HEALTHCARE STAFF

INFORMATION
e-LEAFLET
1

Handling of Histological Samples

Specimen Handling
Samples for routine
examination should be placed into 10%
formalin and sent to the laboratory with
the next courier.
Samples for Immunofluorescence,
frozen sectioning or cytology must NOT
be placed in formalin.
Routine histology requests
Immediately place each specimen in a
tightly secured, leak-proof container
with 10% neutral buffered formalin. Do
NOT allow the specimen to dry out.
For optimal sample fixation, the formalin
volume to specimen ratio should be
10:1. Best clinical practice is to use a
separate container for each specimen.
Do NOT crush or stretch the specimen
with forceps or other instruments.
Histology requests for specific
Histological tissue types
Breast core biopsies
These must be immediately placed
in formalin pots, to preserve both the
tissue integrity and ER, PR and HER-2
receptors. These core biopsies must be
fixed for at least 6 hours before they can
be processed, again to ensure optimal
expression of hormonal receptors.
If these cannot be sent to the laboratory
immediately, it is advisable that formalin
is injected around the tumour area as
this has been found to improve fixation
and reduce tissue autolysis.
When specimens x-rays are taken
please send these with the sample for
correlation to avoid potential delays in
the assessment of these specimens.
Skin excision for malignancies
It is preferred that skin excisions for
malignancies are orientated by placing
a suture or a double surgical nick on the
specimen, stating its location (e.g. 12
o’clock). This makes it possible for
the pathologist to measure
precise peripheral margins
as well as the deep margin.
This information should be
provided on the request
form.

Ensure that you use the correct Colectomies and resections

Breast wide
container size; do not force a large of small intestine
local excisions and
specimen into a small container as this These specimens must be fixed
mastectomies
will deform the specimen and reduce in formalin immediately and sent to
These must be fixed in formalin
the rate of fixation. the Laboratory for proper handling. The
immediately to ensure that tumour
specimens may need to be inked and
tissue is fixed properly and its
Specimen labelling and completion of opened partially or completely. This
assessment (including hormonal
request forms is covered earlier in the ensures the penetration of formalin into
receptors) is not compromised.
leaflet “Requesting Specimen Analysis”. tumour tissue from both the mucosal
and serosal surfaces.
For further information please contact us on:

01923 233 299 www.cellularpathologyservices.co.uk

Out of hours: 07775 44 66 88 info@cellpathservices.co.uk

© Cellular Pathology Services Limited 2019 Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA

Handling of Histological Samples
Lymph node
Do not handle or palpate the node.
Nothing of value will be learnt from
such examination and may distort the
architecture to an extent that makes
subsequent histological interpretation
very difficult or impossible.
As formalin penetrates lymphoid tissue
slowly, the node should be immediately
placed in formalin fixative. Correct
fixation is vitally important. If there is any
indication of an inflammatory condition,
and particularly if tuberculosis is
suspected, a portion of the lymph node
should be submitted fresh in a sterile
container to a Microbiology Laboratory,
and a portion of it fixed in formalin and
sent to the Histopathology laboratory
for histological examination. Attempts
at microbiological culture from formalin
fixed tissues will be unsuccessful,
although increasingly PCR studies can
be undertaken on formalin fixed tissue.
Prostatic Core biopsies including
mapping biopsies
Place all cores from one site in a separate
pot from the other sites. If appropriate,
the lab will use multiwall cassettes. For
mapping prostate core biopsies, please
send the biopsy grid and the MRI scoring
of the prostatic zones.
For further information please contact us on:
01923 233 299
Out of hours: 07775 44 66 88
© Cellular Pathology Services Limited 2019
Cone/LLETZ Excisions of the Cervix
Place the specimen in formalin intact.
If the specimen is taken in pieces, a
drawing explaining the relationships
between the various pieces will be very
helpful in determining which margins
the pathologist should be reporting on.
Unusual Cases
If special investigations such as electron
microscopy and muscle or nerve
biopsies for degenerative conditions
are required, please discuss them with
us in advance. These may require non-
routine fixation, special transport media
and referral to a specialist laboratory.
www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk
Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
HEALTHCARE STAFF
INFORMATION
e-LEAFLET
2
Specimens requiring consent
We are unable to examine, process
or dispose of specimens that contain
foetal tissue without a fully completed
consent form, which must be submitted
to the laboratory with the specimen.
Consent forms are available from our
team on 01923 233299 or info@
cellpathservices.co.uk. We cannot
handle foetal specimens of 24 weeks or
greater gestational age.
Specimens that may contain foetal
tissue require a consent form include:
• Products of conception
(miscarriage)
• Salpingectomy for suspected
ectopic pregnancy
• Termination of pregnancy
specimens
Ref: 1-240465912
9685
Accredited to
ISO 15189:2012

