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Histopathology Fixation and Transportation

Fixation and transport

Completion of Histopathology Requests

Request forms should include 3 patient identifiers, details of sending clinician and location for report to be sent, clinician information and date the specimen was taken. The specimen pot should also have 3 patient identifiers as a minimum.

Specimens lacking correct information will be returned to sender for inclusion of these details. Incorrect requests lacking sufficent clinical information will significantly delay the issue of the Histopathology report.

Routine Histology

Please note that formaldehyde is known to be carcinogenic in high doses and suitable precautions must be taken when dealing with it.

Specimens should be placed in 10% formal saline in a properly sealed container, with an adhesive label indicating the toxic nature of formalin. Sometimes, especially with larger specimens, this may not be possible and these should be sent to the laboratory as soon as possible for gross dissection, or dissected by the surgeon at the time of operation. However, every effort must be made to place specimens in suitably sized containers and there should be enough fixative to cause total immersion of the specimen by at least 10 times its own volume. The specimens should not be refrigerated.

Histology Turnaround Times

The department operates to the following turnaround times (calendar days from receipt of specimen unless otherwise specified)

  • Identified TWR (cancer pathway) specimens – 100% within 7 days
  • Confirmed cancer cases – 90% within 14 days
  • General (other) TAT – 28 days

The following cases are excluded from the above

  • Bone specimens requiring decalcification
  • Referred cases for second opinion/MDT review

Urgent Histology

Specimens marked "urgent" are usually ready to be diagnosed by a Histopathologist on the first working day afternoon for biopsy cases. Larger excisions/resections will take longer due to fixation and processing schedules. Preliminary findings can be communicated by telephone, therefore please indicate the bleep or contact number of the relevant medical person. Only a small number of cases can be handled in this way so please limit such requests to cases of genuine urgent clinical need.

Specialised procedures

Frozen sections

Frozen sections are performed routinely on all sites contact the relevant laboratory before the operation to book the frozen section and confirm that a Pathologist is available at the planned time.

Details required:



Date and time



Surgeon



Patient’s name



Nature of specimen



Telephone/bleep number for report

Send the specimen in a dry container WITHOUT fixative as quickly as possible with the request form to the appropriate Histology laboratory.

The report for single block cases will be telephoned to the number given within 30 minutes of receipt of the specimen. Complex cases, such as those with multiple blocks to establish clearance, will take longer.

Specimens for immunofluorescence (Hospital only)

Immunofluorescence is used mainly on cutaneous biopsies. Specimens should be sent immediately to the Royal Surrey laboratory or the Royal Berkshire laboratory, to arrive within 30 minutes of excision in normal working hours. If this is not possible transport medium should be used (such as Michel’s from Zeus laboratories). This is available from the laboratory. Formalin MUST NOT be used as it will render the specimen uninterpretable.

Breast

Place all specimens in a large volume of formal saline, and send to the laboratory as quickly as possible. Please do not leave to the end of a long operating list, and do not leave the specimen in theatre over the weekend.

Gastrointestinal specimens

All specimens should be transported to the laboratory in formal saline. Some larger specimens (not AP resections) would benefit from opening on the anti-mesenteric border and pinned on a corkboard immersed in formal saline. Segments of bowel that contain tumours that involve less than the full circumference should be opened through the uninvolved part.

Lymph nodes

If possible these specimens should be sent fresh as soon as possible to the laboratory. If it is not possible to do this immediately, place in formal saline and send to the laboratory as soon as possible.

Testicular biopsies for investigation of subfertility/infertility

These should be placed in Bouin’s solution (available from the laboratory if not present in Theatres).

Report form

The Histopathologist will give a diagnosis where possible, or a differential diagnosis. It may be helpful for the case to be discussed to achieve a more precise diagnosis. Advice on the margins of excision and expected behaviour of tumours should be given. The Histopathologists may be able to help on future management of the patient.

Out-of-hours service

No routine out-of-hours service is provided.