The Role Of Histopathology Specimens?

Histopathology specimens are a vital cornerstone of inpatient care. They not only establish a tissue diagnosis but are crucial in clinical management decisions and provide important prognostic data. They are nodal events in a patient’s illness shaping the choice of relevant medical and surgical therapies and determining follow-up strategy.

The Role Of Histopathology Specimens

The data they provide is used to assess the efficiency of current and new investigation and treatment regimes and to monitor the impact of population screening programs. Clinical governance has recognized its key role in auditing not only individual clinicians but also the patterns and quality of overall health care provision.

Biomedical research with advances in investigations and therapy would flounder without them. They are therefore a precious resource to be handled with great care by sufficient numbers of appropriately trained and experienced personnel. The data generated are of confidential nature privacy to the patient, consultant clinician or general practitioner, and the reporting pathologist.

This information may be shared as appropriate with other directly involved health care professionals, for example, in the context of multidisciplinary team meetings, but laboratory practice (e.g., telephoned results and report authorization) must be geared to protect patient confidentiality at all times.

The patient not only has a right to see and have explained the information in his/her specimen but must undergo a process of informed consent prior to the clinical procedure. Thus the nature, purpose, extent, and side effects of the procedure are explained in understandable terms.

This process extends to the laboratory as patients can express their wish for disposal and use of the tissue not only for diagnosis but also for educative, audit, and research purposes. Additionally, research projects should be verified by an appropriate research ethics committee. Patient denial of any of these uses must then be communicated to the laboratory and incorporated into the handling and disposal procedures.

The histopathology specimen report forms a permanent part of the patient’s medical record and as such may be used as medico-legal evidence in negligence and compensation cases. These various factors serve to emphasize the importance of the care that should be taken with these specimens by histopathology laboratory personnel.

The Handling Of Histopathology Specimens?

Specimen transportation, accession, clinical prioritization, dissection, audit, and reporting are considered.

Specimen Transportation

There must be a close liaison between pathology and clinical staff to ensure appropriate transportation of specimens between the outpatient department, operating theatre, and the laboratory, for example, prompt transport of fresh specimens or the provision of special fixatives. This must be reflected in shared protocols, a user information manual, and education of the clinical and portering staff.

Specimen Accession

Allocation of a unique laboratory number and accurate computer registration of patient details are fundamental to the maintenance of a meaningful and practicable histopathology database. This is important not only to the individual patient care (e.g., a sequence of biopsies) but also for the provision of statistics, for example, download to cancer registries.

Specimen Prioritisation

With the ever-increasing workload and limited staffing resources, pathologists may find it necessary to put in place a specimen pull-through protocol related to the clinical need to ensure that diagnostic results are available within an appropriate time frame. This can be based on various criteria such as specimen type and request form information (Appendix A).

Suggested overall turnaround times for histopathology specimens are 80% and 90% of cases reported within 7 and 10 working days, respectively, subject to individual case needs and in agreement with local clinical teams.

Specimen Dissection

Traditionally the role of a medical pathologist specimen dissection is now also being performed by an increasing number of biomedical scientists (BMSs) as has been the situation for several decades in some laboratories in America (Pathologist Assistants) and the UK. BMSs, trainees, and consultant pathologists are all appropriate to the task provided that several principles are adhered to:

• The histopathology specimen and its report remain the overall responsibility of the reporting consultant pathologist.

• here is close proximity and ready availability of active consultant pathologist supervision before, during, and after handling of the specimen.

Specimen Dissection Audit

The quality of specimen dissection must be meaningfully monitored, and the majority of this is done actively at the laboratory bench by the consultant pathologist/BMS supervisor team as part of the specimen dissection pre-/peri-/post-view and reporting feedback procedures. In addition, this team should carry out formal periodic audits and assessments of dissectors’ skills.

This combination of approaches forms the basis for an individual dissector’s continued practice and progression between specimen categories (see Appendix D). It also identifies the areas of subspecialist expertise or in need of further training.

It must be recognized that category progression cannot be proscribed by rigid time frames but rather related to the aptitude of the individual dissector and the spectrum of workload that is encountered.

Specimen Reporting

Histopathology specimen reports remain the responsibility of an appropriately trained and experienced medical pathologist. Increasingly Royal College of Pathologists Cancer Datasets is mandating key audit data to assess the standards of specimen dissection and reporting, for example, colorectal cancer mean lymph node harvest and the reported percentages of serosal and extramural vascular involvement by tumor.

Other key service quality indicators include pathologist participation in relevant interpretive histopathology external quality assurance (EQA) schemes and appropriate continuing professional development (CPD) activity. These issues are discussed at the annual appraisal and are foundational to medical revalidation.