Histopathology Service

Pathology

Location of the Laboratory
Histopathology is located on the 3rd Floor CSSB which is situated on Vernon Street.

Address:
Department of Cellular Pathology
Liverpool Clinical Laboratories
Royal Liverpool University Hospital NHS Trust
Liverpool, L7 8YE

Opening Hours
Laboratory Hours:7am – 7pm Monday to Friday 8am - 4pm Saturday

Histology Specimen Reception: 7am - 7pm Monday to Friday 8am - 4pm Saturday and Sunday

Out of Hours - Deliver to main Specimen Reception

Bank Holidays: 8am - 4pm

Histology Office Hours: 9am – 5pm Monday to Friday

Forensic Pathology Office Hours: 9:30 – 5pm Monday to Friday

Histopathology Service
Overview of Histopathology

Histopathology is the study of microscopic changes or abnormalities in tissues that are caused as a result of diseases. There are a number of processes involved to produce a stained tissue section that can be examined under the microscope.

Flow chart of process

Request Forms

Where possible the preferred request form is an ICE format

Instructions for completion of request forms and criteria for accepting and rejecting samples

The Minimum Data Set Policy applies to all users in the requisition, collection and reception of patient samples processed and analysed by Cellular Pathology, Liverpool Clinical Laboratories.

Aims
The aims of the policy are;

To ensure that results of Pathology tests are assigned to the correct patient.

To reduce the number of repeat samples required due to mislabelling or inadequate information.

To ensure laboratory and clinical personnel have accurate clinical and sampling information for result interpretation.

To ensure that results (electronic and paper) are received at the correct location.

To comply with the Data Protection Act 1998 with respect to accuracy of patient data and confidentiality.

To enable activity data to be credited to the right consultant/clinical team.

To support Laboratory staff when the decision to reject samples has to be made.

To view the full document click here.

Common reasons for rejecting/delaying sample processing or result being issued due to request form errors;

No clinician signature

Not all specimens received listed on form

Illegible ward/department

Use of abbreviations for Consultant/Clinician, please use; forename and surname to assist us when we are booking specimens onto our system

Please ensure that the information provided is accurate and legible

NOTE: Specimens arising from patients with known or transmissible diseases e.g. TB, hepatitis, HIV must be clearly indicated on the form and labelled as such using the appropriate danger of infection stickers. This is important to ensure the safety of the laboratory staff handling the samples.

Request forms are available on request from Oracle E-Procurement on Staff Intranet, order code WVG014.

Patient Consent

The laboratory complies with the Trusts Consent Policy which can be accessed via the link

The removal, use and disposal of human organs and tissue processes are regulated by the Human Tissue Authority (HTA). The department is compliant with the Codes of Practice covering consent, the removal, uses, storage and disposal of human material, available via the Human Tissue Authority’s website.

For information on the use of patient samples in research, education and training please refer to the Trust’s Research and Development’s Standard Operating Procedure (SOP) or contact the Research and Development manager for advice.

Preparation of the Patient

There are no special requirements for patient preparation for the collection of histopathology samples.

Patient collected Samples

There are no patient collected samples taken for histopathology

Transportation of Samples

Special handling Instructions – All service users should be aware of the Health and Safety requirements regarding the use of chemical fixatives. The most common fixative used for Histology specimens is 10% neutral buffered formalin. Ensure that all lids are securely fastened to avoid leakage and the request form is packaged separately from the sample.
Blue transport bags with a yellow flash on the directions are also used to indicate delivery to Cellular Pathology/Histology

Routine Samples

Royal Liverpool Hospital: should be transported via the hospital porters to central specimen reception on the 3rd Floor CSSB.

Broadgreen Hospital: should be transported via the couriers using YELLOW appropriate UN3373 compliant transport carriers brought directly to Histology Specimen Reception 3rd Floor CSSB.

Courier pick up times are: 8:30 and 3:30

Liverpool Women’s Hospital: should be transported via the couriers using YELLOW appropriate UN3373 compliant transport carriers delivered to central specimen reception on the 3rd Floor CSSB.

Courier pick up times are: 9:30, 10:30, 12:00, 13:30, 14:30, 15:45, 16:50

Aintree Hospital:should be placed in a PURPLE UN3373 compliant transport carrier and taken to central specimen reception where they will be transported by courier to the laboratory. Ad hoc samples can be delivered to central specimen reception where staff will add them to a transport carrier.

Courier pick-up times are: 9.30 10.30 12.30 13.30 14.30 15.30 16.30

**N.B. Do not use the courier service for frozen sections or renal biopsies. See Specialised Samples**

Specialised Samples

Frozen Sections

Must be pre-booked (see below) and the laboratory should be notified on 0151 706 4500/4501 when sample is in transit.

The sample sender must organise and manage the courier for the transit of the sample to the laboratory. It is the responsibility of the Users of the service to ensure that the sample has reached Histopathology for assessment.

If there is delay to, or cancellation of a frozen section request, it is the responsibility of the sample sender to notify the laboratory and Consultant Pathologist.

