORATORY

DEPARTMENTS OF HISTOLOGY & CYTOLOGY

FOR LAB USE ONLY

Lab No.:

PLEASE WRITE CLEARLY _{Date received:}

Surname: (PRINT) JOLLY Unit No: 67482 GP DR SMITH GP No

8752 Specimen opened by: Date opened: Forename: (PRINT)

JOAN

Date of Birth: 21.6.2016 Sex: F NHS No: 8787542430 Consultant

Cut up by Address: 61 PARKFIELD GROVE CHEYNEY NOOK POINTON STOKE ON TRENT Post code: ST7 4TH Tick as appropriate NHS PP 

Date specimen taken Time specimen taken

2.2.2017 16:20

Surgery Address:

SMITH GREEN SURGERY HASSEL GREEN

MINSHULL STOKE ON TRENT ST5 2JJ

Assisted by

MOs Signature: H.Foddy

Specimen code/s

MOs Name (PLEASE PRINT) H.FODDY

Site and nature of Specimen(s)

(PLEASE WRITE CLEARLY) A MAIN SPECIMEN (RESECTION OR LARGEST BIOPSY) B NEXT BIOPSY C NEXT BIOPSY D ETC. UP TO LAST BIOPSY

NB, MUST HAVE THE MAIN SPECIMEN AS

“A”

Relevant clinical details: (PLEASE WRITE CLEARLY) CLINICAL DETAILS

 MUST BE LEGIBLE

 MUST BE RELEVANT

 MUST, MUST, MUST HIGHLIGHT INFECTION RISK

STATUS AND DETAILS

 CYTOLOGY/MICROBIOLOGY SPECIMENS ASSOCIATED

WITH CASE SHOULD HAVE A SEPARTE FILLED OUT REQUEST FORM

 PREVIOUS TREATMENT e.g. CHEMOTHERAPY

(please continue over if required)

Block/s checked by Processor schedule/s (ES,EX,P or V) D at e Init ’s Slide/s checked by Slides distributed by

REPORT ENQUIRIES Histology x74288 Cytology x74229 SPECIMEN ENQUIRIES Histology x74899 Cytology x74229

PATHOLOGY LABORATORY

DEPARTMENTS OF HISTOLOGY & CYTOLOGY

FOR LAB USE ONLY

Lab No.:

PLEASE WRITE CLEARLY

Surname: (PRINT) JOLLY Unit No: 67482 Ward: 721 Theatre: 4

Date specimen taken:

7.2.2016

Time specimen taken:

12:10

Date received: Specimen opened by: Date opened: Forename: (PRINT) JOAN Date of Birth 21.6.2016 Sex: F NHS No: 32792634285 Consultant Cut up by Assisted by Address: 61 PARKFIELD GROVE CHEYNEY NOOK POINTON STOKE ON TRENT Post code: ST7 4TH Tick as appropriate NHS PP  Consultant: S.WAINWRIGHT

If urgent , date report required by:

9.2.2016

Specimen code/s Block/s checked by MOs Signature: H.Foddy Contact/Bleep Number BLEEP: 75225 TEL: ext 74692 Processor schedule/s (ES,EX,P or V) D at e Init ’s

Site and nature of Specimen(s) (PLEASE WRITE CLEARLY)

NB, MUST HAVE THE MAIN SPECIMEN AS“A”

A - RIGHT BREAST B - SUPERIOR CAVITY BIOPSY

C - LATERAL CAVITY BIOPSY D - INFERIOR CAVITY BIOPSY

E - MEDIAL CAVITY BIOPSY F - SENTINAL LYMPH NODE G - RIGHT AXILLARY LYMPH NODES

MOs Name (PLEASE PRINT ) _H.FODDY

Relevant clinical details: (PLEASE WRITE CLEARLY)

CLINICAL DETAILS

 MUST BE LEGIBLE

 MUST BE RELEVANT

 MUST, MUST, MUST HIGHLIGHT INFECTION RISK

STATUS AND DETAILS

e.g.

 28 ♀ INCIDENTAL FINDING

 PREVIOUS ER+ CORE BIOPSY OF UOQ

TAKEN 20/09/11 L11/45000

 INVASIVE ADENOCARCINOMA

 RIGHT BREAST WIDE LOCAL EXCISION DONE.

 LONG SUTURE = *****, SHORT SHUTURE = ****

(please continue over if required)

Slide/s checked by Slides distributed by

Histology Specimen advice

Specimens for routine histology at The Royal Stoke Hospital must be submitted to the laboratory in 4% buffered formalin.

Please note the following dependant on where the specimens are sourced.

Specimens being sourced at The Royal Stoke for reporting at the Royal Stoke Hospital must be sent

directly to The Royal Stoke Hospital Histology department for processing and reporting using internal portering services

Specimens being sourced at County Hospital for reporting at The Royal Stoke Hospital must be sent

directly to the County Hospital specimen reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at GP surgeries for reporting at The Royal Stoke Hospital must be sent

directly to The Royal Stoke Hospital using either UHNM transport couriers or City Sprint (dependant on where you are situated).

Specimen containers and formalin are available to The Royal Stoke Hospital users from the Pathology Stores (contact number as shown on page 4).

