Department of Histopathology
Histopathology is the microscopical analysis of diseased tissues. The purpose is to provide a tissue diagnosis, which is the gold standard for medical diagnosis and allows a patient's treatment and prognosis to be decided. The department of Histopathology is based in North Wing, level 3 together with other sections of Pathology.
- Histopathology Key Contacts
- Histopathology Laboratory Opening Hours
- Availability of Results
- Department Turnaround Times
- Specimen Collection, Storage and Transport
- Frozen Sections
- Specimen Acceptance Criteria
- Specimens processed outside of the department
- Special Stains and Immunohistochemistry
- Molecular Sendaway Tests
- Second Opinions/ Reference Laboratories
- Time Limits for Requesting Additional Tests
-Gynaecological Cytology Specimens
-Non-Gynaecological Cytology Specimens
Histopathology Key Contacts
Histopathology Laboratory Opening Hours
The Histopathology laboratory is open from 7.00am – 17:30pm Monday-Friday and is able to accept specimens until 17:15pm daily.
Please note: the Histopathology department is not open outside the working hours detailed above and is not open during weekends or bank holidays.
Availability of Results
Consultant histopathologists are available Monday to Friday from 8am to 5pm should advice or clinicopathological correlation be required. They can be contacted via phone through the main histopathology office
The results of specimens originating at Dorset Country Hospital will be available electronically on ICE once results have been authorised, however preliminary results may be available by discussion with the reporting consultant. Please note paper copies are no longer sent unless specifically requested. Results from specimens received from general practitioners are available electronically or by printed copy. If results are requested over the phone the caller's identity must be confirmed before any results are provided. We are unable to give results directly to patients or their relatives.
The time taken for a result to be available will depend on the size and complexity of the specimen. Cases in which the histopathologist considers the findings to be of clinical urgency may be communicated with the clinical team by telephone and/ or email.
Rapid processing of very urgent biopsy specimens can be arranged following discussion with the appropriate pathologist enabling a result to be available within 24 hours. Rapid processing is not available on large specimens in order to preserve the quality of the specimen.
Departmental Turnaround Times
The following lists the departments' targets for turnaround of work from receipt of specimen to final report which are in line with RCPath guidelines; there may be some occasions where this is not achievable.
- 90% biopsies reported in 7 calendar days
- 90% large resections reported in 10 calendar day
- All specimens 100% reported in 30 calendar days
Non Gynae Cytology
- Urgent non-gynae cytology specimens, 80% will be reported within 3 working days from receipt.
- Non urgent non-gynae cytology specimens, 80% will be reported within 7 working days from receipt.
Specimen Collection, Storage and Transport
If service users are in any doubt as to how specimens should be sent to the histopathology department for analysis, it is essential to discuss your requirements with the laboratory or with a consultant histopathologist. The majority of specimens taken either at a GP surgery or in hospital should normally be transferred to the department in 10% neutral buffered formalin. Formalin pots can be obtained from the department of Histopathology. However some specimens have specific requirements:
- Specimens for frozen section must be FRESH (no fixative added)
- Skins for immunofluorescence can be FRESH, in MICHEL's solution or wrapped in SALINE soaked gauze
It is important to ensure that surgical specimens are placed in an adequate volume of fixative as soon as possible after removal. It is also important that appropriate sized containers are used to allow sufficient fixation of the specimen, therefore it is important not to squeeze specimens into too small a container. Large specimens from surgical operations should be fixed in formalin and transferred to the department in large plastic containers within large white specimen bags to avoid leakage. Should a specimen be too large for a container, please contact the laboratory for advice; under no circumstances should specimens be placed into a sharps bin if they are for histopathological examination. In the event of a large formalin spillage please contact the laboratory for advice and/or assistance. The telephone number is 01305 254306.
Theatre support workers and porter staff are on hand to collect samples from source within DCH and deliver them either directly to the Histopathology cutup room for signed receipt, or the main pathology specimen reception (both locations can be found on Level 3 of the North Wing). If samples are particularly urgent it is advantageous to bring them directly to the Histopathology cutup room where they can be received by a member of laboratory staff.
For those samples being transported from outside the hospital, there is DCH transport which provides daily pathology transport links between the local health centres/community hospitals and the main pathology reception at DCH.
Histopathology provide two types of specimen bag for container transport; large white bags for specimens transported within white formalin buckets and a smaller clear bag for the orange/white-topped prefilled formalin pots.
Please follow packaging instructions noted on the specimen bags, affixing addressograph labels to both the request form and specimen pot. The large white bag will require the request form to be placed into a clear bag and placed inside with the specimen pot, whereas the clear specimen bag provides a pocket for the specimen request form.
Please ensure specimen bags are sealed to avoid the request form and pot becoming separated. Should a specimen bucket be too large for the white specimen bag, please place the specimen request form into a clear bag and fix to the top of the labelled specimen bucket for transport.
NB: Please send specimens for Histopathology separately from Non-gynae Cytology specimens; providing individual request forms for both sample types.
