Histology

Please note the request forms are titled as 'Pathology Laboratory Departments of Histology & Cytology' and should be completed for either Histology or Non-Cytological test requests.

Provision of 'Histology & Cytology' request forms

The ordering of 'Histology & Cytology' request forms is dependent on where the source department, ward or clinic is located. 

• For Staffordshire based users, request forms and specimen bags can be requested from UHNM Procurement and Supplies department (contact x72672).
• For Cheshire based users, request forms and specimen bags can be requested from MCHFT Pathology Reception team at pathology.reception@mcht.nhs.uk. 

It is imperative when sending any Histology or Non-Gynaecological specimen to the UHNM Histology laboratory that it should be accompanied by the correct and complete 'Histology & Cytology'  request form.  All sections of the request form should be completed as shown on the provided example (see below). Failure to do so WILL result in rejection and the returning of the specimen and request cared to the requesting Clinic, Ward or GP practice for amendment and return. 

If other pathological tests are required alongside a Histology or Non-Gynaecological specimen, separate specimens and separate request forms MUST be submitted as the specimen(s) will be dealt with in different laboratories which are in different locations. These samples cannot be shared.

The minimum data set for completion of the 'Histology & Cytology' request cards and specimen pots must be followed. This can be found in UHNM Policy Number C49 – ‘Policy for Requesting Patient Investigations and Referrals and the Reporting and Interpretation of Results’. 

All 'Histology & Cytology' request forms MUST have the NHS number noted on the form. It is vital that request forms are correctly completed and more importantly, legible. 'Clinical details' are a vital part of the Histology request and integral to aiding in a diagnosis.

In addition;

• For colonoscopy biopsy cases please also ensure that a copy of the Colonoscopy Report is attached to the request form. Reports may be delayed if notes have to be retrieved by pathologists in cases where clinical information provided on the requests card is deficient.

• For Products of Conception (POC / RPOC) please ensure an appropriately completed and legible 'Histological Investigation Consent Form' is attached to the request form.

Please ensure the resection or main specimen is labelled as “A” on the request card and representative specimen pot/container. The proceeding specimens should then be labelled as ‘B’, ‘C’, ‘D’ etc.

Please do add any further 'relevant' information to the request form where required, including the following examples;

• Information regarding danger of infection status if known or suspected.
• Radioactive specimen.
• Note if the patient is on a 'cancer pathway'.
• Note 'breach dates' for MDT if applicable.

The UHNM Histology laboratory runs a very strict zero tolerance approach to ALL Histology requests. Specimens WILL be returned if the correct format is not followed and appropriate information is not provided. This zero tolerance approach is designed to ensure the correct and accurate receipt of specimens and request cards, to sufficiently fulfil the laboratory requirements for safe and reliable testing and result provision. 

Failure to follow this procedure will result in delayed testing and ultimately delayed receipt of the final report and results. 

To ensure your 'Histology & Cytology' request card is accurately filled out, please study and follow the template/s and example provided over page. The example test required is in blue text.

All patient and requestor details shown in red must be completed and correct to ensure acceptance.

Please ensure the name of the consultant is shown in the consultant field and not the requesting clinician. This will also cause rejection of the specimen.

Provision of specimen containers and 10% Neutral Buffered formalin

• For Royal Stoke Hospital users, these can be requested from the UHNM Pathology Stores team on PathLabStores@uhnm.nhs.uk or extension 72672.

• For County Hospital users, these can be requested from the County Pathology Specimen Reception team on extension 4733.

• For ECT and MCHFT 'general surgical' users, these can be requested from the MCHFT Pathology Reception team on pathology.reception@mcht.nhs.uk.              PLEASE NOTE: ECT and MCHFT Labour Ward's will be able to collect pre-filled 10% Neutral Buffered Formalin pots via the on-site Mortuaries. Please ensure that you request your supplies in plenty of time. The pots will need to be collected from the relevant mortuary when they are ready.

• For ECT and MCHFT Mortuaries, orders for '10% Neutral Buffered Formalin Bag in a box' and empty pots please contact MCHFT Pathology Stores on pathology.reception@mcht.nhs.uk.

Specimens for ‘routine’ Histology processing and reporting at UHNM must be submitted to the laboratory in 10% Neutral Buffered Formalin.

Specimens for 'routine' Cytology processing and reporting at UHNM must be submitted to the laboratory either fresh or in the appropriate preservative - please see section below titled 'Non-Gynaecological Cytology'.

Histology and cytology specimens should be collected and handled with care. If fresh or small specimens such as endoscopic biopsies, punch biopsies, small skin biopsies etc. are crushed, contaminated or allowed to dry out, an accurate histological or cytological diagnosis may not be possible. This may also lead to a degree of uncertainty of measurements within the result being provided. It is the responsibility of the users to safely dispose of all materials used in the collection of specimens and these must not be transferred alongside the specimen.