Specimen containers and formalin are available to the County Hospital users from County specimen reception (contact number as shown on page 4).

Please ensure that the lids of specimen containers are properly secured to avoid leakage of formalin.

Histology specimens should be collected and handled with care. If small specimens such as endoscopic biopsies, punch biopsies, small skin biopsies etc are crushed or allowed to dry out accurate histological diagnosis may be impossible. This may also lead to a degree of uncertainty of measurements within the result being provided.

‘Fixation’ of specimens in formalin is the crucial first step in the histology process and should not be delayed unless necessary.

If a specimen is to be sent to the Histology laboratory dry (i.e with no formalin) please read the ‘Specimens sent ‘dry’’ section on page 11. Please note that here should not be any reason for County users to send any specimens dry to The royal Stoke Histology laboratory.

Specimens should have a correctly filled out histology label attached to the side of the specimen container -

not the lid.

Specimens must be submitted to the laboratory in a sealed Histology specimen bag.

For The Royal Stoke Hospital users these can be requested from The Royal Stoke Hospital Pathology Stores (contact as shown on page 4).

For County Hospital users these can be requested from The Royal Stoke Hospital Procurement and Supplies department (contact as shown on page 4).

We strongly advise that a check of details on cards and specimens be made before specimens are bagged for dispatch to the laboratory.

Any unacceptable transcription errors (as noted under zero tolerance) which occur will give cause to the specimen being returned to the source. This will cause a delay in the report turnaround time for the specimen which may cause it to breach its target turnaround time (as noted on page 22).

If there is any known infection risk with the specimen e.g. HIV, Hepatitis and TB this should be clearly written on the request card.

Transport of histology specimens to the laboratory

Specimens being sourced at Royal Stoke must be sent directly to The Royal Stoke Hospital Histology

department for processing and reporting using internal portering services

Specimens being sourced at County Hospital must be sent directly to the County Hospital specimen

reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at GP surgeries must be sent directly to The Royal Stoke Hospital using

either UHNM transport couriers or City Sprint (dependant on where you are situated).

All specimens are collected on a 90 minute, daily basis Monday to Friday and 3 times per day at weekends. Please note due to the schedules in place for these collections, we have aimed to optimise the run times in order to maintain target Histology turnaround times. We heavily discourage any batching of samples as if samples are batched then this will cause delays in turnaround times of the reports.

Health and Safety advice for handling formaldehyde

Histological fixative is a 4% solution of formaldehyde in water (4% buffered formalin). Formaldehyde at this concentration is classified under COSHH regulations as harmful. It is sensible to avoid all contact with skin and inhaling fumes. Repeated exposure to formaldehyde can lead to sensitisation and may cause an allergic reaction. Formalin is now classified as ‘suspected of causing cancer’.

The following safety information is printed on the label of all histology specimens:

Spillage advice

In the event of a small spillage ventilate the area, put on gloves and apron and dilute the spill with water and mop up the fluid with tissue paper. Put the tissue into a polythene bag and seal it and then double bag. This can be disposed of into normal waste. Keep the area ventilated until the spillage site is dry. In the event of a large spillage of formalin, warn others to keep away from the area. Ventilate the area well; wear a respirator if necessary along with other protective clothing. Use spillage absorption granules to soak up the spillage (special formalin neutralising granules are available). Collect up the granules and double bag them and wash the area well with water and then mop this up. Used spillage granules should be incinerated with clinical waste. Keep the area well ventilated until the spill area is dry.

Possible risk of irreversible effects.

May cause sensitisation by skin contact.

In case of contact with eyes rinse immediately with

water and seek medical advice.

Use only in well ventilated areas.

Wear suitable protective clothing and gloves.

In case of accident or if you feel unwell seek medical

advice immediately.

If a spillage occurs in a public area or in a theatre, the spillage response team should be alerted. The team have been trained to deal with spillages of formaldehyde.

With any UNHM formalin spillage, a Datix incident form must be submitted.

Routine Histology Specimens

Specimens for routine histology should be sent totally immersed in 4% buffered formalin - please note the warning on the label. Ideally the formalin should be ten times the volume of the tissue. Please use the correct sized container.

The frequency for testing of routine Histology samples is daily Monday through to Friday 9am – 5.30pm except for when bank holidays occur and no service is provided.

Please see ‘Specimen Advice’ section above.

Urgent Histology Specimens

If a report is required urgently please state clearly on the request form when it is required for, where it is to be sent and also a contact name and phone or bleep number.

Patients being treated under the 31/62 wait pathways should be clearly indicated on the request card. Urgent specimens should be taken without delay to the sites specimen reception and The Royal Stoke Hospital Histology specimen reception should be informed (contact as shown on page 4).

Note: for a clinically urgent specimen that must be reported within 6 calendar days, and where a delay of

one more day would adversely affect management, the clinical must contact the Histology laboratory and ask to speak with a Pathologist before or if this is not possible, immediately after the sample is taken. If you wish to speak to someone about your requirements please telephone The Royal Stoke Hospital Histology laboratory (contact as shown on page 4) and ask to speak with a Senior Biomedical Scientist. The frequency for testing of urgent Histology samples is daily Monday through to Friday; 9am – 5.30pm except for when bank holidays occur and no service is provided. We will however aim to provide, under special circumstances, a report on the same day as a biopsy is taken/accepted into the laboratory but this can only be done by prior notification and arrangement.