For this service the department must be alerted prior to the date of the operation so that appropriate planning can be arranged. Frozen section requests can be made via email to the laboratory manager, senior BMS or by phone to the laboratory on 01305 254306.
- The department are unable to accept any specimens of an infectious nature for frozen section processing
- To ensure the necessary staffing levels within the laboratory, tissue for frozen sectioning should be received by the department by 3pm.
- Samples for frozen section should be hand delivered directly to the department unfixed, i.e. in a dry pot with no fixative present.
- Request forms should be clearly labelled 'frozen section' and a contact telephone number provided for delivery of results.
- Unpredictable frozen sections should be phoned directly through to the laboratory as soon as the requirement for frozen section diagnosis is realised.
Specimen Acceptance Criteria
All tissue samples submitted to the Histopathology Department must be in a suitable container clearly labeled with a minimum of 3 point of patient identifiable information and must include:
- first name and surname
- date of birth
- hospital and/or NHS number
While ideally the pot should be labelled with a pre-printed addressograph label, the laboratory will also accept hand labelled pots providing they include all in the necessary information. The specimen pot should also be labelled with the specimen type and date sample was taken.
A histopathology request form must be completed and submitted with the histopathology sample and the use of ICE is encouraged. The form must contain a minimum of 3 points of patient identifiable information as listed above but may also include the patients address, gender and GP. In addition to the patient details the form should detail the specimen type, requesting consultant, source of request e.g. GP surgery or hospital ward and the date and if possible the time of specimen collection. As the specimen request form will be handled by staff outside the laboratory it is important to ensure that all forms are free of contamination by blood or body fluids.
The spellings of names must be correct, with matching details presented on both the pot and specimen request form. Specimens that do not meet these criteria cannot be processed by the laboratory until the correct details have been provided by the requesting clinician/ clinic. It is the responsibility of the requesting clinician to provide any relevant clinical details which may assist the pathologist in diagnosis; such information may include recent history, examination findings such as recent radiological or laboratory test results.
PLEASE NOTE: ANY SAMPLES RECEIVED WITHOUT A FULLY COMPLETED REQUEST FORM AND CORRECTLY LABELED SPECIMEN POT WILL BE RETURNED TO THE ORIGINATOR FOR AMENDMENT; THIS WILL CAUSE DELAYS IN SPECIMEN PROCESSING.
Specimens processed outside of the departmentThe following specimens are sent away for processing on the same day they arrive in the department:
- Skin immunofluorescence – Viapath at St. Thomas' Hospital in London
- Medical kidney biopsies – South Mead Hospital in Bristol
- Products of conception requiring genetic analysis – Wessex Genetics Salisbury
Special Stains and Immunohistochemistry
The Histopathology department has a repertoire of special stains and immunohistochemistry protocols used in the diagnosis of various diseases and conditions. These types of stains can take a further 1-2 working days and may be required on some of the more difficult cases to assist in diagnosis, thus delaying the submission of final reports. In some instances reports may be issued with the results of these additional tests pending to be added as a supplementary report once complete. There are some additional immunohistochemical stains which may be required that are not performed in-house, requests for these staining protocols are sent to Health Services laboratories Advanced Diagnostics (HSL-AS) in London and normally take an additional week for stained slides to be returned, results of such stains are usually issued as supplementary reports.
Time Limits for Requesting Additional Tests
- Residual formalin fixed wet tissue is stored for a minimum of four weeks after issue of final report to allow for MDT discussion and supplementary reporting of any additional tests
- Histopathology stained slides are retained for a minimum of 10 years
- Formalin fixed paraffin embedded tissue blocks are stored for a minimum of 30 years
- Diagnostic cytology samples are kept for 2 weeks after receipt and also a minimum of 2 days after sign out
Please note all requests for additional investigations must be made after discussion with the reporting consultant histopathologist or at an multidisciplinary meeting.
