Tissue Sampling
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.
• 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.
• Never
process a specimen without a patient name. Never label the container yourself
with patient name or specimen source/type.

• Never have
more than one specimen out at a time.
• Close
containers when leaving the area.
• Don’t
leave small biopsies on the cutting board or on paper towels.
• Keep
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.
• Beware of
“carry-over” from case to case
Specimens can be subclassified
on utility
Routines –
Small and Large
on Nature of handling:
Specimens only requiring transfer from container
to tissue cassette.
All small biopsies
Bone marrow & Aspirates.
Punch biopsies.
Needle biopsies
Any biopsies not requiring dissection
Specimens requiring transfer, but with standard
sampling, counting, weighing or slicing.
Sebaceous cysts.
Small lipomas.
Unremarkable tonsils.
Unremarkable nasal polyps.
Temporal arteries.
Thyroglossal cysts.
Lymph nodes.
Simple dissection required with sampling needing
a low level of diagnostic assessment and/or preparation.
Salivary gland – non-tumour.
Cone biopsy.
Small soft tissue tumours.
Skin biopsies – benign – requiring dissection.
Simple small benign biopsies.
Dissection and sampling required needing a
moderate level of assessment.
Salivary gland – tumours.
Pigmented skin lesions.
Complex (non-neoplastic) gastrointestinal
Specimens requiring complex dissection and
sampling methods.
Bone tumours.
Neck dissection.
• Diagnostic
Cases: Small tissues being submitted to establish a diagnosis or monitor
Typical features of biopsy tissues;
Small in size (minute to ~1cm)
Do not require orientation
Require counting when possible
Often are submitted in “toto”
specimens come as multiple tissue fragments admixed with; Blood or Blood Clot
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
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.
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.
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.
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.

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. 


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