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Dahl Chase Folders

Surgical Pathology Specimen Collection Requirements

Reference Number: AA-00277

SECTION TEN

Dahl-Chase Diagnostic Services

SURGICAL PATHOLOGY

SPECIMEN COLLECTION REQUIREMENTS

 

Formalin Fixed Specimens (includes all tissues, biopsies, and bone specimens)

                                                                                                                      

Routine or Rapid microscopic exam:

Formalin fixed specimens are to be labeled with patient’s full name, second identifier (DOB or MR#), and tissue source accompanied by a completed surgical pathology requisition.  The vials containing 10% formalin should be large enough for a 10:1 formalin to tissue ratio.

 

The containers are available in several sizes through the purchasing department (see supply list in the general section of the directory).  The formalin containers and requisitions should be transported in Dahl-Chase biohazard bags through the Uniship courier. 

 

Placenta:

The following information must be included with all placentas: 

·        The reason for submission

·        The estimated time of confinement

·        The weight, sex, and apgar scores of the baby

A stamp with space for this information is available by calling Michael Tan at 941-8250


Place in formalin prior to transport (Genetics and culture specimens need to be obtained before placing in formalin)

 

Intraoperative Consultations (IOC) / Fresh Specimens

 

Frozen sections:

Frozen sections should be scheduled by requesting hospitals in advance by calling 941-8221. Preferably with at least 3 days to 1 week's notice.

 

St. Joseph Hospital does not need to schedule frozen sections; however, pathology will be called 15 minutes prior to the frozen being sent to the cutting room at SJH.  SJH calls 941-8252.

 

Sentinel nodes for touch preps:

On occasion, touch preps for sentinel lymph nodes may be requested by surgeons.

 

Intraoperative Consultations:

For rapid gross assessment of specimens

 

Other Special Procedures

 

Cytogenetics testing:

Tissue should not be submitted in formalin for cytogenetics.   For proper collection requirements, please call genetics at 973-7355.  This requires a separate cytogenetics requisition, available by calling 973-7355.

 

Breast Specimen Handling

 

Purpose:

To ensure proper handling and testing of breast tissue by following the guidelines for ER/PR testing. Specimens that are improperly handled may yield false negative results and may negatively impact patient care.

 

Guidelines:

1.   Time at which the specimen is removed from the patient should be recorded.

2.   Time at which the incised specimen is placed in formalin should be recorded.

3.   Total time in formalin should be recorded.

4.   Specimen should be sectioned prior to being placed in formalin. 

5.   Tissue should be placed in 10% Neutral Buffered Formalin within and hour of extraction.

6.   Tissue is to be fixed in 10% NBF at a ratio of 10:1 (formalin : tissue)

7.   Specimen must fix in 10% NBF for at least 6 hours and no longer than 72 hours

 

Protocol:

  1. Breast specimen requisition is to be properly filled out, to include:

                  a) The time the specimen is removed from the patient

                  b) The time at which the specimen is placed in formalin

c) Orientation of specimen (Including color code for ink and suture designation).

  1. Needle Core Biopsies:
    1. Document the time of excision.
    2. Document the time the specimen is placed in formalin.
    3. Any needle core breast biopsies done for microcalcification must be accompanied by the specimen xray.
  2. Lumpectomy:
    1. Document the time of excision.
    2. Mark the orientation of the specimen with sutures.
    3. Ink the specimen using q-tips or gauze.

Anterior - Green

Posterior - Black

Superior - Red

Inferior - Blue

Medial - Yellow

Lateral - Orange

d.   The ink should be blotted.

e.   A mordant (ex. Acetone, vinegar) should be applied and the specimen blotted dry a second time.

f.    Incise the specimen perpendicular to the long axis, to expose the tumor or area of suspicion to formalin. Avoid cutting all the way through the specimen.

g.   Insert gauze or paper towel into the incision site. This will allow the formalin to directly contact the area of interest.

h.   Place the specimen in formalin. Document the time at which tissue is submerged in formalin. Radiology or the lab may need to record the time at which the specimen is placed in formalin.