Molecular Sendaway tests
The department is unable to process molecular tests onsite and therefore must send requests for these tests to external laboratories. Molecular tests are normally requested by consultants at MDT although can be requested at a later date should they be required. The table below demonstrates where such tests are sent and the requirements:
|ALK IHC (lung)||HSL Advanced Diagnostics. London|
|BRAF – Colorectal||Molecular Pathology Diagnostic Service, QEH Birmingham|
|BRAF - Skin||Molecular Pathology Diagnostic Service, QEH, Birmingham|
|EGFR/ T790M||Molecular Pathology Laboratory, Royal Bournemouth Hospital|
|GIST KIT/ PDGFRa||Department of Cellular Pathology, QEH, Birmingham|
|HER2 ISH||HSL Advanced Diagnostics, London|
|KRAS/ NRAS||Molecular Pathology Diagnostic Service, QEH, Birmingham|
|MMR IHC||HSL Advanced Diagnostics, London|
|MULTIGENE PANELS||Sarah Canon Molecular Diagnostics, London|
|PDL-1||Molecular Pathology Diagnostic Service, QEH, Birmingham|
|T-CELL (TCR)/ B-CELL (IgH)||Skin Tumour Unit, St John's Institute of Dermatology, London|
Second Opinions/Reference Laboratories
In some cases that are more difficult to diagnose, it may necessary for them to be sent away to an external expert for second opinion or to a regional reference laboratory. A list of referral laboratories are found below:
|TEST/ INVESTIGATION||REFERENCE LABORATORY|
|Lymphoma cases for opinion||Lymphoma team, Department of Cellular Pathology, University Hospital Southampton|
|Liver biopsies||Hepatology consultants, Department of Cellular Pathology, University Hospital Southampton|
|Thyroid cases||Dr Sarah Johnson, Department of Histopathology, The Royal Victoria Infirmary, The Newcastle Upon Tyne Hospitals|
|Thyroid cases||Dr Miranda Pring, Department of Histopathology, Bristol Royal Infirmary|
|Adult cardiac specimens||Professor Mary Sheppard, St George's Hospital, London|
|Urological tumours||Professor Stewart Fleming, Medical Research Institute, University of Dundee |
|Soft tissue tumours/ sarcoma lesions ||Professor Cyril Fisher, Department of Cellular Pathology, Royal Marsden Hospital|
|Urology/ Lung||Dr Brendan Tinwell, Cellular Pathology Department, St George's University Hospital|
|Gynaecological cases||Dr Raji Ganesan, Histopathology, Birmingham Womens & Children's Hospital|
|Gynaecological cases||Professor Glen McCluggage, Department of Pathology, Belfast Health and Social Care Trust|
|Lung/ neck node pathologies||Professor Andrew Nicholson, Histopathology, Royal Brompton and Harefield|
|Liver ||Hepatobiliary Team, Department of Cellular Pathology, University Hospital Southampton|
|Head and Neck pathologies||Professor E Odell, Department of Oral Pathology, United Medical & Dental Schools of Guy's & St Thomas Hospital Trust, Guy's Hospital, London|
|Ophthalmic/ eye pathologies||Dr Caroline Thaung, National Specialist Ophthalmic Pathology Service (NSOPS), Institute of Ophthalmology, London|
|Kidney/ nephrectomy cases||Dr Anastasios Chatzitolios, Department of Cellular Pathology, North Bristol NHS Trust|
|BCSP Panel Review||Professor Neil A Sheppard, Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital|
|Products of conception/ Molar Pregnancies||Professor N Sebire, Trophoblastic Disease Unit, Charing Cross Hospital, London|
|Breast ||Professor Sarah Pinder, Viapath, Department of Histopathology, St Thomas Hospital|
|Rectal adenocarcinomas||Professor M Novelli, Department of Histopathology, University College London|
|Head and Neck Pathologies||Dr Judit Sutak, Department of Cellular Pathology, North Bristol NHS Trust|
|Orthopaedic ||Professor Adrienne Flannagan/ Dr Roberto Tirabosco, Histopathology Department, Royal National Orthopaedic Hospital, Middlesex|
|Skin ||Dr Eduardo Calonje, St John's Institute of Dermatology, St Thomas Hospital|
|Tumour Cytogenetics||Wessex Regional Generics Laboratory, Salisbury District Hospital|
|LD Path – external reporting||LD Path Group, London|
Cytology is the study of cells in a liquid suspension and is often used in screening programmes or for diagnosis, the cytology laboratory is open from 8am to 4pm Monday to Friday. It is divided into two main sections as described below:
- Gynaecological Cytology
Cervical cells are collected in a pot containing a special fluid for liquid based cytology. These pots can be ordered from Taunton Hospital, Cytology Department as all gynae cytology screening is undertaken there. Contact telephone number at Taunton Cytology Department is 01823 343186 and Fax number is 01823 343185.
- Non-Gynaecological Cytology Specimens
The majority of non-gynae specimens are collected at the hospital and smaller numbers at GP Surgery. These specimens are submitted for the identification of atypical cells and include the examination of synovial fluids (currently an examination not UKAS accredited to ISO15189), fine need aspirates (FNA), sputum, bronchial lavage, mid-stream urine, and other fluids collected in sterile universal pots labelled with 3 points of patient information and received with a completed request form. If service users are in any doubt as to how specimens should be sent to the non-gynae cytology department for analysis, it is essential to discuss your requirements with the laboratory or with a consultant histopathologist.
Please note that if specimens are collected outside of laboratory working hours it is advisable to store them between 2-8ºC until the next laboratory working day. It is advisable to ensure contaminants are not included in samples submitted for analysis and the specimen is delivered to the lab as soon as possible after collection to prevent microbial growth impacting on the preparation and report.
Where slides are prepared from FNA it is important to ensure that they are labelled with the patient name and hospital number and are received in the laboratory with a completed request form. Please contact the laboratory should advice be required for optimal FNA preparation; slides should be sent to the department in an appropriate slide box labeled with at least 3 points of patient identifiable information.
If you are sending a both histology and cytology samples on the same patient we require separate request forms for both samples.
Please be aware that the cytology laboratory also handles andrology specimens, specific information for these samples can be found on the separate Andrology page.