| Common Guidelines : |
| 1) |
The biopsy / FNAandclinical impression must be mentioned on the request form. |
| 2) |
Request forms with 'FNA/ biopsy of retroperitoneal mass/ abdominal mass' are not informative if the exact location is not mentioned. |
| 3) |
In case of lymph nodes, the location of the node (especially in the neck) is needed. |
| 4) |
All specimen containers (or envelopes in case of slides/blocks) must be labeled with the following details at least: patient's full name, age, sex, medical records number and doctor's name. |
| |
| Cytology/ FNA : |
| 1) |
As far as possible, both fixed and airdried smears of FNA must be sent. This is because if the aspirate is highly contaminated with blood, air- dried smearsstainpoorly and make interpretation difficult. |
| 2) |
For procedures done elsewhere, the
smears may be put in a fixative,
removed after 5minutes, fixative
evaporated and then put in paper/ box,
labelled as 'fixed' by diamond
marker pencil and sent. |
| 3) |
The slides should be fixed immediately
after smearing to avoid drying
artifacts. |
| 4) |
For air-dried smears, the smears must
dry before being wrapped in paper. |
| 5) |
Crush preparations of core biopsies
must not be made. A touch imprint of
the biopsy may be made and the core
tissue itself must be sent for processing. |
| 6) |
For fluids (peritoneal/ pleural/
pericardial etc) being sent for cytology
from an outside hospital/lab, the fluid
must be allowed to stand for an hour.
After decanting the supernatant,
smears can be made from the
sediment. If adequate sediment is
obtained, formalin must be added and
specimen sent to the lab (for cell block
preparation). |
| |
| Surgical Specimens |
| 1) |
It is anticipated that lesions will be
resected according to a defined surgical
protocol. If the surgical resection differs
from the protocol, eg if dissection does
not extend to the deep fascia or skin
when this is the norm (eq. skin sparing
mastectomy or modified radical neck
dissection), this should be clearly
indicated on the request form. |
| 2) |
The surgeon should orientate the
resec t ion spec imens . A code of
orientation can be established using either different lengths of suture or
metal staples/clips or ink. The code
should be anatomically relevant and
assist in accurate evaluation of the
specimen and its margins. |
| 3) |
If more than one piece of tissue is
removed; it should be made clear how
the samples are orientated with respect
to each other in order to simplify
assessment of the size of the lesion and
distance to margins. |
| 4) |
Wherever relevant, the radiology
findings must be mentioned on the
pathology test request form. This will
facilitate diagnosis. |
| 5) |
The specimen should be sent to the
laboratory as soon as possible. If this is
not possible, it should be immediately
placed in a fixative (buffered formalin is
recommended) whose volume is at least
twice that of the specimen size. In the
latter circumstance, and by arrangement
with the pathologist, the surgeon must
make controlled incision/s into the
lesion, thus preserving the integrity of
key margins while allowing immediate
penetration of fixative. The incision
should be made from the posterior
aspect or from the skin inwards. Hollow
viscera must be cut open and then
incision/s made in the lesion. In general,
the benefits of rapid fixation (good
morphological conservation with preservation of mitotic figures and
retention of proteins such as the ER/PR
in breast cancer) outweigh the desire to
preserve the specimen intact before
examination by the pathologist
preservation of mitotic figures and
retention of proteins such as the ER/PR
in breast cancer) outweigh the desire to
preserve the specimen intact before
examination by the pathologist |
| 6) |
For samples being sent from outside laboratories,
Small biopsies may be put in a small bottle
containing formalin.
Quantity of formalin added to preserve
the tissue specimen in transit, must be
just enough to cover the tissue biopsy.
For larger specimens, it is recommended
that after initial fixation, the specimen is
wrapped in formalin soaked cotton and
placed in a strong plastic bag with
identifying label.
The bottle or vacutainer must be
recapped/ plastic bag should be sealed
tightly and additionally fortified by
brown tape.
The bottle/ vacutainer/ plastic bag must
then be packed in a corrugated
cardboard box along with the request
form and couriered to the laboratory.
If slides and blocks are being sent, these
should be placed in cardboard slide
boxes. Please place slide box in cloth
lined envelope. |
| 7) |
If specimen is a whole lymph node
excision biopsy (specially for the
diagnosis of lymphoma), it must be
bisected using a sharp knife / scalpel and
put it into formalin immediately, for
good / optimal fixation for routine
reporting and Immunohistochemistry.
Small node less than 1 cm need not be
bisected. |