Handling of Histological Samples
Frozen sections
Frozen sections will be undertaken after Specimens
discussion with one of the Consultant
Histopathologists. Contact
Histopathologists on 01923 233299.
Requests for frozen section should
be booked at least a week in advance.
However, we may be able to assist you clinically uninvolved skin (perilesional).
with ultra urgent requests for frozen For a large blister, biopsy edge of
section such as may occur as a result of
an unexpected intraoperative finding.
Handling specimens for Frozen Section studies and the remaining blister for
Fresh specimens for frozen section histology. For uninvolved skin, a 3mm
must be sent directly to the frozen punch biopsy is sufficient.
section station without delay in a dry
container. Do NOT add any formalin.
The telephone number of the theatre
should be noted on the request form
so that the pathologist can discuss
the frozen section findings with the
consultant surgeon.
Direct immunofluorescence
This is a procedure for detecting in-
vivo deposition of immunoglobulins,
complement components and fibrinogen Indirect immunofluorescence
in a patient’s skin or oral mucosal tissue. 10ml clotted blood should be sent to
For further information please contact us on:
01923 233 299
Out of hours: 07775 44 66 88
© Cellular Pathology Services Limited 2019
Procedure for biopsy
for
immunofluorescence studies must be
the sent in Michel’s transport medium,
which is available on request from CPS.
Whenever possible, biopsy a single
fresh small blister including adjacent
blister and adjacent uninvolved skin
(perilesional). Cut the perilesional end
and send for immunofluorescence
the laboratory within 48 hours or serum
separated and sent within one month
of collection.  
www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk
Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
HEALTHCARE STAFF
INFORMATION
e-LEAFLET
3
Other useful leaflets
direct
In addition to this healthcare staff
information leaflet we also have:
HEALTHCARE STAFF
INFORMATION 1
eLEAFLET
Requesting Specimen Analysis
Requesting Specimen
Completion of request form Information required on request form Information required for sample
labelling
If you need assistance with this process, All samples must be accompanied by
please contact our office staff on 01923 a fully completed Histology/Cytology Specimen containers must have a
233299, who are more than happy to request form. minimum of the following information
assist you. written clearly and legibly:
The following information are required, • Patient forename and surname (or
For everybody’s peace of mind, our staff and should be written clearly and legibly: anonymous)
will contact you or your staff in case • Patient forename and surname (or • Date of birth
there is any issue with the completion anonymous) • Patient ID number
of the request form or the sample • Patient date of birth • Biopsy type and site plus cross
labelling. • Patient gender reference on request form
Analysis
• Patient ID number • Date and time of collection
Where there are discrepancies, such • Name and signature of requesting
specimens cannot be processed until consultant It is also desirable to have the following
correct information is supplied. • Date and time of sample collection information:
• Clinical details • NHS number (if known)
• Anatomical site of each specimen • Patient gender
identified by a letter / number
The date and time that the specimen
• Hospital / Clinic Name
was taken allows us to assess whether
the material has been in formalin long
It is also desirable to have the following
enough for it to be processed on receipt.
information:
• Patient address We regret that in some cases where it
• Patient GP is not possible to resolve un-labelling
• Priority status of the or mis-labelling of sample and request
case for triaging forms, it may be necessary to return the
• Who to invoice whole case to the base hospital/clinic
• NHS number (if known)
for correct labelling so as to correctly
• If you wish to be identify the patient.
phoned or faxed with results
then please state this on the Such discrepant specimens cannot be
form providing relevant phone/ processed until correct information is
fax numbers and/or email address supplied.
