CP4 revision 4 Approved by Mr D Muskett 18/04/2016

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Cellular Pathology: Information for Users

CP4 revision 4 Approved by Mr D Muskett 18/04/2016

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Contents

Contents ............................................................................................................................................................................ 1

Section 1: General Information ......................................................................................................................................... 2

Location ......................................................................................................................................................................... 2

Clinical Services ............................................................................................................................................................. 2

Opening hours ............................................................................................................................................................... 2

Key Personnel & Contact Information .......................................................................................................................... 2

Sample transport .......................................................................................................................................................... 4

Packaging labelling and dispatch .................................................................................................................................. 4

How to complete the histology request form .............................................................................................................. 5

Section 2: Histology ........................................................................................................................................................... 6

Section 3: Cytology ............................................................................................................................................................ 9

Cervical cytology ........................................................................................................................................................... 9

Non – gynaecological cytology .................................................................................................................................... 10

Section 4: List of Referral laboratories ............................................................................................................................ 13

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Section 1: General Information

Location The laboratory is located at Level 0, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH.

Clinical Services The department provides:

Histology including immunocytochemistry, frozen section service and immunofluorescence

Non-gynae Cytology

Andrology – please refer to the Andrology User Information page The department holds full CPA accreditation and is accredited for training with the Royal College of Pathologists for junior medical staff and the Institute of Biomedical Sciences for Biomedical Scientists.

Opening hours The department is open from 8 am to 5pm Monday to Friday. There is no out of hour’s service.

Key Personnel & Contact Information For results and general enquiries Cellular pathology results line - 01254 732621 (82621) Clinical advice Clinical advice is available between 8.45 and 5pm Monday to Friday. If you require clinical advice please contact (01254) 732621 or extension 82621 if ringing from within the hospital Clinical Staff: Dr Santhi Kumar Consultant Histopathologist (Head of Department) Dr Abdul Al-Dawoud Consultant Histopathologist Dr Kathryn Brelsford Consultant Histopathologist Dr Madhuri Deolekar Consultant Histopathologist Dr Alec Howat Consultant Histopathologist Dr Deepa Jacob Consultant Histopathologist Dr Muamar Al-Mudhaffer Consultant Histopathologist Dr Marina Perera Consultant Cytopathologist Dr Richard Prescott Consultant Histopathologist Dr Neil Sahasrabudhe Consultant Histopathologist Dr Zuhair Twaij Consultant Histopathologist Lead Biomedical Scientist – Cellular Pathology Mr David Muskett 82438 Directorate Staff Clinical Director Dr K Brownbill 84153 Directorate Business Manager Mr J Cottam 84106 Pathology Operations Manager Mr D Squires 84162 Pathology IT Manager Mr H Briggs 82473 return to contents

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Ordering specimen pots and request forms Specimen pots (formalin, cytology, Michel's transport media) and request forms can be ordered by contacting the laboratory on 01254 732621 or by e-mail at gppathologysupplies.rbh@elht.nhs.uk Complaints Any complaints about the service should be directed to the Lead Biomedical scientist - David Muskett in the first instance on 01254 732438 or via e-mail david.muskett@elht.nhs.uk return to contents

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Sample transport Frozen section Specimens for frozen section need transporting urgently to the laboratory. High risk specimens are not suitable for frozen sections.

Routine samples All histology specimens need to be transported to the lab as soon as possible. Once in formalin the process of fixation preserves the tissue. Specimens should be stored at room temperature. There are transport runs from the GP practices within the East Lancashire area.

High risk specimens High risk specimens i.e. suspected category 3 pathogen specimens such as TB, and blood borne virus specimens should be sent clearly marked to the laboratory as 'HIGH RISK'. The specimens should be double bagged before being sent to the laboratory. Specimens will be fixed for 48 hours before being processed.

Packaging labelling and dispatch The miss-labelling and packaging of specimens is a major risk to patient safety. Packaging Ensure the lid is fixed firmly to the pot. Labelling The specimen and the request card must bear matching patient information. Please include details of the specimen site. Please label specimens with the following information.

