Tissue Sampling
Techniques – Small Biopsies & Triaging
Techniques – Small Biopsies & Triaging
Most Important Steps
• Patient
identification – Identification on the requisition must match the container(s).
This includes name. Accession number must match requisition, specimen container
and cassette.
identification – Identification on the requisition must match the container(s).
This includes name. Accession number must match requisition, specimen container
and cassette.
Receiving/Accepting
Specimens
Specimens
• If you
accept a specimen in the receiving area with incorrect information, it becomes
the laboratories problem to get it back to the sender for correction. Better to
refuse the specimen at the time of delivery.
accept a specimen in the receiving area with incorrect information, it becomes
the laboratories problem to get it back to the sender for correction. Better to
refuse the specimen at the time of delivery.
• Never
process a specimen without a patient name. Never label the container yourself
with patient name or specimen source/type.
process a specimen without a patient name. Never label the container yourself
with patient name or specimen source/type.
GROSS BENCH RULES
• Never have
more than one specimen out at a time.
more than one specimen out at a time.
• Close
containers when leaving the area.
containers when leaving the area.
• Don’t
leave small biopsies on the cutting board or on paper towels.
leave small biopsies on the cutting board or on paper towels.
• Keep
cutting area neat, clean and organized.
cutting area neat, clean and organized.
• Keep
sharps in clear view, not under toweling etc. Clear cutting area of sharps when
leaving, and disinfect the cutting board and countertop.
sharps in clear view, not under toweling etc. Clear cutting area of sharps when
leaving, and disinfect the cutting board and countertop.
• Beware of
“carry-over” from case to case
“carry-over” from case to case
Specimens can be subclassified
Depending
on utility
on utility
Diagnostics
specimen
specimen
Routines –
Small and Large
Small and Large
Dermatology
Resections
Others
Depending
on Nature of handling:
on Nature of handling:
·
Specimens only requiring transfer from container
to tissue cassette.
Specimens only requiring transfer from container
to tissue cassette.
o
All small biopsies
All small biopsies
o
Bone marrow & Aspirates.
Bone marrow & Aspirates.
o
Punch biopsies.
Punch biopsies.
o
Needle biopsies
Needle biopsies
o
Any biopsies not requiring dissection
Any biopsies not requiring dissection
·
Specimens requiring transfer, but with standard
sampling, counting, weighing or slicing.
Specimens requiring transfer, but with standard
sampling, counting, weighing or slicing.
o
Sebaceous cysts.
Sebaceous cysts.
o
Small lipomas.
Small lipomas.
o
Unremarkable tonsils.
Unremarkable tonsils.
o
Unremarkable nasal polyps.
Unremarkable nasal polyps.
o
Temporal arteries.
Temporal arteries.
o
Thyroglossal cysts.
Thyroglossal cysts.
o
Lymph nodes.
Lymph nodes.
·
Simple dissection required with sampling needing
a low level of diagnostic assessment and/or preparation.
Simple dissection required with sampling needing
a low level of diagnostic assessment and/or preparation.
o
Salivary gland – non-tumour.
Salivary gland – non-tumour.
o
Cone biopsy.
Cone biopsy.
o
Small soft tissue tumours.
Small soft tissue tumours.
o
Skin biopsies – benign – requiring dissection.
Skin biopsies – benign – requiring dissection.
o
Simple small benign biopsies.
Simple small benign biopsies.
·
Dissection and sampling required needing a
moderate level of assessment.
Dissection and sampling required needing a
moderate level of assessment.
o
Salivary gland – tumours.
Salivary gland – tumours.
o
Pigmented skin lesions.
Pigmented skin lesions.
o
Complex (non-neoplastic) gastrointestinal
resections.
Complex (non-neoplastic) gastrointestinal
resections.
·
Specimens requiring complex dissection and
sampling methods.
Specimens requiring complex dissection and
sampling methods.
o
Bone tumours.
Bone tumours.
o
Neck dissection.
Neck dissection.
o
Mandibulectomy.
Mandibulectomy.
Diagnostic
• Diagnostic
Cases: Small tissues being submitted to establish a diagnosis or monitor
status.
Cases: Small tissues being submitted to establish a diagnosis or monitor
status.
