Consultant Histopathologists can be contacted for clinical advice and interpretation during the working day and out of hours (see opening hours and contact details section for further information).

Sample Requirements

At least three identifiers are required together with the specimen site on both the pot and request form. The link below offers further guidance from the Institute of Biomedical Science.

http://www.ibms.org/go/media:publications:professional-guidance

• Histopathology and cytology samples must be brought in a specimen transport container directly to the Histopathology Department.  (We do not have a pod system available)
•  All fresh samples must be pre-booked and arrive at the laboratory before 4pm. See repertoire for more information on the relevant samples. 
  
• All requests must be generated via Meditech. There are Meditech user guides for staff available on the intranet. Problems with generating a request form should be reported to the IT department.
  
• Samples will not be accepted unless accompanied by a printed Meditech request form (with barcode) and with the minimum identification criteria (Patients name, DOB, AH number, specimen type (on pot and form) and requesting consultant.
  
• The specimens must be labelled correctly otherwise they will be returned. 
  
•  Advice on completing or printing a request form can be obtained from the IT department.
  
• Urgent samples should be clearly marked and in the case of fresh tissue brought immediately to the Histopathology Department.

 Repertoire:

• Routine Surgical Specimens:
  Samples must be placed in an appropriate sized container labelled with a formalin hazard symbols and arrive covered with at least 10 times the volume of 10% Neutral Buffered Formalin.
  
• All suspected high-risk specimens must come double-bagged and clearly labelled as biohazard. (You must discuss with a pathologist before any fresh samples that are suspected high-risk are sent to the laboratory).
  
• If you have any doubts about how to send a specimen, please contact the laboratory.

 Fresh Specimens:

• Frozen section:
  All frozen sections requests must be booked with the laboratory and discussed in advance between the surgeon and the pathologist. A contact number must be written on the Meditech request form to enable the Pathologist to issue a verbal report.
  
• Any frozen section samples must be brought immediately to the laboratory by the theatre staff accompanied by a printed Meditech request form.
  
• We do not perform frozen sections on high-risk specimens.

• Fresh Tissue (Tumours): 
   All tumour specimens for histology must be discussed between the surgeon and the pathologist in advance.
  
• All tumour samples must be brought immediately to the laboratory.

• Rectal biopsy for initial assessment of Hirschsprung’s Disease:
  
• All biopsies for assessment of Hirschsprung’s disease should be booked with the laboratory in advance and arrive no later than 4pm.
  
• Ideally two deep biopsies should be taken at each site.
  
• The fresh biopsies should be placed on a saline soaked filter disc and placed in a clean container, labelled appropriately with the sites of each biopsy clearly marked (e.g. 2cm, 3cm). They should be brought to the laboratory immediately with a printed Meditech request form.
  
• Pull-through biopsies on confirmed cases of Hirschsprung’s Disease are treated as frozen sections; please see above for specimen requirements

• .Renal Biopsies:
  
• All renal biopsies must be booked with the laboratory in advance, please call ext 3505/2177. The cut off time for requesting staff to be in attendance at a renal biopsy is 4pm.
  
• A printed Meditech request form must be received prior to the procedure.
  
• Laboratory staff are available to attend the biopsy session to assess adequacy of sample. 10-15 minutes notice is required prior to collection of the first biopsy.

• Muscle Biopsies:
  All muscle biopsies must be booked with the laboratory in advance and arrive no later than 4pm.
• The fresh muscle biopsy should be sent immediately to the laboratory wrapped in saline soaked gauze. 
  
• For further information please see links below.

• Skin samples for fibroblast culture only (cytogenetics):
  All samples are to be sent via histology. They are then forwarded to the cytogenetics department at Liverpool Women’s Hospital.
  
• Place skin in cytogenetics (solid tissue) media as soon as possible and label the container appropriately. The media is available for collection from the histopathology laboratory.
  
• A printed Meditech request form accompanied with the sample is required and must arrive at the laboratory before 3pm. 
  
• The cytogenetics department state that the samples are only viable for up to 72 hours in the media therefore if it is received after 3pm (especially on a Friday or bank holiday) it will not be sent until the next working day and the viability of the sample and following results cannot be guaranteed. 
  
• The results are recorded on Meditech on receipt by the Histopathology Department.
  

Skin samples for Immunofluorescence:

• The skin sample must be appropriately labelled, wrapped in saline soaked gauze and placed in a clean container before immediate transfer to the laboratory. It should arrive no later than 4pm. 
  
• The sample must be accompanied by a printed Meditech request form, which should clearly state that the sample is for immunofluorescence.
  

Fluid samples for cytology:

• All fluid samples for routine or urgent cytology (except CSF) are to be sent via histology to the Royal Liverpool Hospital for processing and reporting.
  
• All samples must be accompanied by a printed Meditech request form and arrive at the laboratory by 3pm. If the sample is received after 3pm it will not be sent until the following working day. Delays in sample transfer may affect the viability of the sample and subsequent results.
  
• The results are recorded on Meditech by the Histopathology Department
  

Transmission Electron Microscopy:

• All requests for transmission electron microscopy must be discussed with the pathologist in advance who will advise on specimen collection.
• Specimens are processed off site at Manchester Royal Infirmary.