For further information please contact us on:
01923 233 299 www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
© Cellular Pathology Services Limited 2015
HEALTHCARE STAFF
INFORMATION
eLEAFLET
1
Handling of Histological Samples
Handling of Histological
Specimen Handling Histology requests for specific If these cannot be sent to the laboratory
Samples for routine Histological tissue types immediately, it is advisable that formalin
examination should be placed into 10% is injected around the tumour area as
Breast core biopsies
formalin and sent to the laboratory with this has been found to improve fixation
These must be immediately placed
the next courier. and reduce tissue autolysis.
in formalin pots, to preserve both the
tissue integrity and ER, PR and HER-2
Samples for Immunofluorescence, When specimens x-rays are taken
receptors. These core biopsies must be
frozen sectioning or cytology must NOT please send these with the sample for
fixed for at least 6 hours before they can
be placed in formalin. correlation to avoid potential delays in
be processed, again to ensure optimal
the assessment of these specimens.
expression of hormonal receptors.
Routine histology requests
Immediately place each specimen in a Skin excision for malignancies
tightly secured, leak-proof container It is preferred that skin excisions for
with 10% neutral buffered formalin. Do malignancies are orientated by placing
Samples
NOT allow the specimen to dry out. a suture or a double surgical nick on the
specimen, stating its location (e.g. 12
For optimal sample fixation, the formalin o’clock). This makes it possible for
volume to specimen ratio should be the pathologist to measure
10:1. Best clinical practice is to use a precise peripheral margins
separate container for each specimen. as well as the deep margin.
This information should be
Do NOT crush or stretch the specimen provided on the request
with forceps or other instruments. form.
Ensure that you use the correct Colectomies and resections
Breast wide
container size; do not force a large of small intestine
local excisions and
specimen into a small container as this These specimens must be fixed
mastectomies
will deform the specimen and reduce in formalin immediately and sent to
These must be fixed in formalin
the rate of fixation. the Laboratory for proper handling. The
immediately to ensure that tumour
specimens may need to be inked and
tissue is fixed properly and its
Specimen labelling and completion of opened partially or completely. This
assessment (including hormonal
request forms is covered earlier in the ensures the penetration of formalin into
receptors) is not compromised.
leaflet “Requesting Specimen Analysis”. tumour tissue from both the mucosal
and serosal surfaces.
For further information please contact us on:
01923 233 299 www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
© Cellular Pathology Services Limited 2015
HEALTHCARE STAFF
INFORMATION
eLEAFLET
1
Handling of Diagnostic Cytology Samples
Diagnostic cytology is mainly concerned Fine needle aspiration cytology,
with providing a diagnosis in patients urine cytology, fluid cytology, joint
with suspected disease, whereas most fluid cytology for crystals and other
Prepare direct smears on slides, which
should be labelled in pencil with the
patient’s surname. If you are taking
Handling of Diagnostic
Gynaecologic cytology is concerned with diagnostic cytology samples are material from more than one site,
the detection of pre malignant disease in processed and examined in-house. All indicate the individual site on each slide.
predominantly well women as part of a these samples are seen and reported It is also important to indicate whether
screening programme. by a Consultant Pathologist. These or not the slides are fixed, by labelling
specimens are mostly reported within them as “dry” or “fixed”.
Cytology Samples
The method of cell sampling will depend 24 hours of receipt in the laboratory.
upon the site to be examined. In many Urgent samples can be processed Urine cytology
cases, cells will naturally exfoliate; in sooner. The cytological analysis of urine is
others assisted exfoliation may be useful in the screening, diagnosis and
required with the use of brushes. Less follow-up of urological malignancy, in