Frozen section will be accepted between 09:00 and 16:30 only. Any request for frozen section outside these times must be discussed and agreed with the appropriate Consultant Pathologist before sending to the laboratory.

Samples must be handed by the porter/courier directly to a member of laboratory staff within the Histology laboratory. The samples must not be left in Specimen Reception.

To book a frozen section:

Royal Site: Contact 0151 706 4500/4501 to book frozen. We will require the following information;

Patient's Full Name

Hospital Number/NHS Number

Type of tissue

Theatre Location and Contact Number

Time and Date of procedure

Samples must be delivered to the department by a hospital porter immediately after collection.

Aintree Site: Contact 0151 706 4501 to book frozen, information we will require includes;

Patient's Full Name

Hospital Number/NHS Number

Type of tissue

Theatre Location and Contact Number

Time and Date of procedure

Samples to be transported via the blood bike couriers following the agreed SOP.

Liverpool Heart and Chest: Contact 0151 706 4500/4501 to book frozen, information we will require includes;

Patient's Full Name

Hospital Number/NHS Number

Type of tissue

Theatre Location and Contact Number

Time and Date of procedure

Samples to be transported to the department by a theatre porter via taxi following the agreed SOP.

**Frozen sections will not be performed on specimens originating from patients with known transmissible diseases e.g. TB, hepatitis, HIV, to minimise the risk of infection to laboratory staff **

Renal Biopsies

Must be pre-booked by contacting the laboratory on 0151 706 4500/4501. Please also notify the department when the biopsy is in transit.

If a result is required same day the biopsy should reach the department by 1pm and the Renal Pathologist must be contacted (see contact list or call ext. 4483/4501) to confirm whether we can provide this service.

We do provide an out of hour’s service for clinically urgent samples. This must be confirmed with the Renal Pathologist.

Samples must be handed directly to a member of laboratory staff within Histology they must not be left in Specimen Reception.

Royal Site: Renal biopsies must be placed into 10% neutral buffered formalin, use pre-filled formalin biopsy pot. Samples are transported to the department via hospital porters.

Aintree Site: Renal biopsies must be placed into 10% neutral buffered formalin, use pre-filled formalin biopsy pot. Samples should be transported via taxi or blood bike couriers following the agreed SOP.

Referred Samples

All referred samples should be correctly packaged and postal regulations must be adhered to. It is good practice to include a fax back sheet and to notify the laboratory in advance when sending referred samples.

Blocks and Slides

Securely wrap wax blocks and place slides in a suitable container, place into a padded envelope to prevent damage during transport. Address to the relevant Consultant Pathologist or Department required.

Specimens for Cytogenetic Testing

Send to the department in a sterile container dry (NO FIXATIVE) or in Cytogenetics transport medium (pink fluid) supplied by the Cytogenetics Laboratory located at Liverpool Women’s Hospital. A Cytogenetics request form must be completed.

HODS Wet Specimens

Place formalin pot containing sample into suitable transport packaging, ensure that request form is also included.

Protection of Personal Information

The department is compliant with all Trust policies and legislations such as the Data Protection Act and Caldicott Guidelines. Staff training in Information Governance is completed on an annual basis.

In order to remain compliant when completing request forms, service users are asked to ensure that the data is accurate, up-to date and legible. Please avoid the use of abbreviations where possible and use full names for Consultants/Clinicians and locations to ensure that the report is issued to the correct person at the correct location.

Turnaround Times

Currently we aim to provide 70% of all reports (excluding the Haematological Diagnostic Service, specimens requiring decalcification, genetics or molecular testing) within 10 calendar days from collection. Frozen section reports are provided on the day .

HODS samples have an agreed turnaround of 14 calendar days for clinically urgent and 21 calendar days for routine from date of receipt in laboratory

This time-period can be shortened when there are urgent clinical decisions to be made. Urgent reports are available by telephone or fax, if requested. Diagnoses are usually made on sections stained by routine techniques, but not infrequently cases require more sophisticated and extensive studies. The Department can offer a wide range of immunohistochemical methods, electron microscopy and molecular testing which are mainly used for the identification of neoplasms.

Current turnaround times, Laboratory Accreditation status, EQA participation and performance details are kept by Quality Practitioner, Jane Harrison-Williams. These may be obtained on request.

Urgent Requests and Clinical Advice

Please indicate on request forms if a report is required urgently, when the report is required, and details of a medic to contact.

Consultant pathologists are available between 8am – 5:30pm Monday to Friday for clinical advice on ordering examinations and on interpretation of examination results. Contact 0151 706 4483

Histopathology Examinations

Test	Sample container and volumes	Special Precautions
Biopsies	10% Neutral buffered formalin. Pre-filled formalin pots 40mls. Where possible use Activflow mini cassettes. Bouins fixative for testicular biopsies	Please ensure that when closing mini cassettes that you do not press down on the biopsy sample as this will cause a crush artefact. Do not allow tissue to dry out before placing in fixative.
Tissues	10% Neutral buffered formalin. Various size buckets are available. Users must ensure that a sufficient volume of fixative is used for each sample, approx. 10 times.	Do not allow tissue to dry out before placing in fixative.
Resections	10% Neutral buffered formalin Various size buckets are available. Users must ensure that a sufficient volume of fixative is used for each sample, approx. 10 times.	Do not allow tissue to dry out before placing in fixative.
Renal	10% Neutral buffered formalin. Pre-filled formalin pots 40mls.	Do not allow tissue to dry out.
HODS - BMT	10% Neutral buffered formalin. Pre-filled formalin pots 40mls.	Do not allow tissue to dry out before placing in fixative.
Frozen section	Fresh unfixed tissue*	Do not allow tissue to dry out.
IMF	Saline or Michel’s transport medium	Do not allow tissue to dry out.

