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.

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 number x74899)

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 x74932) 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 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.

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.

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.

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 The Royal Stoke Hospital Histology laboratory within a week of the specimen being sent.   

These specimen types require consent for examination and/or disposal. We cannot process and report samples which are presented without a completed consent form along with the Histology request card.

The consent form should ideally be sent with the specimen.  If this is not possible it should be sent to The Royal Stoke Hospital Histology laboratory within a week of the specimen being sent.   

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

The EM is received by us at UHNM Histology department. This is then sent away to Southampton if EM is required.

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

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.

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

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 (x 74932) to inform a Senior Biomedical Scientist of the samples impending arrival.

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.

Contacts for this project are;

  • 01782 (6)71939 – R&D Academic Development Officer
  • 01782 (6)76003 – Pathology Clinical Trials Officer
  • 01782 (6)74278 – Histology Tech Lead BMS Immunocytochemistry & HER2 Testing

More Information about the 100,000 genome project can be found here.

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. 

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.

The term non-gynaecology cytology relates to all specimens that are received within cytology that are not part of the cervical screening programme.

If a report is required by a certain day/time this information must be stated on the request form.

Non-Gynaecological cytology opening hours are from 9-00-4.30pm Monday to Friday.

It is imperative when sending any specimen to the Histology Laboratory that it should be accompanied by a correctly filled out request form.  Failure to do so WILL result in rejection and the returning of the specimen to the requesting Clinic/ward/GP practice for amendment.

If either the specimen request form or the specimen are labelled incorrectly or inadequately labelled, a request will be returned.  Processing of these samples may result in miss identification of the patient constituting a clinical risk.

It is vital that forms are correctly filled out and more importantly, legible. Clinical details are a vital part of the non gynae cytology request. Please provide legible and relevant information in this field , examples of which are noted below. This information will help in the interpretation of the specimen.

  • Symptoms
  • Underlying conditions
  • Previous history of neoplasia/pathological conditions
  • Recent infections
  • Danger of infection status if known or suspected. Please be advised that air-dried preparations must not be performed on patients that are identified as ‘danger of infection’ e.g. ?TB, ?HIV.

The minimum data set for completion of the request cards, specimen pots and specimen slide preparation 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’.

Prepared slides that are to be processed must be labelled with pencil as ink is removed by the solvents that are used during specimen preparation.

If Microbiology is required, separate specimen/s and separate form/s 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 x72672)

To order preservcyt, cytorich red and cytofixx spray, please call the department on 01782 674853.

All non-gynaecological specimens should be sent to the department ASAP. Any received prior to 4 pm will normally be processed on the day of arrival within the department.  ‘Out of Hours’ Non-gynae specimens must be refrigerated at 4oC. 

Clinical advice from Consultant Histopathologist is available.  This can be achieved by telephoning during normal working hours.

Urgent Non-Gynaecological Cytology specimens must be telephoned in advance to request an urgent report; these will be reported on the same day, if possible.

For all other specimens, please see page Table of Non-Gynaecological Specimen Types’.

Needle washes prepared by the clinician - the slides must be sent in slide carriers and in cases where needle washes are prepared, these must be sent in phosphate buffered saline fluid.  Both are available from the laboratory. Some specimen needle washes can be received in Preservcyt – please refer to the table of Non-gynaecological Specimen Types.

Procedure for High Risk Specimens

High risk specimens are those that could, potentially contain category 3 pathogens (i.e. Hepatitis, HIV, TB).  For a list of organism categories refer to the Advisory Committee on Dangerous Pathogens (ACDP) Approved list of Biological Agents.  High risk specimens must be labelled with the appropriate biohazard label and placed into a sealed outer risk container during transportation to the laboratory. The accompanying request card must also carry the biohazard label.

CSF specimens

Please send CSF specimens to Cytology immediately after taking them – they are time sensitive and  the cells start to deteriorate over time, possibly causing them to be reported as ‘non-diagnostic’. CSF specimens should not be taken after 3pm for this reason – this allows for transport and preparation time. In cases where a malignant lesion is suspected clinically, these will be sent away to Birmingham for reporting by a neuropathologist.  This will be performed by the cytology laboratory.

Specimen Problems

Specimens that arrive within the department that are correctly labelled will be dealt with promptly and without delay.  Unlabelled specimens will not be prepared.

Please ensure that all lids are secured prior to transportation of the specimen as leaking specimens may not be processed.

Please note that it is the responsibility of the users to safely dispose of all materials used in the collection of specimens.

What is the Histology Failsafe role?

The Histology Failsafe team ensure that all Histology and Non-Gynae Cytology samples are reported in a timely manner, and escalate cases appropriately to the laboratory and Histopathologists as and when required or requested.

What is the Failsafe team’s working hours?

The Histology Failsafe team work between 09:00 and 17:00, Monday to Friday. Any escalations which fall outside of that timeframe will be addressed on the next working day.

How can I contact the Failsafe team?

histology.failsafe@uhnm.nhs.uk

What does the Histology process consist of (from the taking of the sample to the Histology report being available)?

The Histology Laboratory Process:

Patient attends UHNM Royal Stoke University Hospital/County Hospital

Specimen taken

Transport (this stage needs to be as time efficient as possible)

Specimen received in the laboratory

Fixation (usually up to 48 hours but some specimens can take longer to fix)

Specimen dissection

Processing (at least overnight but fatty or large samples can take 48 hours)

Wax Embedding

Slide Preparation

Pathologist slide evaluation

Further laboratory testing if the primary investigations require it (up to 48 hours)

Report preparation

Report to clinician

What are the Histology turnaround times?

The departments aim is to report 80% of all Histology and Non Gynae cases received within 10 calendar days.

There will be however, times during which this turnaround time may not be achieved due to fluctuations in demand to capacity ratio within the department.

If a report is required by a certain day/time this information must be stated on the request form.

Inevitably there will also be some cases, particularly complex cases, cases requiring prolonged decalcification or cases requiring tertiary referral will take longer.

What samples should be escalated to the Failsafe team?

  • Clinically urgent or potentially cancerous requests required for MDT.
  • Requests that have breached or are in serious and imminent danger of breaching the 62 day Cancer Diagnostic Pathway target, or the Histology turnaround time.

What information is required by the Failsafe Team in order to escalate a case?

  • Please provide the following information:
    • Reason for escalation – this is required by the Histopathologist and Histology Laboratory
    • Patient’s full name
    • Date of birth
    • Unit number and/ or ten digit NHS reference number
    • Date sample taken
    • Sample type