4.   Needle localization Biopsies:

a.   Document the time of excision.

b.   Mark the orientation of the specimens with sutures.

c.   Send the specimen to radiology then ink once it has been x-rayed or ink the specimen with the Vector Margin Marker (to minimize the risk of radiology artifacts).

d.   Ink the specimen using q-tips or gauze:

Anterior - Green

Posterior - Black

Superior - Red

Inferior - Blue

Medial - Yellow

Lateral - Orange

e.   A mordant (acetone) should be applied and the specimen blotted dry a second time.

f.    Incise the specimen perpendicular to the long axis, to expose the tumor or area of suspicion to formalin. If it is not clear as to where the area of interest is located, make an incision along the length of the wire. Avoid cutting all the way through the specimen.

g.   Insert gauze or paper towel into the incision site. This will allow the formalin to directly contact the area of interest.

h.   Place the specimen in formalin. Document the time at which tissue is submerged in formalin. (Radiology or the lab may need to record the time at which the specimen is placed in formalin.)

i.    Needle localization breast biopsies should be submitted with the wire in place and must be accompanied by the specimen xray. 

j.    Specimens with a needle or wire should be placed in a puncture proof container with a warning on the outside of the container that says "needle" or "wire".

 

5.   Mastectomies:

a.   Document the time specimen is removed from patient.

b.   Ink the deep margin with black ink using q-tips or gauze.

c.   Blot dry. Spray with mordant. Blot dry again.

d.   Incise the specimen from superior to inferior to expose the tumor/area of interest to formalin. Avoid cutting all the way through the specimen.

e.   Insert gauze or paper towel into the incision site. This will allow the formalin to directly contact the area of interest.

f.    Place the specimen in formalin. Document the time at which tissue is submerged in formalin. (The lab may need to record the time at which the specimen is placed in formalin.)

CONCLUSION: By adhering to these guidelines and protocols, we will better serve the patient with accurate assessment of the margins and valid ER/PR testing.

 

Scabies Identification Procedure:

 

Purpose:

To identify the presence or absence of scabies in patients suspected of having scabies (itch,rash, burrows) so that appropriate isolation, treatment and public health measures can be taken. 

 

Equipment:

Gloves, glass microscope slides, slide cover slips, mineral oil or other transparent oils,  and a sterile scalpel blade.

 

Comments:

·        The treatment of scabies usually requires the documentation of the presence of the scabies mite, eggs or fecal pellets.  Rarely, treatment may be instituted in a highly suspicious clinical setting, even if the mite or mite product are not seen. 

·        Mite, eggs or feces may not stay on the slide if simply transferred to a slide, especially if the slide must be transported to another location.  The collection of the specimen sample and mineral oil or other transparent oil may increase the diagnostic yield. 

 

Procedure:

1.    Place a drop of oil on the skin lesion of interest (the oil prevents loss of mites, eggs or feces to the air during scraping and transfer to the glass slide). 

2.    Hold the scalpel blade in your gloved hand in between your thumb and first finger (the glove is to avoid becoming infected yourself), place the sharp edge of the scalpel blade lightly on the skin perpendicular to the skin surface and scrape the blade horizontally back and forth 10 or 20 times vigorously over the lesion and transfer the scrapings in the oil to a glass slide leaving the scalpel blade.  Place a cover slip over the oil. 

3.    Put the slide in a cardboard mailer and send it to Dahl-Chase ATTN:  Pathologists.  Provide a person and phone number to be called promptly with the results. 

 

Comment:

Because the mite, eggs and feces are in the superficial most portion of the epidermis, the scraping is not intended to penetrate the epidermis or cause bleeding.  It simply dislodges the mite or its products.  In practice – vigorous scraping gives more positive results then slight scraping.  At the end of the scraping there might be a pinpoint of blood – if the epidermis has been completely eroded.  If you see a drop of blood, stop the scraping. 

 

Notes:

The scalpel is not used for cutting.  It is simply a clean edge to produce a scraping action.  You may be able to use the corner or side of a glass slide to get a positive result. 

 

Mites and eggs may deteriorate over time so getting the slide to a pathologist within 24 hours is strongly recommended.  The mite is easily recognized as a “bug” at 10 or 20X under the microscope – so the person obtaining the specimen can scan the slide before sending it if they wish.  After seeing their first mite, they will feel proficient in mite recognition.

 

Interpretation:

Presence of mite, eggs with a smooth black egg case in an oval shape or fecal pellets (small round to oval reddish brown structures) are considered positive.

 

Method Limitations:

Failure to scrape the appropriate location may result in a false negative.  False negatives can also occur when mites are rare.  Failure of egg, mite or feces to stick to the slide or be blown off the slide can produce a false negative.

 

References:   J Am Acad Dermatol 4:715-722, 1981.               Author:  John S. Kaiser, MD