*Frozen section will not be performed on specimens arising from patients with known or transmissible diseases e.g. TB, hepatitis, HIV

N.B: Biological Reference Intervals and Clinical Decision Values are Not Applicable

Routine histopathology

Histopathology involves taking patient tissue samples and processing them to obtain thin sections that can be stained and viewed using a microscope. The preferred method of processing is production of a paraffin wax block which allows the laboratory staff to produce multiple thin sections using a microtome to do a variety of stains that can identify diseases such as cancer, inflammation and infection.

Frozen Section

Frozen section is a rapid intra-operative procedure, the surgeon will send a piece of tissue to the laboratory, and this is snap frozen so a thin section can be obtained using a cryostat. Staining the section allows the Pathologist to view using a microscope and confirm tissue type e.g. parathyroid or presence of a tumour.

Immunofluorescence (IMF)

IMF is a staining technique carried out by the Immunocytochemistry department. Samples must be received unfixed as the fixation process masks the autoimmune antibodies which we are trying to demonstrate.

Factors affecting the performance of examination or interpretation of results

Factor	Impact	Possible Cause	Solution
Crush artefact	Distortion of the cells	Specimen is damaged during removal	Tissue should be excised gently avoiding trauma caused by crushing or tearing
Drying artefact	Cells appear dehydrated and shrunken	Specimen is left to dry out prior to fixation Sample placed on absorbent material prior to fixation	Samples should be placed in fixative immediately after removal
Heat damage	Tissue margins become distorted and cells are damaged	Use of cauterisation during removal	As far as possible avoid heat during removal
Chemical damage	Inadequately fixed samples	Use of out of date fixatives	Always check the expiration date before use
Inadequate volume of fixative	Degradation of the area of specimen not submerged in fixative	Formalin stores low Inappropriate size of container used	Contact relevant supplier for formalin delivery, either the lab or pharmacy department Contact the lab to inform them that a specimen needs more formalin adding to pot and write this on the request form Ensure that the container allows for 10x volume of fixative to be added to fully submerge the specimen
Inadequate fixation	Cell degradation, nuclear detail not preserved	Formalin fixation slows down when refrigerated Biopsy/specimen stuck in lid of container	Please store formalin pots and samples within them at room temperature Ensure that biopsy/specimen is fully submerged in fixative
Delay in transportation of fresh unfixed samples	Degradation of the specimen Unable to perform certain tests due to delay in preservation	Samples being held waiting for porter or transport e.g. frozen and renal	Ensure prompt delivery to laboratory after sample taken Ensure correct sample container and instructions for transport followed

Complaints and Compliments Procedure

We aim to provide a first class service for our users at all times however we know that mistakes will be made from time to time. We have procedures and policies in place to limit any incidences and we encourage you to inform us in these instances so we can correct and use your comments to improve our service.

Complaints

Complaints can either be made verbally or formally in writing. If you wish to raise a concern or complaint regarding the service, please contact any of the following;

Cellular Pathology Clinical Director Dr Vijay Sharma via email vijay.sharma@LiverpoolFT.nhs.uk

Ceullular Pathology Service Manager Mr James Wingfield via email james.wingfield@LiverpoolFT.nhs.uk

Histopathology Laboratory Manager Georgio Bristol via email georgio.bristol@LiverpoolFT.nhs.uk or via telephone on 0151 706 4677

Quality Practitioner Jane Harrison-Williams via email jane.harrison-williams@LiverpoolFT.nhs.uk or via telephone on 0151 706 11093

Compliments

Our staff work hard to deliver a first class service to our users and the receiving compliments about our work is positive and rewarding. If you feel we have delivered an outstanding service please send your compliments to the contacts listed above.

Referrals

INVESTIGATION	REFERRAL LABORATORY	ADDRESS
Electron Microscopy	Cellular Pathology (EM Unit)	c/o Linn Tindale Cellular Pathology (EM Unit) Level 3 New Victoria Wing Royal Victoria Infirmary Queen Victoria Road Newcastle-Upon-Tyne NE1 4LP
Histology Outsourcing	LDPath	Nathan Field - Account manager (LD Path) 6 St John's Place Farringdon London EC1M 4NP nhs@ldpath Tel: 0207 336 0921
Cytogenetics	Cytogenetics Liverpool Women’s Hospital	Cytogenetics Liverpool Women’s Hospital Crown Street Liverpool L8 7SS
Histology Cases for 2nd Opinion	Various Laboratories	Please contact the Histology Office on 0151 706 4483 for more information