Please see ‘Specimen Advice’ section above.

Histology specimens sent ‘dry’

Please note that we would advise that Histology specimens sourced at County Hospital are always fixed due to the transport times of these samples. If you are in any doubt please contact The Royal Stoke Hospital Histology laboratory for advice (contact as shown on page 4).

If dry specimens are not transported to the laboratory immediately, within a short timeframe and handled correctly on arrival it can result in compromised quality of the subsequent histological examination and report. As noted earlier this may also lead to a degree of uncertainty of measurements within the result being provided.

If a specimen is to be sent to the laboratory ‘dry’, i.e. not in formalin, it is very important to inform The Royal Stoke Hospital Histology laboratory beforehand by telephone so that appropriate transport and handling arrangements can be discussed and made.

Always use a standard formalin label as the specimen will be placed in formalin when received in the Histology department.

If it is apparent that the specimen cannot be received in The Royal Stoke Hospital Histology laboratory by 5pm, please contact The Royal Stoke Hospital Histology laboratory to discuss appropriate handling of the specimen.

As a last resort the specimen can be placed in formalin and refrigerated in the theatre overnight BUT IN

THESE CIRCUMSTANCES IT MUST BE TRANSPORTED TO THE LABORATORY FIRST THING THE FOLLOWING MORNING AND THE LAB SHOULD BE INFORMED IT IS ON ITS WAY.

Also please see ‘Specimen Advice’ section above.

Histology Frozen Sections – only available to clinicians based at The Royal Stoke Hospital

Frozen sections should not be performed on cases at high risk of infection.

The frequency for testing of Histology frozen section samples is daily Monday through to Friday except for when bank holidays occur and no service is provided. Frozen sections can only be processed in the lab between the hours of 8.30am and 4.30pm.

If a frozen section is anticipated, The Royal Stoke Hospital Histology laboratory must be informed by telephone on x74932 or via electronic frozen section request, by at latest, the day before the operation. The laboratory staff will need to know ALL the following information:

a) The patient's name and unit number.

b) The nature of the specimen and the reason for the request. c) The requesting consultant.

d) The operating theatre to be used. e) The date and time of the operation.

f) Any known infection risk. This is critical for containment level 3 pathogens such as TB. Frozen sections cannot be performed on these samples because of the inability to contain these samples preventing exposure of staff to the risk of infection.

g) Any relevant information about previous biopsies.

In the event of an unanticipated frozen section during the course of an operation the laboratory should be telephoned immediately giving the information outlined above.

The specimen should be sent in a dry specimen container, correctly labelled with a standard histology label (the specimen will be put into formalin eventually) and accompanied by a correctly filled out histology form. A telephone number should also be provided, so that the report can be

telephoned through when ready.

If Microbiology and/or Cytology are required then separate forms and specimens for each discipline should be sent where possible.

Specimens should be submitted to the laboratory in the orange Histology Specimen bags which are available from the department (Tel x74932) WITH A PINK ‘FROZEN SECTION’ LABEL on the outer surface of the bag. This helps all those handling the specimen to identify it as very urgent.

Please see ‘Specimen advice’ section above.

Specimens requiring consent for examination and/or disposal

The specimens that fall into this category are those which may contain foetal material. This includes:  Products of Conception (miscarriage specimens)

 Ectopic pregnancies

We are unable to process or dispose of these specimens without a fully completed consent form. The consent form should ideally be sent with the specimen. If this is not possible it should be sent to

Please see ‘Specimen Advice’ section above.

OSNA – only available to clinicians based at The Royal Stoke Hospital

OSNA is a specialist molecular technique used to detect lymph node metastases in breast cancer patients. This test is pre-booked by the breast surgeons on a weekly basis.

The frequency for testing of OSNA samples is alternate Mondays between midday and 4.30pm (County patients only) and then Tuesday, Wednesday and Thursday 9am – 4.20pm (Royal Stoke patients) except for when bank holidays occur and no service is provided.

There must be verification that the patient has been ‘dosed’ (verification of either blue dye and / or radioisotope injection).

The minimum data set for completion of the request cards and specimen pots must be followed. This can be found in UHNM Policy Number C49 – ‘Policy for Requesting Patient Investigations and Referrals and the Reporting and Interpretation of Results’.

Collection of specimens

Upon removal of a node:

1. The theatre staff nurse must telephone

The Royal Stoke Hospital

Histopathology department on extension 74932 and inform the Histology member of staff that the first node has been removed. The Histology BMS will then attend the OSNA laboratory ready for processing of this/these nodes. 2. Upon resection, each lymph node(s) must be placed into its own correctly labelled, sterile empty

specimen pot which must then be placed into a ‘size 1’ bucket half-filled with crushed ice.

Transportation of specimens

When all nodes for analysis have been removed a member of theatre staff must: 1. Correctly and fully complete the OSNA request form.

2. Deliver the node(s) and OSNA request form to the Histology staff member in the OSNA laboratory

ALL NODES MUST BE IN THE OSNA LABORATORY READY FOR ANALYSIS WITHIN 15 MINUTES OF RESECTION ELSE THE TISSUES WILL START TO DEGRADE.

