Histology Services Overview

Written by Robert Storer.

 

Histopathology Services

Histopathology provides a fully comprehensive diagnostic histology service to Heart of England NHS Foundation Trust and its GP community. The Department is able to provide a wide range of expertise to include chest, gastrointestinal, breast, skin, renal, urological, ENT and lymph node pathology.

All histology specimens requiring routine diagnosis must be placed in an adequate volume of 10% formalin (where possible there should be 20 times the volume of formalin to the volume of the specimen). Large resection specimens must be completely immersed in formalin. Whilst tissue sampling is a clinical decision tissues of less than 1mm cubed may not survive tissue processing.

Where an urgent report is required, the urgent nature of the request should be indicated on the request form along with a contact name and telephone/bleep number.

Urgent small biopsies may be processed more rapidly provided the necessary arrangements are made directly with a senior member of staff.

Frozen sections must, where possible, be arranged 24 hours in advance by contacting the department on Ext 43188  (BHH) with details of the name of the patient, the surgeon, the time of operation, the nature of the specimen, the number of the theatre and its telephone extension. The specimen must be brought directly to the histopathology service laboratory and handed over to a senior member of the medical or biomedical staff.  The request form must include a contact telephone or bleep number.  THE SPECIMEN MUST NOT BE SENT IN FORMALIN.  If the specimen is likely to be infective (eg TB HIV) the clinician must discuss this with the consultant pathologist upon booking the frozen section.  There is a duty of care upon the person bookin the frozen section to disclose all relevant information. If the surgical procedure is delayed, please inform the laboratory.

Frozen sections for Solihull and Good Hope hospital can be performed provided that arrangements are made with the Department of histopathology 24 hours in advance. (EXT 43188)

An extensive immunohistochemistry section is available, providing prognostic and diagnostic information to pathologists and clinicians.

A molecular biology service is offered to aid in the diagnosis of lymphoproliferative disorders utilising PCR (Polymerase Chain Reaction) for IgH and TCR gene reaarangments translocation plus FISH (Fluorescence In-Situ Hybridisation) based assays including Bcl2 break apart, Bcl6 break apart, Cyclin D1 break apart, Malt1 break apart, Myc break apart and IgH break apart.

A HER2 testing service.  We perform over 2000 HER2 Immunohistochemistry and 800 FISH tests per year using FDA approved assays.  All testing is performed in accordance with National Guidelines.  We are actively involved in monitoring and auditing all aspects of the HER2 service to best meet the need of our users.  For further information please contact Dr jane Starcynski 0121 424 2705. The turnaround time for HER2 immunohistochemistry is 14 days.  Request forms are available from 0120 424 2705. Ref HER2 Service Details

Electron microscopy is available as a routine service for renal biopsies.  However, requests outside this sphere should be discussed with a Consultant a member of staff.

A Mohs diagnostic service is currently provided for the dermatology and ophthalmology departments.

The department also houses a modern autopsy suit at the Heartlands site and quiet viewing room facilities for families and friends of deceased patients at both Heartlands, Solihull and Good Hope sites.

Outside routine working hours a Consultant Pathologist can be contacted in case of emergency via the HOEFT switchboard.

Turn Around Times

Written by Robert Storer.

Turnaround times, High risk, retention and reports

The majority of urgent biopsy specimens are reported within 7 days of receipt, but Major resections, complex cases and specimens requiring special techniques will take longer.  If delays are anticipated, an interim/provisional report will be issued or the lead clinician contacted by telephone.

It is the departments aim to report 75% of inpatient cases, 80% outpatient cases and 90% of direct access cases within 10 working days.

Due to increased workload and some staff vacancies, the turnaround times are increased at present.  Please highlight any specimens that may need prioritising. 

High risk cases are left to fix for 24 hours after the date the specimen was taken, prior to cut-up.

Additional examinations on wet tissues are possible upto 28 days after a final report has been issued.  Additional examinations on the tissue blocks can be requested upto 30 years post reporting.  Microscope slide preparations of routine cases are available for examination 20 years post reporting.  HER2 FISH slide preparations are kept 12 months post reporting.  If a request has been made to freeze tissue it is kept for 10 years in liquid nitrogen.  Human DNA is kept for 30 years for familial studies in the laboratory freezer.

Pathology reports are available to medical, selected nursing and secretarial staff within the Trust via the hospital intranet.  Similar facilities are available to GP users.

NEQAS/EQA (Histopathology)

Written by Craig Webster.

Consultant Pathologists belong to the General Pathology NEQAS scheme. The following is a list of schemes subscribed to:

  • Regional Histopathology EQA
  • National Renal EQA (general)
  • National GIT EQA
  • Bowel Cancer Screening EQA
  • National Prostate Needle Core EQA
  • National Liver EQA
  • National Breast EQA
  • National Gynaecology EQA
  • National Melanoma Club EQA
  • National Lymphoma Club
  • National Thoracic Club

The laboratory also belongs to the following Technical NEQAS schemes:

  • UK Histopathology Technical NEQAS
  • UK NEQAS for Immunohistochemistry
  • UK NEQAS for Her 2 Immunohistochemistry and F.I.S.H.

Any significant technical noncompliances or EQA failures will be reported on this web site.