‘Fixation’ of specimens in 10% Neutral Buffered Formalin is the crucial first step in the histology process and should not be delayed.

If a specimen is to be sent to the Histology laboratory dry (i.e. with no formalin) please read the ‘Histology specimens sent 'dry'' in the FAQ section. Please note that there should not be any reason for the County, ECT or MCHFT users to send any specimens dry to The Royal Stoke Histology laboratory.

1. Specimens should have a correctly filled out histology or non-gynaecological patient specimen label attached to the side of the specimen container - not the lid. 
2. Specimens must be submitted to the laboratory in an appropriate sealed specimen bag.
3. Please ensure that the lids of specimen containers are properly secured to avoid leakage of fluids, formalin and loss of sample/s.

We strongly advise that a check of details on the request forms and specimens be made before specimens are bagged for dispatch to the UHNM Histology laboratory.

Any unacceptable transcription errors found on receipt (as noted under ‘zero tolerance’ in the above section) will give cause to the specimen being returned to the source. This will cause a delay in the report turnaround time for the specimen which may cause it to breach its target turnaround time.

If there is any known infection risk with the specimen e.g. HIV, Hepatitis and TB this should be clearly written on the request card.

Specimens being sourced at The Royal Stoke for reporting at the Royal Stoke Hospital must be sent directly to The Royal Stoke Hospital Histology department for processing and reporting using internal portering services.

Specimens being sourced at County Hospital for reporting at The Royal Stoke Hospital must be sent directly to the County Hospital specimen reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at ECT for reporting at The Royal Stoke Hospital must be sent directly to the Macclesfield Hospital specimen reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at MCHFT for reporting at The Royal Stoke Hospital must be sent directly to the Leighton Hospital specimen reception whereby they will then be transported to The Royal Stoke Hospital Histology department for processing and reporting.

Specimens being sourced at GP surgeries for reporting at The Royal Stoke Hospital must be sent directly to The Royal Stoke Hospital using either UHNM transport couriers or City Sprint (dependant on where you are sited). 

All specimens are collected at intervals during the working day Monday to Friday and 3 times per day at weekends.

Please note due to the schedules in place for these collections, we have aimed to optimise the specimen collection times in order to maintain Histology turnaround times. We heavily discourage any batching of samples as if samples are batched then this will cause delays in turnaround times of the reports.

Biological spillages

For any biological sample spillages please refer to your own local spillage procedures. 

10% Neutral Buffered Formalin spillages

Our histological fixative is a 4% solution of Formaldehyde in water and ethanol and users will see these containers labelled with ‘10% Neutral Buffered Formalin’.  Formaldehyde at this concentration is classified under COSHH regulations as harmful. It is sensible to avoid all contact with skin and inhaling fumes.  Repeated exposure to Formaldehyde can lead to sensitisation and may cause an allergic reaction. Formaldehyde is now classified and it is noted that it ‘may cause cancer’.

Please note below the main ‘hazard warnings’ and ‘label elements’ for 10% Neutral Buffered Formalin.

Please also note the attached leaflets for further advice.

• Material Safety Data Sheet for Neutral Buffered Formalin
• Policy to Control Substances Hazardous to Health (COSHH)

Spillage advice      

In the event of a small spillage ventilate the area, put on gloves and apron and dilute the spill with water and mop up the fluid with tissue paper.  Put the tissue into a polythene bag and seal it and then double bag.  This can be disposed of into normal waste.  Keep the area ventilated until the spillage site is dry.

In the event of a large spillage of formalin, warn others to keep away from the area.  Ventilate the area well; wear a respirator if necessary along with other protective clothing. Use spillage absorption granules to soak up the spillage (special formalin neutralising granules are available).  Collect up the granules and double bag them and wash the area well with water and then mop this up.  Used spillage granules should be incinerated with clinical waste. Keep the area well ventilated until the spill area is dry.

If a spillage occurs in a public area or in a theatre, the spillage response team should be alerted. The team have been trained to deal with spillages of formalin.

With any Formalin spillage, please complete your local incident report form (i.e. IR1, Datix, etc.).

All histology reports, once authorised are available immediately in electronic form via local reporting systems such as EPR, ICE, GP desktops etc. (dependant on the site you are working at). Hard copies of all reports are issued for insertion into the patients notes. It is the responsibility of the user to perform this action.

The ‘Turn Around Time’ (TAT) that can be expected by users (from receipt of specimen to a report being available electronically is as follows.

The departments aim is to report 80% of all Histology and Non Gynae cases received within 10 calendar days. There will be however, times during which this turnaround time may not be achieved due to fluctuations in demand to capacity ratio within the department. If a report is required by a certain day/time this information must be stated on the request form.

For the most recent and up to date turnaround times, please refer to the 'Histopathology Position Statement' which is distributed to all UHNM Histopathology users or the UHNM intranet (Histopathology Position Statement | University Hospitals of North Midlands NHS Trust).