Who the patient is

Who is requesting the result

Who requires the result

When the sample was taken

What the specimen is

All relevant clinical information Please include as much relevant clinical information on the request form as you are able. This will aid diagnosis and reporting Dispatch It is the responsibility of the specimen taker to ensure transfer of the specimen to the laboratory. There are regular pick up of samples from GP surgeries. return to contents

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How to complete the histology request form

Please remember the specimen pot should be labelled with the patient’s full name, date of birth, NHS number or RXR number and the site of the specimen. return to contents

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Request Forms Each specimen or set of specimens from a patient must be accompanied by a Histology Request Form with ALL the relevant details completed. Previous histology and cytology, and treatments such as drug therapy, radiotherapy, and hormones should also be noted on the request form as well as the site of the specimen (e.g. Right, Left). It is important for the laboratory computer database records that the patient's date of birth rather than age is noted on the request form. return to contents

Section 2: Histology All specimens for routine histopathology (except frozen section material) must be immersed in a wide-mouthed container of formalin fixative as quickly as possible after excision. For identification purposes, the container should be labelled with at least the patient's name, folder number or date of birth, ward or department, date and consultant. The container must be of sufficient size to allow the specimen to be surrounded by fixative. Ideally the volume of fixative should be at least 10x the volume of the specimen. If multiple specimens are taken from the patient at any one session, they must be put into separate containers. THE PATIENT NAME, DATE OF BIRTH, NHS or HOSPITAL NUMBER SITE OF SPECIMEN ORIGIN OF EACH TISSUE MUST ALSO BE CLEARLY STATED ON THE JAR LABEL, AS WELL AS ON THE REQUEST FORM. Specimen containers are available from the laboratory during working hours. GPs may order specimen pots Specimens received into the Department without adequate identification will be returned to the sender, as the laboratory cannot accept any responsibility in such circumstances. This may delay the report. Formalin filled 60ml screw-topped plastic containers are available for small biopsies such as skin, tru-cut and endoscopic biopsies. There is also a range of containers of different sizes available from the laboratory on request. Please ensure that all containers have their lids either screwed on tightly or snapped on completely around the whole circumference of the container before transporting to the laboratory. If the specimen is suspected to be ‘HIGH RISK” the request form and the specimen pot should be clearly marked with high risk stickers. The specimens should be double bagged before transport to the laboratory. Specimens will be fixed for 48 hours before being processed. Breast specimens removed at BGH should be transferred to the histology specimen reception at BGH. All other specimens should be sent directly to Royal Blackburn Hospital. Specimen storage Specimens in formalin should be stored at room temperature. There are transport runs from the GP practices within the East Lancashire area to deliver specimens to the laboratory. Hospital samples must be delivered to the laboratory. Frozen Sections If a frozen section for immediate diagnosis is scheduled, the laboratory should be informed at least 24 hours before the operation takes place. The laboratory must be informed of unscheduled frozen sections as soon as possible to ascertain the availability of a Consultant Histopathologist for tissue diagnosis. The specimen should be sent to the Department immediately after excision in a dry specimen container (i.e. without fixative). Please inform the department if there is likely to be a significant delay or cancellation. A telephone extension number indicated clearly on the request form will assist in giving a speedier service.

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Lymph Nodes Tuberculosis or other high risk lymph nodes should be sent in formalin and labelled ‘High Risk‘.

Skin Biopsy for Immunofluorescence Skin biopsies for immunofluorescence should be placed in Michel's transport medium. This is available from the laboratory at RBH into which the skin should be collected before being transported to the laboratory at the earliest opportunity. Skin specimens for immunofluorescence should not be placed in formalin. Ideally peri-lesional skin should be submitted for examination. Samples for Epidermolysis bullosa investigations need to be sent with a St. John’s Institute of Dermatopathology request for. Samples are forwarded via the Cellular pathology Department to St. John’s. Urgent Specimens In genuinely urgent cases, where the immediate clinical management of the case depends on speedy tissue diagnosis, please telephone the Histopathologist to discuss the case. The request form should be clearly marked “URGENT” preferably in red ink.

Muscle biopsies Muscle biopsies are sent directly to Royal Preston Hospital from theatre. For further information please contact the laboratory. Ophthalmic specimens Ophthalmic specimens are sent to Manchester Royal Infirmary for Reporting. For further information please contact the laboratory. Foetal and peri-natal specimens Foetal and peri-natal specimens are sent directly to Manchester Children's Hospital form Reporting. For further information please contact the laboratory. Reporting Routine histology specimens are usually reported on within 5-7 days from receipt. In some instances it may be found necessary to take extra blocks and/or apply specialised staining techniques to clarify or confirm the diagnosis. In such cases results will be delayed. If a case is on a patient pathway please label the request form with a red Cross. Occasionally slides are sent away for a second opinion and this will significantly delay the final diagnosis. In such cases, the Consultant Histopathologist dealing with the particular case will inform the Consultant concerned. For details about turnaround times please contact the laboratory. Photography Photography of surgical specimens can be performed in selected cases, and may be requested by clinicians. Factors affecting the performance of the test