Renal biopsy – only available to clinicians based at The Royal Stoke Hospital

Biopsies may be collected for direct immunofluorescence (DIF), light microscopy (LM) and electron microscopy (EM).

The EM is managed by us at UHNM Histology department but we do lease ‘space’ and ‘EM scope time’ from Keele University, S-O-T.

The specimen sourcing and first part of the EM processing (including the initial quality analysis of the sample) is performed at the Histology department, UHNM.

One day per week a Senior BMS will attend Keele University in order to complete the processing and sectioning of the tissue. He then views the tissue using the Keele EM scope and taking images from this to return to UHNM.

The tissue is then diagnosed by a UHNM Histopathologist and an MDT attended.

The frequency for testing of Histology renal biopsy samples is daily Monday through to Friday, 9am-4pm except for when bank holidays occur and no service is provided.

Collection of specimens

For routine renal biopsies, the doctor carrying out the procedure must inform The Royal Stoke Hospital Histology laboratory by telephone on extension 74932 as far in advance (no less than 1 hour) as possible giving the date, anticipated time and location of the biopsy.

Reasonable notice of the procedure is required prior to the specimen being taken, in order to guarantee the presence of BMS staff on receipt of the specimen into the lab.

Should an urgent result be required, then discussion with a Consultant Pathologist is necessary.

Transportation of specimens

1. Correctly and fully complete the Histopathology request form and specimen pot.

2. Ensure the specimen is placed onto a piece of ‘normal saline’ moistened gauze and placed into a sterile empty specimen pot. Do not soak.

3. Immediately after, the specimen must be taken directly to the Histopathology department by a member of the renal team and the specimen must be handed to a member of the Histology staff with an explanation of what the tissue is and tests required.

Biopsies for Immunofluorescence

The frequency for testing Histology immunofluorescence samples is daily Monday through to Friday, 9am – 4.30pm except for when bank holidays occur and no service is provided.

Specimens sourced at The Royal Stoke Hospital site post excision must be placed onto a small piece of gauze dampened with normal saline and sent to The Royal Stoke Hospital Histology laboratory immediately. The outer packaging should have a “Dry specimen for histology” label attached.

Specimens that are sent from County Hospital, off site clinics and theatres will take longer to arrive and therefore MUST be immersed in Michel’s fixative.

In both of these incidents, please telephone The Royal Stoke Hospital Histology laboratory (contact as shown on page 4) to inform a Senior Biomedical Scientist of the samples impending arrival.

Neuropathology specimens

Neuropathology specimens sourced at The Royal Stoke Hospital site are reported at the Neuropathology department of the Queen Elizabeth Hospital Birmingham (BQEN). All neuropathology specimens are received in The Royal Stoke Hospital Histology laboratory and are booked onto the computer system. They are sent “wet” via a taxi the same day if possible to BQEN for processing and reporting.

In the event of a result being required very urgently please contact BQEN on 0121 627 2102.

There is no frequency of testing provided due to this being an externally performed test.

Neuropathology reports are sent directly from Birmingham to the requesting Neurosurgeon and also The Royal Stoke Hospital Histology Office. For any queries regarding reports please phone 0121 627 2102.

Muscle biopsies sourced at The Royal Stoke Hospital site are collected by staff from Queen Elizabeth Hospital Birmingham Neuropathology department and must be arranged at least 48 hours before by telephoning 0121 697 8474.

There is no frequency of testing provided due to this being an externally performed test.

Rectal biopsy for investigation of Hirschsprung’s disease

These biopsies are reported at the Birmingham Children’s Hospital and require special handling. When planning a biopsy of this kind the patient’s consultant or a suitable representative should contact the Children’s Hospital on 0121 333 9833 to discuss exact requirements.

The paediatric pathologist, Dr Marie-Anne Bründler is keen to speak to the surgeons who take the specimens in an effort to reduce the number of unsatisfactory specimens being sent.

There is no frequency of testing provided due to this being an externally performed test.

Procedure for the arrangement of a rectal biopsy

Telephone The Royal Stoke Hospital Histology laboratory at least one day before biopsy is to be carried out, the person giving the date, time and location of the biopsy together with relevant patient details also a name and contact number of someone to contact on the day of the biopsy.

It is strongly recommended that the procedure takes place in the morning in order to facilitate preparation of samples, packing and transport to Birmingham for diagnosis.

If this is not possible then the procedure below should be followed by the person taking the biopsy and the biopsy must be transported directly to The Royal Stoke Hospital Histology laboratory in 4% buffered formalin.

Guidance for taking biopsy (issued by Birmingham Children’s Hospital):

Birmingham Children’s hospital require 2-3 SUCTION BIOPSIES that ARE NO LESS THAN 0.2CM

MAXIMUM DIMENSIONS, and should include submucosa. In older children A SINGLE RECTAL STRIP BIOPSY AT LEAST 0.3-0.4CM MAXIMUM DIMENSION containing submucosa is also acceptable.