Typical features of biopsy tissues;
Small in size (minute to ~1cm)
Do not require orientation
Require counting when possible
Often are submitted in “toto”
Currettings
Currettage
specimens come as multiple tissue fragments admixed with; Blood or Blood Clot
/Mucous
specimens come as multiple tissue fragments admixed with; Blood or Blood Clot
/Mucous
Sample EMC
dictation – “Specimen consists of multiple fragments of pink/tan irregular soft
tissue admixed with mucous and blood having aggregate dimensions of _____ x
______ x _____cm which are submitted in toto in a single cassette, levels are
requested.
dictation – “Specimen consists of multiple fragments of pink/tan irregular soft
tissue admixed with mucous and blood having aggregate dimensions of _____ x
______ x _____cm which are submitted in toto in a single cassette, levels are
requested.
·
Small specimens should never be forcibly
squeezed between the ends of a forceps or the tips of the fingers. Instead,
small specimens should be gently lifted from the specimen container using the
end of a wooden applicator stick or pickups. Alternatively, small specimens can
be filtered directly into a tissue bag, avoiding instrumentation altogether.
Small specimens should never be forcibly
squeezed between the ends of a forceps or the tips of the fingers. Instead,
small specimens should be gently lifted from the specimen container using the
end of a wooden applicator stick or pickups. Alternatively, small specimens can
be filtered directly into a tissue bag, avoiding instrumentation altogether.
·
Small specimens should be quickly placed in
fixative. Ideally, most small specimens (i.e., less than 1 cm) should reach the
surgical pathology laboratory already in fixative.
Small specimens should be quickly placed in
fixative. Ideally, most small specimens (i.e., less than 1 cm) should reach the
surgical pathology laboratory already in fixative.
·
This requires that physician offices, biopsy
suites, and operating rooms be supplied with appropriate fixatives, and that
all personnel involved be instructed as to their proper use. Sometimes delays
in fixation are necessary, as when a frozen section is required or when special
tissue processing is indicated. In these instances, the tissue should be kept
damp in saline-soaked gauze.
This requires that physician offices, biopsy
suites, and operating rooms be supplied with appropriate fixatives, and that
all personnel involved be instructed as to their proper use. Sometimes delays
in fixation are necessary, as when a frozen section is required or when special
tissue processing is indicated. In these instances, the tissue should be kept
damp in saline-soaked gauze.
·
Never leave small tissue fragments exposed to
the air on the cutting table, and never place these small fragments directly on
a dry paper towel. These practices are sure to hasten tissue desiccation.
Never leave small tissue fragments exposed to
the air on the cutting table, and never place these small fragments directly on
a dry paper towel. These practices are sure to hasten tissue desiccation.
·
For extremely small specimens, the journey from
specimen container to histologic slide is a treacherous one, and they may be
lost at any point along the way. For this reason, it is a wise practice to
identify these small tissue fragments first and then mark the fragments so that
they can be found more easily by the histotechnologist.
For extremely small specimens, the journey from
specimen container to histologic slide is a treacherous one, and they may be
lost at any point along the way. For this reason, it is a wise practice to
identify these small tissue fragments first and then mark the fragments so that
they can be found more easily by the histotechnologist.
·
Before the specimen container is even opened,
check its contents for the size and number of tissue fragments, and record
these in the gross description.
Before the specimen container is even opened,
check its contents for the size and number of tissue fragments, and record
these in the gross description.
·
If no tissue is seen or if inconsistencies with
the requisition form are noted, carefully open the specimen container and
thoroughly examine its surfaces (including the undersurface of the lid) for
adherent tissue fragments. If no tissue is found or if discrepancies persist,
the submitting physician should be notified immediately, and the outcome of
this investigation should be documented in the surgical pathology report.
If no tissue is seen or if inconsistencies with
the requisition form are noted, carefully open the specimen container and
thoroughly examine its surfaces (including the undersurface of the lid) for
adherent tissue fragments. If no tissue is found or if discrepancies persist,
the submitting physician should be notified immediately, and the outcome of
this investigation should be documented in the surgical pathology report.
·
Once all of the tissue is identified in the specimen
container, efforts should be taken to ensure that it safely reaches the
histology laboratory and that it is easily identified for embedding and
sectioning. Minute tissue fragments should be wrapped in porous paper or
layered between porous foam pads before they are placed in the tissue cassette.
Once all of the tissue is identified in the specimen
container, efforts should be taken to ensure that it safely reaches the
histology laboratory and that it is easily identified for embedding and
sectioning. Minute tissue fragments should be wrapped in porous paper or
layered between porous foam pads before they are placed in the tissue cassette.
·
Before these fragments are submitted to the histology laboratory, they can be
marked with eosin or mercurochrome so that they are easier for the
histotechnologist to see.
Before these fragments are submitted to the histology laboratory, they can be
marked with eosin or mercurochrome so that they are easier for the
histotechnologist to see.