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 Histopathology Department is based in North Wing, Level 3 together with other sections of the Pathology Department. 

The histopathology laboratory is open from 7.am – 5.30pm Monday to Friday and is able to accept specimens until 5.15pm daily.  

Contact details

Histopathology Secretarial Office
01305 254301
HistologySecretaries@dchft.nhs.uk

Samantha Hansford (Laboratory Manager/Head BMS)
01305 254307
samantha.hansford@dchft.nhs.uk

Dr Oliver Foot (Interim Lead Consultant/Consultant Histopathologist)
01305 254302
oliver.foot@dchft.nhs.uk

Dr Saleem Taibjee (Consultant Dermatopathologist)
01305 253278 / 5361
saleem.taibjee@dchft.nhs.uk

Dr San Karunaratne (Specialist Grade Doctor, Histopathology)
01305 254300
sanwadana.karunaratne@dchft.nhs.uk

Dr Segun Odetola (Locum Consultant Histopathologist)
01305 255938
segun.odetola@dchft.nhs.uk

Dr David Ibikunle (Speciality Doctor)
01305 255381
david.ibikunle@dchft.nhs.uk

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.

Histology

• 90% biopsies reported in seven  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 three working days from receipt
• Non urgent non-gynae cytology specimens, 80% will be reported within seven 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 Histopathology Department. 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 and main body/side of the specimen pot (not the lid). 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.  

Please send specimens for histopathology separately from non-gynae cytology specimens; providing individual request forms for both sample types.

Frozen sections

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 labelled with a minimum of three point of patient identifiable information and must include:

• first name and surname
• date of birth
• hospital and/or NHS number

Patient ID labels should be affixed to the side/main body of the specimen pot (not the lid); whilst 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 three 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.

Any samples received without a fully completed request form and correctly labelled specimen pot will be immediately removed from processing until the originator can attend the department for amendment. This will cause delays in specimen processing. 

Tissue for Sensitive Disposal (POC)

All products of conception (POC) specimens must be accompanied by a consent form entitled “Consent form for Histopathological Examination and Sensitive Disposal of Pregnancy Tissue (up to 12 weeks and 6 days) form” – a printable copy of this form is available within the Early Pregnancy Assessment Clinic (EPAC) Guidelines (policy 0629 on SharePoint). The legislation surrounding this is very stringent, and the form must be signed and completed with care; to include the patient’s wishes for Histological examination and disposal thereafter.  Should the consent form not be made available on receipt of the sample or if parts are left incomplete, the processing of these samples will be delayed; laboratory staff will contact the requesting clinician to request that this form is completed as soon as possible so there is minimal delay for the histology report.

Specimens processed outside of the department

The 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 one to two 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 (HSL) in London and normally take an additional week for stained slides to be returned; results of such stains are usually issued as supplementary reports.

Please note: due to the addition of a new staining machine for special stains the department is currently performing the following special stain techniques outside of its UKAS accreditation to ISO15189 (2012); Alcian Blue, ABPAS (±D), Congo Red, Giemsa, Grocott, Masson Trichrome, Periodic Acid Schiff’s (±D), Perls Prussian Blue, Reticulin and Elastin Van Gieson. Application to bring these stains into the department’s accredited repertoire is in progress.

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 a minimum of two 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:

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:

Cytology

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 - 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 Berkshire and Surrey Pathology Services (BSPS) as all gynae cytology screening is undertaken there.

For specimen / results enquiries
BSPS HPV Helpdesk email: asp-tr.bspshpv@nhs.net

BSPS HPV Helpline: 01932 726622

Francesca Albertini, Consultant Biomedical Scientist:
E-Mail: f.albertini@nhs.net
Phone: 01932 872000

Non-gynaecological cytology specimens
The majority of non-gynae samples are collected at the hospital and smaller numbers at GP Surgeries. These samples 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.

Non-gynae fluid samples must be collected in in sterile universal pots labelled with:

• three points of patient information
• sample type
• date sample was taken.

All samples must be sent to the laboratory with an accompanying sample request form. If service users are in any doubt as to how samples 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 samples are collected outside of laboratory working hours it is advisable to store them between 2-8ºC until the next laboratory working day since there is no out of hours service for non-gynae cytology. It is advisable to ensure contaminants are not included in samples submitted for analysis and the sample is delivered to the lab as soon as possible after collection to prevent microbial growth impacting on the preparation and report.

Please contact the laboratory should advice be required for optimal FNA preparation. Where slides are prepared from FNA it is important to ensure that each slide is labelled with the patient’s name, hospital number and preparation technique (fixed / airdried) written in pencil. Slides are to be sent to the laboratory in a plastic slide box labelled with at least three points of patient identifiable information and the site of FNA, accompanied by a completed request form. 

Similarly, needle washings are to be submitted to the lab in a 25ml pot of 10% formalin, labelled with at least three points of patient identifiable information and the sample type, accompanied by a completed request form. 

25ml formalin pots, Cytofix spray and glass slides are distributed from the laboratory; please call 01305 254308 to request items are readied before coming to collect. 

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 samples; specific information for these samples can be found on the separate andrology page.