If a same day diagnosis is required then the biopsies MUST be received at the Children’s Hospital laboratory by at the latest 13:00hrs, so that rapid processing and ACHE procedures can take place. If the diagnosis can wait until the following day or is not urgent, then the biopsies MUST be received within the department by at least 16:00hrs.

If it is anticipated that delivery time cannot be achieved by 16:00 hours then in rare circumstances the biopsies may be kept in a moist, cool environment overnight. The biopsies can then be sent as early as possible the next working day (these details should be confirmed with the consultant histopathologist beforehand); the ACHE technique may be compromised if the biopsies dry out.

Sural Nerve biopsies

Please telephone the Histology laboratory at Queen Elizabeth Hospital Birmingham Neuropathology Department (0121 697 8474). So that arrangements can be made to prepare and transport the specimen from the Neuro Theatre (or wherever the biopsy is being carried out). The specimens are sent directly to BQEN and reports are issued directly by them.

There is no frequency of testing provided due to this being an externally performed test.

Please refer to the UHNM Cytopathology Departmental Handbook – reference CYPOL002

Referral Laboratories names and address

These referral laboratories are audited annually to ensure they are CPA accredited and hold external quality control certificates.

Dr Brian Angus

University Department of Histopathology

Royal Victoria Infirmary Queen Victoria Road Newcastle-upon-Tyne NE1 4LP

0191 2336161, Ext 24445

Dr M Stephens Dr D Gey van Pittius

Lymphoreticular Dr M Brundler Consultant Histopathologist Department of histopathology Birmingham’s Children’s Hospital Steelhouse Lane Birmingham B4 6NH 0121 333 9999 Dr J Starczynski Birmingham Heartlands NHS foundation Trust Cellular Pathology Department

Bordesley Green East Birmingham B9 5SS 0121 424 2000 Dr M Stephens Ms Deborah Latham Lymphoma FISH HER2 FISH

Dr E Calonje

Director of Diagnostic Dermatopathology The Property of St. John’s Histopathology Department St John’s Institute of Dermatology 2nd Floor, Block 7 South Wing St. Thomas’ Hospital Lambeth Palace road LONDON

SE1 7EH

020 7188 6254 Dr M Stephens Dr D Gey van Pittius Dr V Mudaliar Skin Dr Martyn P Carey Department of Neuropathology Level 1

Queen Elizabeth Hospital Mindelsohn Way Edgbaston West Midlands B15 2WB 0121 371 3314 Neuropathology Professor D M Fletcher FRCPath Director of Surgical Pathology Department of Pathology Brigham and Women’s Hospital

75 Francis Street Boston MA 02115, USA

+001 617-732-7510 Dr M Stephens Dr D Gey van Pittius Dr V Mudaliar Skin Professor D M Fletcher FRCPath Director of Surgical Pathology Department of Pathology Brigham and Women’s Hospital

75 Francis Street Boston MA 02115, USA

+001 617-732-7510 Dr D Gey van Pittius Soft Tissue

Dr A Gallimore (London) [email protected] 0207 299 4490 Dr B Latifaj Dr C Howitt ENT Dr Raji Ganesar Birmingham Women’s Hospital 0121 6272 724 Dr G Douce Dr N Cooper Gynaecology

Histology Department Mindelsohn Way Edgbagston West Midlands B15 2TG

Dr A Gibbs and Dr Attanoos Consultant Histopathologist Department of histopathology Llandough Hospital Penlan Road Penarth South Glamorgan CF64 2XX 029 20711711 Dr Green Consultant Histopathologist Department of Histopathology

Royal Shrewsbury Hospital Mytton Oak Road

Shrewsbury Shropshire SY3 8XQ

01743 261000

Patricia Harnden Senior Consultant in Urological Pathology St James’s University Hospital Histopathology Beckett Street Leeds LS9 7TF 0113 2064891 Dr N Cooper Dr Karthik Kalyanasundaram Urology Professor P N Hawkins Professor of Medicine The National Amyloidosis Centre

Royal Free and University College medical school Royal Free Hospital Rowland Hill Street London NW3 2PF 020 7433 2816 Amyloid Dr Andrew Hitchcock Department of Histopathology Derby Royal Infirmary

London Road Derby DE1 2QY Dr E Hodges Southampton University Hospital NHS Trust Molecular Pathology Unit Division of Laboratory Medicine

Mail Point 225, Duthie Building

Tremona Road Southampton S16 6YD

023 8079 6976

Professor Stefan G Hubscher Department of Cellular Pathology

Level 1

Queen Elizabeth Hospital Mindelsohn Way Edgbagston West Midlands B15 2WB 0121 4143314 Dr V Smith Dr Karthik Kalyanasundaram GI - Liver Professor Kindblum Consultant Musculo-skeletal Pathologist

Royal Orthopaedic Hospital Department of

Musculoskeletal Pathology Robert Aitken Institute of Clinical Research The Medical School University of Birmingham Birmingham

B15 2TT

0121 4147641 Dr D Gey van Pittius Soft Tissue

Professor A G Nicholson Consultant in Histopathology Department of

Histopathology

Royal Brompton Hospital Sydney Street

LONDON SW3 6NP

0207 3518425 Dr D Gey van Pittius Respiratory Tract

Dr I Roberts

Consultant Histopathologist

Department of Cellular Pathology

Level 1

John Radcliffe Hospital Headley Way Headington Oxford OX3 9DU Dr Nigel Scott Consultant Histopathologist Department of Histopathology