accessible lesions can be sampled using particular, transitional cell carcinoma.
fine needle aspiration (FNA) cytology Cytological assessment is based upon
with or without the assistance of imaging the examination of desquamated
devices such as ultrasound, X ray guidance, epithelial cells the urine passes from
Computerised Assisted Tomography or the excretory tubules in the
Nuclear Magnetic Resonance. kidney via the ureter and
bladder to the urethra. A
Although the primary aim of diagnostic combination of urothelial
cytology is to assist in the making of cells and squamous
a diagnosis for malignant disease, cells (derived from the
sometimes it is useful for the detection of trigone and/or urethra)
infective agents. and glandular cells may
Fine needle be present. Additionally,
Sampling of the respiratory tract can aspiration vulvovaginal contaminant
be used to diagnose both primary and Fine needle aspiration (FNA) squamous cells are also normally
secondary (metastatic) lung tumours. is frequently used to provide a rapid seen in samples from women.
Unless the tumours have characteristic diagnostic procedure performed in an Samples may be obtained by direct
features it is not possible to always outpatient setting with or without the collection of urine, bladder washouts,
distinguish between primary and use of imaging. samples obtained from cystoscopy,
metastatic disease.
For further information please contact us on:
01923 233 299 www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
© Cellular Pathology Services Limited 2015
HEALTHCARE STAFF
INFORMATION
eLEAFLET
1
Handling of Gynaecologic
Handling of Gynaecologic Cytology Samples
Clinician information (as per NHS cervical screening programme Additional testing
Hologic Thin-Prep Liquid based cytology guidelines) and then returned for in-house The HPV test and other tests for infectious
is the only acceptable format for reporting and issuing of result. All cervical agents can be performed on the Thin-
Gynaecologic samples. smears are examined and reported by a Prep vial using a PCR platform. Additional
Consultant Pathologist. swabs are not necessary.
Be aware that conventional smear
preparations have been phased out and Turnaround times
The following additional tests can be
the Screeners are no longer trained to The laboratory provides a rapid service performed on the Thin-Prep vial.
read these preparations; therefore they for liquid based gynaecologic samples. • Routine collective HPV testing
cannot be accepted. Average turnaround for cervical smears • 20 HPV DNA subtypes
Cytology Samples
is 48-72 hours from receipt of sample • HPV20 with reflex mRNA for E6/E7
We ask that you fully complete the and 72-96 hours if associated tests such oncoprotein expression
request form. Details of previous smear as HPV, Chlamydia and Gonorrhoea have • Chlamydia PCR
history and treatment are helpful. also been requested. • Gonorrhoea PCR
• Sexual Health Screening by PCR
Laboratory processing testing (Chlamydia, Gonorrhoea,
Cervical smears received at CPS are Mycoplasma, Ureaplasma,
referred to a CPA-accredited laboratory Gardnerella, Trichomonas & HSVI/II)
for processing and preliminary screening
The laboratory may also receive swabs
for HVS or chlamydia. These tests are
referred on to a CPA-accredited laboratory
for assessment.
The results are scanned into our report
format and indicate that they have been
issued by the referral laboratory. The date
of the original report would be clearly
stated in our report.
For further information please contact us on:
01923 233 299 www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
© Cellular Pathology Services Limited 2015
HEALTHCARE STAFF
INFORMATION
eLEAFLET
1
Requesting Consumables
Specimen collection consumables Histopathology Other useful leaflets
All Histology and Cytology specimen We can supply various sizes of pre-filled
collection consumables can be obtained 10% neutral buffered formalin pots: 20ml, In addition to this healthcare staff
Requesting Consumables
from CPS. Please allow 2-3 days for 60ml and 120ml. information leaflet we also have the
delivery of consumables. following:
Formalin buckets for larger specimens
There is a standard form for requesting are also available from us in the following