Time taken for the specimen once excised from the body to get to formalin

Total immersion in formalin (ideally there should be 10x the fixative to specimen)

Time taken for the specimen to arrive in the laboratory (Please send specimens in a timely manner) Time limits for requesting additional information

The time limit for requesting additional information is 4 weeks, although depending on the nature of the request more time may be allowed for additional requests

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Section 3: Cytology Cytology is the study of cells. Cytology samples are preparations of cells received in fluid or by curettings or scrapings. Cytology samples are traditionally divided into two types; Gynaecological samples, scrapings taken from the female genital tract and all other samples.

Cervical cytology Samples for Cervical cytology are picked up from GP surgeries along with routine pathology samples for East Lancashire Laboratories. Cervical cytology samples are processed from Surepath liquid based cytology samples and processed at Manchester Royal Infirmary. The contact details for the lab there are Manchester Cytology Centre First Floor, Clinical Sciences Centre Manchester Royal Infirmary Oxford Road, Manchester M13 9WL

Urgent & general enquiries Tel: 0161 276 5111 Fax: 0161 276 3258 Cyto.pathology@cmft.nhs.uk

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Non – gynaecological cytology

Clinical advice about samples is available from 8.45am to 5pm Monday to Friday on 01254 732621

Turnaround times approximately 80% of cases are reported in 7 working days

Specimen containers for non-gynae cytology samples Samples should not be sent in tubes containing boric acid

SPECIMEN TYPE To be collected in: Preferred minimum volume

FNA – Breast Routine sample

Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

2mls of fluid

FNA – Head/Neck

Routine sample Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container

2 mls of fluid

Air dried direct spread for Romanowsky stain

N/A

Rapid Access - Clinic RBH Fluid in Cytolyt fixative in Red Top Universal NOT Boric Acid Red top container and air dried slides.

1ml of fluid

Air dried direct spread for Romanowsky stain

FNA Any other type of FNA’S Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

1ml of fluid

Air dried direct spread for Romanowsky stain

BRUSHINGS Biliary/Oesophageal

Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

Brush to be placed in fixative vial

10 ml of fixative and fluid – brush head to be immersed in fixative

Bronchial brushings Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

Brush to be placed in the fixative vial Or fixed slides/spreads

10 ml of fixative and fluid– brush head to be immersed in fixative

WASHINGS – Peritoneal Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

5mls of fluid

Bronchial washings Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

Or Plain silver/white top pot

5mls of fluid

Peritoneal washings

Washings with sterile saline to be placed in a sterile universal

5mls of fluids

FLUIDS Peritoneal, Ovarian, CSF, Thyroid cyst fluid, Synovial, Bile.

Cytolyt fixative in Red Top Universal NOT Boric Acid Red top

container.

2mls of fluid

Serous fluids Pleural, Ascitic, pericardial Sterile universal 30-50ml

URINES Not the first urine of the day Urine samples are of limited clinical value

Preferably - Cytolyt fixative in Red Top Universal NOT Boric Acid

5mls of urine

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SPECIMEN TYPE To be collected in: Preferred minimum volume

and sending urine samples for non-gynaecological analysis is not recommended

Red top container. If none available - Plain silver/white top pot.

SPUTUMS Sputum samples are of limited clinical value and sending sputum samples for analysis is discouraged.

Preferably - Cytolyt fixative in Red Top Universal NOT Boric Acid

Red top container. If none available - Plain silver/white top pot.

5mls of sputum

If unsure what to collect any other type of non gynae cytology sample in always collect it in

Preferably - Cytolyt fixative in Red Top Universal NOT Boric Acid

Red top container. If none available - Plain sterile silver/white top pot.

2mls of fluid

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Factors affecting the performance of the test

Fresh specimens should be kept cool and transferred to the laboratory post-haste.