St James’ University Hospital Beckett Street Leeds West Yorkshire L59 7TF 0113 2433144 Dr C Howitt Dr Karthik Kalyanasundaram GI (Lower)

Professor Neil A Shepherd Consultant Histopathologist Pathology Department Cheltenham General Hospital Sandford Road Cheltenham Gloucestershire GL53 7AN 08454 225263 Dr C Howitt Dr Karthik Kalyanasundaram GI (Lower) Dr P Taniere Consultant Histopathologist Dept. of Cellular Pathology Medical School University of Birmingham Edgbaston BIRMINGHAM B15 2TT 0121 414 4016, Ext: 4637 Dr V Smith GI (Upper) EGFR Molecular studies Dr Adrian Warfield Consultant Histopathologist Department of Histopathology Birmingham Heartlands Hospital

Bordesley Green East Birmingham

B9 5SS

0121 414 4016, Ext: 44007

Dr B Latifaj Head & Neck

H Williams (Birmingham) Consultant Oral Pathologist

Department of Cellular Pathology

The Medical School (West Extension) University of Birmingham Vincent Drive Edgbaston BIRMINGHAM B15 2TT Dr Godfrey E Wilson Department of Histopathology/Cytopatholog y 1st Floor

Clinical Science Building Manchester Royal Infirmary Oxford Road Manchester M13 9WL 0161 2768813 Dr G Douce Dr N Cooper Gynaecology

Professor Chas Mangham Applied Molecular Pathology Department of Cellular Pathology

Manchester Royal Infirmary Oxford Road

Manchester M13 9WL

0161 2768813 Soft tissue and bone

Department of Histopathology 1st Floor Bluebell House

Aintree University Hospital NHS foundation trust Longmoor Lane Fazakerley Liverpool L9 7AL 0151 5255980 (switchboard) Oral or Dental Specimens

Professor Marco Novelli Histopathology Department University College London Hospitals NHS Foundation Trust

University College Hospital 235 Euston Road

London

020 7679 6657 Dr Karthik

Kalyanasundaram

NW1 2BU

Dr E Hodges

Molecular Pathology Unit MP88 Southampton University Hospitals NHS Trust Duthie Building Tremona Road SOUTHAMPTON S016 6YD Dr Jane Starczynski Cellular Pathology Department Birmingham Heartlands Hospital

Bordesley Green East BIRMINGHAM B9 5SS Dr Y L Hock

Consultant Histopathologist Walsall Manor Hospital Department of Histopathology Moat Road WALSALL West Midlands WS2 9PS Dr S Chaudhri Consultant Histopathologist Department of Cellular Pathology Level 1

Queen Elizabeth Hospital Mindelsohn Way Edgbaston, Birmingham B15 2W Testicular Cases Dr Rudski Histology Department Heartlands Hospital Bordesley Green East Birmingham

Abbir Shaban University Hospitals

Birmingham NHS Foundation Trust

Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston Birmingham, B15 2WB Jonathan Shanks Histology Dept Chrsities Hispital 550 Wilmslow Road Manchester M20 4BX K Hollowood Histology Department Headley Way Headington Oxford OX3 9DU

Professor Fiona Campbell The Royal Liverpool and Broadgreen University Hospitals NHS Trust Royal Liverpool University Hospital Prescot Street Liverpool L7 8XP Dr. S Sanders Consultant Histopathologist Department of Cellular Pathology

The Old Pathology Laboratory Warwick Hospital Lakin Road Warwick CV34 5BJ Professor N A Shepherd Cellular Pathology Laboratory Cheltenham General Hospital

Sandford Road Cheltenham Gloucestershire GL53 7AN

Professor Paul M Speight Department of Oral Pathology

School of Clinical Dentistry University of Sheffield Claremont Crescent Sheffield S10 2TA Professor MN Sheppard Consultant Histopathologist Cardiovascular Pathology Cardiovascular Sciences Research Centre St George’s University of London Cranmer Terrace, LONDON SW17 ORE Dr V Sumathi ROH/Department of Musculoskeletal Pathology Robert Aitken Institute of Clinical Research The Medical School University of Birmingham Birmingham B15 2TT Dr K Skordillis Consultant Histopathologist Department of Cellular Pathology Level – 1

Queen Elizabeth Hospital Birmingham Mindelsohn Way Edgbaston BIRMINGHAM B15 2WB Dr Arti Bakshi Consultant Histopathologist Department of Cellular

Pathology

5th Floor, Duncan Building Royal Liverpool University Hospital Daulby Street LIVERPOOL L69 3GA Dr A Robson Consultant Dermatopathologist 11 Ivor Place Marylebone LONDON NW1 6HS Dr T Brenn Consultant Dermatopathologist Pathology

1st Floor Alexander Donald Building

Western General Hospital Crewe Road EDINBURGH EH4 2XU Dr R Carr Consultant Histopathologist Department of Histopathology

Old Pathology Laboratory Lakin Road Warwick CV34 5BJ Dr E Hodges Southampton University Hospital NHS Trust Molecular Pathology Unit Division of Laboratory Medicine