consumables, which can be downloaded sizes: 500ml, 1000ml, 2500ml, 5000ml, Requesting Specimen
here (link to e-leaflet). which can be supplied with 10% neutral Analysis
buffered formalin on request.
Diagnostic cytology
Specimen Collection &
All supplies such as glass slides, slide boxes,
Handling of Histological
cytofix spray and universal containers of
Samples
various sizes can be provided.
Gynaecologic cytology
All the necessary collection Specimen Collection &
supplies can be provided. Handling of Diagnostic
These include Cytology Samples
conventional brush,
spatula, Thin-Prep vials
Specimen Collection &
and plastic broom.
Handling of Gynaecological
Cytology Samples
Once completed
the form needs to
be faxed to 01923
233296 or emailed to info@ Histology and Cytology
cellpathservices.co.uk. For urgent despatch Request form
of consumables you are welcome to call
our office on 01923 233299.
To see our full range of Healthcare
Information leaflets visit our website:
www.cellularpathologyservices.co.uk
For further information please contact us on:
01923 233 299 www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
© Cellular Pathology Services Limited 2015
HEALTHCARE STAFF
INFORMATION
eLEAFLET
1
Specimen Packaging and Transporting
Specimen Packaging &
Inadequate packaging of samples may Reviewing specimens Specimen transport bags
cause leakage of tissue or cellular material, Prior to packaging the specimen for All specimen bags have two pockets -
which might result in the loss of the actual transport to the laboratory, please check the front pocket is for the completed
pathology sample, therefore jeopardizing the request form and the specimen request form and the back pocket for the
the laboratory’s ability to undertake the pot(s) to make sure that they are labelled specimen(s). Once both request form and
test. Moreover, there is potential harm to correctly and that the form and the specimen(s) are in the specimen bag, seal
the transporting courier. Hence, we advise sample show the same patient details. the bag properly.
all personnel handling, packaging and
transporting cellular pathology samples to When packing the sample, place the
follow these rules and advice. If you require request form in the outer pocket. This is
any assistance, do not hesitate to call us to avoid it being contaminated should the
on 01923 233299. sample leak and also allows us to read
the request form without touching the
Transportation
Specimens known to be infected with sample container.
high-risk organisms should be
appropriately labelled and placed Preparation for transport
into a biohazard bag. Leaking Maintain formalin specimen pots,
specimens may neither be FNA slides, Thin-Prep vials at room
collected nor accepted into temperature and refrigerate fresh
the laboratory. diagnostic cytology specimens (such
as fluids and cyst aspirates) over the
Samples or request
weekend, unless otherwise noted in the
forms received unlabelled
specimen requirements.
or without the minimum
The patient name,
essential identification criteria
date and time of Health and safety note
may be referred back to the
collection and test requested When decanting formalin into the
requesting practitioner.
should be identical on all items. specimen container, gloves and safety
Closing specimen pots glasses should be worn and the procedure
It is extremely important to close the Please make sure that any special carried out in a well ventilated room.
specimen pots tightly and securely instructions (e.g. fax results; call doctor Formalin is a strong irritant and contact
ensuring that the seal is not broken. with results; send a copy of results to) are with the skin and eyes must be avoided.
Improper closure of the specimen pot(s) is clearly indicated in the appropriate area of Inhalation of fumes can cause damage to
the most common cause for leakage. the form. the respiratory system.
For further information please contact us on:
01923 233 299 www.cellularpathologyservices.co.uk
info@cellpathservices.co.uk Unit 12, Orbital 25 Business Park, Dwight Road, Tolpits Lane, WATFORD, Hertfordshire. WD18 9DA
© Cellular Pathology Services Limited 2015
To see our full range of Healthcare
Information leaflets visit our website.