Inevitably there will also be some cases, particularly complex cases, cases requiring prolonged decalcification or cases requiring tertiary referral will take longer.

For those cases which are referred out to an accredited external NHS Trust, external reporting body or specialist testing site, there may be an increased turnaround time seen and this can be between 2 and 8 weeks dependant on the reason for the referral and complexity of the case. If these delays do occur, this will be nominated to the originating clinicians via the Histology report. The report will state that ‘a supplementary report will be issued’.

We do have contingency plans in place for major failures such as equipment failures, staffing capacity failures, utilities failures, etc. If any of these contingency plans have to be put into place, we will communicate this to our users through electronic interfaces in order to inform the user of the issue, effect on specimen turnaround time and the action plan.

The UHNM Histology management team can provide on request, more speciality based turnaround time data if required by the user.

The diagram below shows the multi-step process involved in Histopathology;

Further Information

For clinical information on a specific case or report callers should speak to a Consultant Histopathologist. Please phone UHNM Histology Office on 01782 674288 or internal extension 74288 and a secretary will put you through to the correct Consultant Histopathologist.

For enquires of a technical nature callers should contact the UHNM Histology laboratory on 01782 674932 or internal extension 74932 Stoke Hospital Histology laboratory.

The Royal Stoke Mortuary and County Body Store’s opening hours are 08:00 to 16:00 Monday to Friday.

On Saturday’s and Sunday’s the mortuaries are not manned but can be accessed by non-Mortuary approved UHNM personnel for delivery of a deceased.

The Mortuary staff take part in an on-call system whereby they will attend at weekends and out of hours if requested. The on-call Mortuary personnel can also be contacted for urgent information as required. These on-call Mortuary staff can be contacted via phone via The Royal Stoke Hospital switchboard for clinical advice in emergencies only.

Coroners Post Mortems

The following deaths should always be reported to Her Majesty’s Coroner.

1. Deaths from unknown causes.
2. All cases seen only after death.
3. Deaths occurring within 24 hours of anaesthetic or operative/investigative procedure.
4. All deaths which occur within 24 hours of admission to hospital.
5. All violent or unnatural deaths related to:
   • Poisoning or drug mishap (recreational/therapeutic).  This includes alcohol related death.
   • Criminal abortions
   • Assault or accident – irrespective of time interval between the event and death.
   • Want, exposure or neglect.
   • Industrial disease e.g. pneumoconiosis, mesothelioma
   • Inmates of prisons.  
   • Any known suggestion of allegations of neglect or malpractice against hospital medical or nursing staff.
   • Suicide.
6. Deaths in custody or shortly after release.

The reporting clinician should fill in a “Clinical summary for cases referred to the Coroner” form prior to discussing the case with the coroner.

If the case is accepted by HM Coroner then this form together the clinical notes, and any x-rays should be sent directly to the mortuary.

The involved clinician will be invited to attend the Post Mortem.

The written report will be sent to the Coroner and copied to the General Practitioner and where appropriate the hospital consultant.

Non Coroner’s Post Mortems

Post Mortem Examination Requests

Post mortems are performed in the hospital mortuary situated at UHNM.  They are usually performed between the hours of 09:00 and 14:00 hours Monday to Friday.

The approximate time of autopsy can be determined by direct contact with the appropriate Consultant Pathologist or with the mortuary technical staff.

Consent

The procedure for obtaining permission for a post-mortem examination in those cases which are not reportable to HM Coroner is as follows.

At the time of filling in the death certificate the clinician seeks permission for an autopsy from the bereaved relatives.  A hospital post mortem consent form must be filled in and signed.  A clinical details form should be completed and submitted immediately with the case notes and x-rays to the mortuary.

High risk cases MUST be brought to the attention of the Pathologist and mortuary staff immediately after consent has been obtained.

Clinicians are encouraged to attend the post mortem.

A written report of post mortem findings is sent directly to the Consultant in charge of the case and to the patient’s General Practitioner.

Do not delay the death certificate until after the post-mortem.  If the cause of death is not known it should be referred to the coroner.

Attendance at autopsies

• Visitors must abide by the Health and Safety notes that apply within the Mortuary.  These will be explained by the mortuary staff.
• People under 18 years of age are not permitted to attend an autopsy.

Attendance by medical personnel and medical students is encouraged.

Non Gynaecological cytology is part of the Histology Department and hence as noted in above sections, all request need to be submitted on the Histology (Histology and Cytology) request form to the UHNM Histology laboratory. 

Due to these samples being fresh or preserved but not fixed, it is imperative that they are not batched and should be transferred to the UHNM Histology laboratory as soon as possible to avoid degradation of the sample integrity.

Table of Non- Gynaecological specimen types and information.

Click the above link to see types of specimens received into the Non-gynaecological cytology department.