Specimen transported in to cytolyt directly

Time taken for the specimen to arrive in the laboratory

Time limits for requesting additional information The time limit for requesting additional information is 2 days although depending on the nature of the

request additional information may be available for a longer period. Non-gynae cytology All cytological samples must be transported along with a fully completed non-gynaecological cytology request form, or the combined pathology request form in the case of non-hospital requests as soon as possible after collection to minimise deterioration of the cells. Please ensure that the cap is secured tightly on the container, and label the container clearly with the patient's details. The patient's date of birth rather than their age should be noted on the request form. FNA slides should be labelled with the patient name, date of birth and RXR number. If specimens from two sites are received together the slides from each site should be clearly marked If both cytological and microbiological examinations are required, please send two specimens, and two relevant fully-completed request form as the whole specimen may be required for each examination. For cytological specimens prepared on slides by the clinician, ensure that the slide is clearly labelled in pencil with the patient's name and the site of aspiration (e.g. right or left), if necessary. Only pencil will resist the fixing and staining fluids. The sample should be evenly spread across the slide, on the same side as the name, and fixed immediately using spray fixative or cervical smear fixative. If the smear is not fixed within 2 - 3 SECONDS of spreading, cell distortion due to pre-fixation - drying artefact may render the preparation useless for diagnosis. There is no service for differential WBC counts on bronchioalveolar lavage samples return to contents

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How to complete the non-gynae cytology request form Please ensure the patient name, date of birth andhospital number (if available) are clearly stated on the request form and the specimen pot. The sample type should be clearly marked on the request form, specimen pot and/ or slides. Please include the date and time of specimen collection (this helps us to audit the transport arrangements to the lab) and as much clinical information as possible to help make an accurate and timely diagnosis. If there are any particular and significant clinical features, please call the lab and speak to a pathologist on (01254) 732621. High risk specimens If the specimen is suspected to be “HIGH RISK‘” the request form and the plastic specimen bag must be clearly marked as such. Urgent specimens Urgent samples should be clearly marked “URGENT” preferably in red ink. Incorrectly labelled specimens will be returned for correction. This will delay specimen processing.

Sputum Cytology A fresh, deep-cough early morning specimen prior to eating or teeth cleaning is the ideal, preferably collected under supervision. If the expectorate appears to consist mainly of saliva, it should be discarded and a repeat sample obtained. An early morning specimen on three consecutive days will yield greater diagnostic information than an isolated sample. Serous Fluid Cytology Transfer a representative sample of the fluid into a clear plastic 60ml sterile specimen container immediately after collection and send to the laboratory together with a fully completed cytology request form. Urine Cytology The first early morning urine sample should be avoided since it will have been in the bladder for some hours and many epithelial cells will show considerable degenerative changes. Best results are obtained from the second (mid-morning) sample, which should include the first and last part of the urine (not a mid-stream urine). Collect the urine into a plain, dry, sterile container (NOT A BORIC ACID CONTAINER) Fine Needle Aspiration Cytology (FNA's) At Burnley General Hospital breast clinics FNA,s are spread directly onto slides but otherwise any FNA,s can be collected into red-topped universals containing fixative. return to contents

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Section 4: List of Referral laboratories

Laboratory Consultant Area of Specialism Weblink

St. John's Institute of Dermatology Dr E. Calonje Dermatology Click here

Christie Hospital

Dr S. S. Banerjee Dr J. H. Shanks Dr L. P. Menasce Dr B. Shakrabaty Dr K. Sikant Dr P. Sherjene

Cancer Pathology Click here

Royal Preston Hospital Dr H. Stringfellow Gynae Pathology Neuropathology

Click here

Leeds Haematological Malignancy Diagnosis Service

Dr A. Jack Haematological Pathology

Click here

Manchester Royal Infirmary Ocular Pathology Gynae Cytology

Click here

Source Bioscience Gastric Her-2 testing Click here

Clinical genetics lab, St Mary's hospital, Manchester

EGFR receptor status K-ras status testing

Click here

Central Manchester Foundation Trust

Cytology GI pathology Histopathology referrals Ophthalmic services Paediatric Pathology Perinatal Pathology

Click here

Morecambe Bay NHS Foundation Trust Royal Lancaster Infirmary

Dr N. Mapstone Upper GI pathology Click here

Cellular Pathology Department University Hospital of Wales Heath Park Cardiff CF14 4XW

Dr A. Gibbs Pulmonary pathology Click here

Queen Elizabeth Hospital Queen Elizabeth Medical Centre Edgbaston Birmingham B15 2TH

Dr Taniere Molecular Pathology tests

Click here

Royal Hallamshire Hospital Glossop Road Sheffield S10 2JF

Dr Wells Dr Perunovic

Gynaecological Pathology

Click here

St. James Hospital Department of Cellular Pathology Level 5 Bexley Wing St James University Hospital Beckett Street LEEDS LS9 7TF

Dr Wyatt Dr Merchant

Liver Pathology Dermatopathology

Click here

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