Mail Point 225, Duthie Building

Tremona Road SOUTHAMPTON S016 6YD

Jane Starczynski Cellular Pathology Department

Birmingham Heartlands Hospital

Bordesley Green East Birmingham B9 5SS Dr P Taniere Consultant Histopathologist Department of Cellular Pathology Level – 1

Queen Elizabeth Hospital Birmingham Mindelsohn Way Edgbaston BIRMINGHAM B15 2WB Dr M Carey Consultant Neuropathologist Department of Cellular Pathology Level – 1

Queen Elizabeth Hospital Birmingham Mindelsohn Way Edgbaston BIRMINGHAM B15 2WB Dr Y L Hock Consultant Histopathologist Department of Histopathology

Wallsall Manor Hospital Moat Road

WALSALL West Midlands WS2 9PS

Professor P N Hawkins National Amyloidosis Centre UCL Division of Medicine Royal Free London NHS Foundation Trust Rowland Hill Street

LONDON NW3 2PF

Professor Mary Sheppard Department of Cardiovascular Pathology Jenner Wing St George’s University of London Cranmer Terrace LONDON SW17 0RE Professor A G Nicholson Consultant in Histopathology Department of Histopathology

Royal Brompton Hospital Sydney Street

LONDON SW3 6NP Dr A R Gibbs

Consultant Histopathologist The Cellular Pathology department

University Hospital of Wales Heath Park CARDIFF CF14 4XW Mrs Alison Teague Department of histopathology- Immunohistochemistry Lead University Hospitals Birmingham NHS Foundation Trust

Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston Birmingham, B15 2WB Dr N Aluwihare Consultant Histopathologist Department of Cellular Pathology (Histopathology)

C37

New Cross Hospital WOLVERHAMPTON WV10 0QP Dr B Wilkins Consultant Histopathologist Histopathology Department St Thomas’ Hospital 2nd Floor North Wing Westminster Bridge Road LONDON SE1 7EH Dr E Calonje Director of Diagnostic Dermatopathology Department of Dermatopathology St John’s Institute of Dermatology

St Thomas’ Hospital - South Wing, 2nd Floor

Westminster Bridge Road LONDON SE1 7EH Dr D Neil Consultant Histopathologist Department of Cellular Pathology Level – 1

Queen Elizabeth Hospital Birmingham Mindelsohn Way Edgbaston BIRMINGHAM B15 2WB Prof DC Mangham Professor of Applied Molecular Pathology Department of Cellular Pathology

Manchester Royal Infirmary Clinical Sciences Building 1 Oxford Road

Manchester M13 9WL

Dr I Roberts Level 1,

John Radcliffe Hospital, Headley Way, Headlington, Oxford

OX3 9DU

Renal

Patricia Harnden Senior St James University Hosp, Histopathology, Beckett Street, Leeds LS9 7TF Urology Dr Raji Ganesar,

Birmingham Women’s Hosp. Histology Dept, Mindelsohn Way, Edgbaston, West Midlands B15 2TG Gynae Professor Kindblum, Musculo-skeletal Pathologist, Royal Orthopaedic Hospital, Dept of Musculoskeletal Pathology,

Robert Aitken Institute of Clinical Research, The Medical School, University of Birmingham, Birmingham

B15 2TT

Soft Tissue & Bone

Dr E Calonje

Director of Diagnostic Dermatopathology, The Property of St Johns Histopathology Dept. St Johns Institute of Dermatology, 2nd Floor, Block 7, South Wing, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH Skin Dr Rudski Birmingham Heartlands NHS foundation Trust

Cellular Pathology Department

Bordesley Green East Birmingham

B9 5SS

Professor Marc Novelli University College, London Hospitals NHS foundation Trust, University College Hospital,

235 Euston Road, London

NW1 2BU

Upper GI

Professor Neil A Shepherd Cheltenham General Hospital,

Sandford Road, Cheltenham, Gloucestershire

GL53 7AN

Lorna McWilliams Department of Cellular Pathology

Manchester Royal Infirmary Oxford Road

Manchester M13 9WL Sarah Pinder

Royal Free London NHS Foundation Trust Rowland Hill Street LONDON NW3 2PF Abbir Shaban Birmingham Heartlands NHS foundation Trust Cellular Pathology Department

Bordesley Green East Birmingham B9 5SS Jonathon Shanks Christies Hospital 550 Wilmslow Rd, Manchester

M20 4BX

Fiona Campbell The Royal Liverpool and Broadgreen University Hospitals NHS Trust Royal Liverpool University Hospital Prescot Street Liverpool L7 8XP Scott Sanders Department of Cellular Pathology

The Old Pathology Laboratory Warwick Hospital Lakin Road Warwick CV34 5BJ Andrew Nicholson Department of Histopathology

Royal Brompton Hospital Sydney Street LONDON SW3 6NP R Carr Department of Cellular Pathology

The Old Pathology Laboratory Warwick Hospital Lakin Road Warwick CV34 5BJ T Bream Pathology

1st Floor Alexander Donald Building

Western General Hospital Crewe Road

EDINBURGH EH4 2XU

K Hollowood

Department of Cellular Pathology

Level 1

John Radcliffe Hospital Headley Way

Headington Oxford OX3 9DU A Bakshi

The Royal Liverpool and Broadgreen University Hospitals NHS Trust Royal Liverpool University Hospital