Histopathology Reports

Finalised reports are posted onto the Meditech patient index under Anatomical Pathology Reports. Consultants and healthcare professionals can access the reports from any linked terminal within the Trust. Hospital post mortem reports can be sent to the GP if required.

The quality of results is controlled by internal quality control procedures and monitored by external quality assessment. The Histopathology department participates in UKNEQAS external quality assurance schemes including cellular pathology techniques, immunocytochemistry and renal schemes. The department alos participates in the ThermoFisher Quality Review Scheme.

Turnaround Times (TAT)

Turn around times are monitored as one of the departmental quality/performance indicators.  The TAT for surgical samples is 90% reported within 5 working days and hospital post-mortem cases reported within 6-8 weeks. The placental turn around time is three weeks. Complex cases may require further time to report.

A provisional report on urgent cases is made available within 24 hrs if the specimen is received in the laboratory before 3pm.  Please discuss the case with the pathologist before requesting urgent results. Contact details of the person to whom the report is to be communicated are required.

Requests for additional investigations

Tissue taken is either routinely blocked in paraffin wax or frozen which will enable additional investigations to take place beyond the release of a report. Surgical tissue that is not blocked is discarded 1 month following the release of an authorised report.

Post mortems

Post mortems fall into 3 categories:

Hospital post mortems:
A post mortem consent booklet and request form must be completed and received with the body. These can be obtained from the Histopathology Office (0151 293 3656 or 0151 252 5081)

The purpose of hospital post mortems is:

1. To confirm the cause of death.
2. To assess the extent and severity of disease.
3. To assess the effects of treatment.

Coroner’s post mortems:
A Coroner’s post mortem is required when the cause of death is unknown or unnatural. This includes cases where

• Children have died by the time they reach hospital
• Deaths are due to accidents or other injuries 
• Deaths occur during or shortly after surgery 
• Deaths are unexpected or unexplained.

Reporting a death to the Coroner does not automatically mean that a post mortem will be performed if in doubt it is best to speak to the Coroner or his officer. A Consultant Pathologist is also available to offer advice.

If you are unsure whether to discuss the death with the Coroner then please contact the Pathologist.

Home Office Post mortems:
Home Office post mortems are also known as forensic post mortems. Home office post mortems are carried out at the instruction of the police. Home office post mortems are undertaken when the cause of death is unknown and foul play is suspected.

Guidelines for Submitting samples for investigations at external laboratories

• A Meditech request form must be printed (with barcode) and brought to the laboratory with the sample.
  
• See individual specimen types for guidance.

Please inform the laboratory of any changes to the scheduled time of the biopsy.

The deadline for submission of all fresh tissue samples is 16:00h, after which time there can be no guarantee that a Histopathologist or Biomedical Scientist will be available to deal with the sample. All fresh samples need to be pre booked with the laboratory.

The department holds full accreditation with Clinical Pathology Accreditation

The department is accredited for the training of junior pathologists with The Royal College of Pathologists.

The department is accredited with The Institute of Biomedical Science for the training of Biomedical Scientists.

The department is registered with the Children's Cancer and Leukaemia Group as a Regional Childhood Tumour Tissue Bank.

The department holds the Human Tissue Authority license to handle and store tissue

List of referral centres

Muscle Biopsy Protocols

Muscle biopsies should be booked in advance with the laboratory. Please call 0151 252 2177 and indicate the following information:

• Patient name
• Unit number
• Date of birth
• Date of procedure
• Theatre number
• Surgeon
• Differential diagnosis (this will affect how the sample is treated)

Please ensure samples reach the lab by 4pm and please do not batch the samples.

Muscle biopsies should measure at least 10 x 10 x 5mm. Samples should be received in the laboratory fresh on saline soaked gauze. Do not place the samples in formalin or allow them to dry out. Once the biopsy is removed it should be transferred to the laboratory immediately.

The muscle biopsy samples are routinely divided thus:

• Orientated frozen sample for enzyme histochemistry
• Samples for electron microscopy

There are a number of specialist referral centres to which muscle samples are sent. Some centres have specific request forms which may be downloaded below. Request forms for specialist centres must be completed before samples are dispatched. The specialist areas are:

Mitochondrial Myopathies

Mitochondrial research group, Newcastle University

Turnaround times

Assays measuring individual respiratory chain enzyme activities usually take between 4-6 weeks to complete. If a required report is not available please contact the Histopathology office in the first instance.

Making requests

A referral form must be sent with the muscle to Newcastle.

The referral form must be completed and sent with the muscle to Newcastle, otherwise it will not be accepted. A clinical letter may also be prepared and sent to Histopathology either before or with the specimen. The letter should include details of the child’s condition and details of any available lab tests. Also include details of to whom the report should be sent.

Limb girdle muscular dystrophies

Institute of Human Genetics, Newcastle University

Institute of Human Genetics Newcastle staff

Turnaround times

The turnaround time is 6-8 weeks for routine biopsies and 2-4 weeks for urgent biopsies.

Information Pack

Referral Form

Congenital Muscular Dystrophies

Imperial College/Hammersmith Hospital London

NSCAG dispatch instructions

Referral form

Referral for fibroblasts for collagen IV

Pyruvate Dehydrogenase assays

Department of Genetics, Oxford University

The initial report will take 6-8 weeks.

Version 2

Authorised by: Pamela Ashton, Histopathology Lab Manager 

Review date: November 2013