The Handling of Histopathology Specimens

Specimen transportation, accession, dissection, audit and reporting are considered.

Specimen transportation: There must be close liaison between pathology and clinical staff to ensure appropriate transportation of specimens between the operating theatre and the laboratory, e.g., prompt transport of fresh specimens, or the provision of special fixatives. This must be reflected in shared protocols, a user information manual and education of the portering staff.

Specimen accession: Allocation of a unique laboratory number and accurate computer registration of patient details are fundamental to maintenance of a meaningful and practicable histopathology database. This is important not only to individual patient care (e.g., a sequence of biopsies) but also for provision of statistics, e.g., download to cancer registries.

Specimen dissection: Traditionally, the role of medical pathologists in specimen dissection is now also being done by an increasing number of biomedical scientists (BMSs) as has been the situation for several decades in some laboratories in America (Pathologist Assistants) and Northern Ireland. BMSs, trainee and consultant pathologists are all appropriate to the task provided that several principles are adhered to:

• The histopathology specimen and its report remain the overall responsibility of the reporting consultant pathologist.

• There is close proximity and ready availability of active consultant pathologist supervision before, during and after handling of the specimen.

• There is workforce stability and staff are prepared to work together as a team. The working unit comprises a variable combination of two people (junior/senior, medic/BMS) fulfilling the roles of dissector/writer/supervisor with active consultant pathologist supervision.

• Staff recognise that acquisition of dissection skills is an at-the-bench apprenticeship based on sufficient knowledge, time, experience and supervision. This knowledge-base requires insight into normal anatomy, clinical presentation and investigations relevant to request form information, common pathological conditions and their effect on specimens, surgical considerations in production of the specimen, and core report data tailored to patient management and prognostic information. Consequently, the chapters in this book are structured accordingly under these headings. The cut-up supervisor plays a vital role in passing on verbal knowledge but this is supplemented by various means, e.g., publications (in-house protocols, ACP broadsheets, textbooks) or training courses. A structured training programme facilitates learning and progression.

Staff must also be familiar with the laboratory process of checking patient details, specimen labelling and past history (cytology, biopsy, treatment), the importance of specimen opening for adequate fixation, demonstration of resection margins and use of orthodox or digital photography. Knife etiquette and sampling blocks of appropriate thickness and fixation are crucial. The supervising pathologist must provide active feedback as to the significance and adequacy of these blocks. Line diagrams are an invaluable communication tool between dissector and reporters. Specimens not infrequently need to be revisited prior to report authorisation or following new information gained from the multidisciplinary team meeting. Retention of "wet" specimens must be sufficiently long (minimum four weeks) to allow this process to happen.

• Dissectors should only work to their individual level of experience and competence - this is determined by the structured training programme, audit process (see below) and categorisation of specimens according to their complexity.

• Dissectors should actively seek supervisor input if a specimen is usually complex, novel, shows an unusual variation on a usual theme, or if they have any doubt.

Specimen dissection audit: The quality of specimen dissection must be meaningfully monitored and the majority of this is done actively at the laboratory bench by the consultant pathologist/BMS supervisor team as part of the specimen dissection pre-/peri-/post-view and reporting feedback procedures. In addition, this team should carry out formal periodic audit and assessment of dissectors' skills. This combination of approaches forms the basis for an individual dissector's continued practice and progression between specimen categories (see appendix). It also identifies areas of subspecialist expertise or if there is need of further training. It must be recognised that category progression cannot be proscribed by rigid time frames but rather related to the aptitude of the individual dissector and spectrum of workload that is encountered.

Specimen reporting: Histopathology specimen reports remain the responsibility of an appropriately trained and experienced medical pathologist.

Sample protocols for general specimen handling, categorisation and laboratory abbreviations are included in the appendices to this section.

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