Prescot Street Liverpool L7 8XP

Keele University

Central Electron Microscope Unit

School of Life Sciences Keele University Keele Staffs ST5 5BG

01782 733484 Renal Pathologists Electron Microscopy

Source BioScience Healthcare

Reference Laboratory 1 Orchard Place

Nottingham Business Park Nottingham NG8 6PX 0115 9739012 All Pathologists Ms Deborah Latham FISH testing K-ras testing

Gastric Her-2 IHC/FISH External Histology reporting Unilabs - IHS 142-144 New Cavendish Street London W1W 6YF

020 7299 4490 All Pathologists External Histology reporting

Report Availability

All histology reports, once authorised are available immediately electronically via the EPR or ICE system (dependant on the site you are working at).

Hard copies of all reports are issued for insertion into the patients notes. It is the responsibility of the user to perform this action. Hard copy reports are provided daily through Monday to Friday 9am – 5pm except for when bank holidays occur and no service is provided.

Approximate turnaround times (from receipt of specimen to a report being available on the EPR or ICE system) are as follows.

Inevitably some cases, particularly complex cases, cases requiring prolonged decalcification or cases requiring tertiary referral will take longer:

The diagram below shows the multi-step process involved in Histopathology;

Turnaround times (TAT) that can be expected by users.

SPECIMEN TYPE TAT (Calendar days)

Urgent cases By arrangement

Cancer diagnostic biopsies (core biopsies, endoscopic biopsies etc) 7

Cancer Resection cases 10

Routine diagnostic histology (non cancer cases) 10

GP cases 10

For clinical information on a specific case or report callers should speak to a Consultant Histopathologist. Please phone The Royal Stoke Hospital Histology Office (contact as shown on page 4) and a secretary will put you through to the correct Consultant Histopathologist.

For inquires of a technical nature callers should contact a Biomedical Scientist or the Lead Biomedical Scientist at The Royal Stoke Hospital Histology laboratory (contact as shown on page 4).

Post Mortem information

The Royal Stoke Mortuary and County Body Store’s opening hours are 08:00 to 16:00 Monday to Friday. On Saturday’s and Sunday’s the mortuaries are not manned but can be accessed by non-Mortuary approved UHNM personnel for delivery of a deceased.

The Mortuary staff take part in an on-call system whereby they will attend at weekends and out of hours if requested. The on-call Mortuary personnel can also be contacted for urgent information as required. There is also a pathologist on call outside normal working hours. These on-call Mortuary staff can be contacted via phone via The Royal Stoke Hospital switchboard for clinical advice in emergencies only.

Coroners Post Mortems

The following deaths should always be reported to Her Majesty’s Coroner. 1. Deaths from unknown causes.

2. All cases seen only after death.

3. Deaths occurring within 24 hours of anaesthetic or operative/investigative procedure. 4. All deaths which occur within 24 hours of admission to hospital.

5. All violent or unnatural deaths related to:

 Poisoning or drug mishap (recreational/therapeutic). This includes alcohol related death.  Criminal abortions

 Assault or accident – irrespective of time interval between the event and death.  Want, exposure or neglect.

 Industrial disease e.g. pneumoconiosis, mesothelioma  Inmates of prisons.

 Any known suggestion of allegations of neglect or malpractice against hospital medical or nursing staff.

 Suicide.

6. Deaths in custody or shortly after release.

The reporting clinician should fill in a “Clinical summary for cases referred to the Coroner” form prior to discussing the case with the coroner.

If the case is accepted by HM Coroner then this form together the clinical notes, and any x-rays should be sent directly to the mortuary.

The involved clinician will be invited to attend the Post Mortem.

The written report will be sent to the Coroner and copied to the General Practitioner and where appropriate the hospital consultant.

Non Coroner’s Post Mortems

Post Mortem Examination Requests

Post mortems are performed in the hospital mortuary situated at the NSRI. They are usually performed between the hours of 09:00 and 14:00 hours Monday to Friday.

The approximate time of autopsy can be determined by direct contact with the appropriate Consultant Pathologist or with the mortuary technical staff.

Consent

The procedure for obtaining permission for a post-mortem examination in those cases which are not reportable to HM Coroner is as follows:

At the time of filling in the death certificate the clinician seeks permission for an autopsy from the bereaved relatives. A hospital post mortem consent form must be filled in and signed. A clinical details form should be completed and submitted immediately with the case notes and x-rays to the mortuary.

High risk cases MUST be brought to the attention of the Pathologist and mortuary staff immediately after consent has been obtained.

Clinicians are encouraged to attend the post mortem.

A written report of post mortem findings is sent directly to the Consultant in charge of the case and to the patient’s General Practitioner.

Do not delay the death certificate until after the post-mortem. If the cause of death is not known it should be referred to the coroner.

Attendance at autopsies

 Visitors must abide by the Health and Safety notes that apply within the Mortuary. These will be explained by the mortuary staff.

 People under 18 years of age are not permitted to attend an autopsy.  Attendance by medical personnel and medical students is encouraged.