Cellular pathology

Cellular Pathology is located on the first floor at East Surrey Hospital.

Cellular Pathology consists of histopathology, cytopathology, andrology and mortuary services.

The Histopathology, Cytology and Andrology service is available from 9am to 5pm Monday to Friday. Outside of normal hours please contact switchboard for the on-call consultant. All urgent requests must be justified clinically.

The mortuary service is described in more detail in the mortuary section.

Cellular Pathology team

All contacts are based at East Surrey Hospital unless otherwise noted.

Out of hours contacts

Mortuary – via switchboard

Operational Manager – via switchboard

General

In order for the Pathologist to write a meaningful report, sufficient specimen and clinical detail, relevant treatment and case history must be given on the request form. The name of the clinician to whom the finished report is to be sent, must also be given on the request form.

Specimen containers (not the lids) must be adequately and clearly labelled with patient identification data, surname, first name, date of birth, hospital number (if known), specimen type and date of specimen or time of production. Request forms must be fully, accurately and legibly completed. Patient details and specimen details should correspond with the information given on the specimen label. Any discrepancies giving cause for concern, which cannot be rectified by telephone enquiry, will result in the return of the specimen. If slides are received it is important to label each slide individually not just the slide container. Unlabelled slides and specimens will be rejected and returned. This will result in delay.

Specimen collection

Specimens generated from outpatients clinics are transferred to the Central Pathology reception (ground floor pathology) throughout the day by the porters. On an hourly basis cellular pathology staff go down and collect specimens from the central pathology reception. Specimens from East Surrey theatres are collected by histology staff at 9.00am and 4.00pm. Specimens from Redwood Diagnostic Treatment Centre are delivered directly to the histology department by DTC porters at 9.30am and 4.00pm. Specimens from GP surgeries, out lying clinics, and hospitals are collected by hospital van and brought to the Pathology Reception area. North Downs Hospital specimens are delivered by a North Downs Hospital van.

Frozen sections

Whenever possible, arrangement for frozen section must be made 24 hours in advance by contacting the Histopathology department (ext 1851) or Consultant Pathologist. The request form accompanying the specimen must show a telephone number to which the result can be telephoned.

Urgent reports

Tick the urgent box on the request form and enter the date / time the results is required by.

If possible arrange for a porter to take the specimen directly to Cellular Pathology Department. For clinically complex cases contact a Consultant Pathologist to discuss the case.

CWT stickers (Cancer Wait Patients)

Patients who are being treated under the two week rule the 31 and 62 day cancer wait targets must have a CWT sticker attached to the request form.

CWT stickers are available from the Histology Dept.

High risk specimens

Known or suspected High Risk specimens and request forms must be clearly labelled (reference—Control of Infection Procedure file). High risk specimens are:- suspected or positive HIV, Hepatitis B and C and Tubercle Bacilli. Theses specimens must be put into plastic zip lock bags and sealed. The request form must be put into the separate compartment provided. High risk specimens are allowed a longer fixation period than normal. Thorough fixation is necessary to control infection before the specimen is handled. Please note that frozen sections cannot be carried out on High Risk specimens.

Safety procedures for 10& formalin

The safety warnings concerning formalin on the specimen label should be observed and followed. 10% Formalin is an irritant to the eyes and respiratory system. It may cause sensitisation by skin contact. It is toxic by inhalation, in contact with the skin and if swallowed. Use in a well ventilated area. Wear suitable protective clothing and gloves. Eye protection is advisable. Wash immediately with water if it does contact the skin. Seek medical advice if in any doubt.

Very small spillages: wearing gloves, should be mopped up with paper towels.

For safe handling information of spillages refer to “Guidance for use of Formalin”.

For advice contact the Histology dept ext. 1851

Histological specimen fixation

Specimen pots and fixative are obtained from the laboratory on request. All specimens (with the exception of specimens for frozen section,) should be submerged immediately in a volume of formal saline x 10 that of the specimen. Inadequate fixation is likely to delay reporting, may compromise complicate histological interpretation and can create an infection hazard for laboratory staff. Larger containers and cork boards for extra large specimens can be obtained on request from the laboratory. In the case of limbs, contact the Histopathology laboratory for advice.

Cracked specimen containers and lids should not be used. The container must be securely closed to prevent leakage. Avoid ‘cross threading’ a screw cap. Specimens should be sent to the laboratory in sealable plastic bags which have a separate compartment for the request form. Any leakage of fixative should be contained due to the seal and not contaminate the request form. Exceptions are specimens generated in theatre which are collected daily by laboratory staff. Contamination of the outside of the container and request form with blood or other body fluid is to be avoided. If contamination occurs transfer the specimen to a clean container, before sending to the laboratory via unsuspecting staff members on route.

Gynaecological cytology

The gynae cytology uses the Cytyc Thin prep system. Vials and brooms are ordered directly from the cytology department on the re-order form sent out with each batch of supplies. Request forms (HMR101) are available or pre-printed forms can be generated from the open Exeter system.

Forms and vials must have two items of patient identification; Christian and surname and either date of birth or NHS number.

Details on the form and vial must match and they must also match the information held on the Open Exeter database to allow the PCSS to send the result to the correct patient. Any discrepancies will be checked with the surgery and where necessary form and vial will be returned.

Samples will usually be reported within 2 weeks. All reports will include a management recommendation. Patients with abnormal smears that require colposcopy will be directly referred by the laboratory. Results are sent to the PCSS to up date the lady’s screening history on the Open Exeter system and to send out result letters.

A fail safe system operates in conjunction with the Open Exeter system.

Now processed and reported by Cytology Department Royal Sussex County Hospital Brighton.

Non-gynaecological cytology

Fine needle aspirates
Material should be spread thinly and evenly on the slide. If possible four slides should be prepared. Two should be air dried and the other two slides should be spray fixed. All four slides should be sent to the laboratory in a white slide container as soon as possible. All slides must be labelled with patient name, date of birth and hospital no.

Breast cyst fluid
Should be collected into a universal container and sent to the Laboratory as soon as possible. In the case of multiple cysts each sample should be collected separately and clearly labelled with the site from which it was obtained.

Joint fluids
Should be collected into a universal container and sent to the Laboratory as soon as possible after collection.

Ascitic and pleural fluids
Fresh fluid is required (not the contents collected over several hours from a drain bottle). 25ml of fluid should be collected into a universal container and sent as soon as possible to the laboratory. Large quantities of fluid are inappropriate for cytological investigation. If a specimen has to be kept overnight it should be refrigerated.

Sputum
Early morning deep cough samples before food and teeth cleaning are required on three consecutive days. For out-patients collection, samples can be stored in the refrigerator and delivered to the Laboratory on the third day. IN-patient samples should be delivered daily. If sputum production is difficult a Physio-aided sample may yield better results. Separate samples should be sent for microbiological investigation.

Urines
A complete mid-morning sample on should be supplied or a 25ml aliquot of the complete sample. Samples should be sent to the laboratory within 4 hoursSamples received in microbiology boric acid container are unsuitable for cytological investigation and a repeat will be requested.

C.S.Fs
A separate sample should be sent for cytological investigation. All CSF’s are treated as URGENT samples and should be sent to the Laboratory as soon as possible.

Reporting of non-gynaecological cytology

Samples received in the Laboratory are normally prepared in batches and stained as soon as possible. It is the aim of the laboratory to report all non-gynaecological samples within 24 hours of receipt of the specimen. There may be a delay in reporting if special investigations are found to be necessary after primary screening.

Andrology samples

Details for collection of seminal fluids can be found on the reverse of andrology request form.
Samples must be delivered to the East Surrey laboratory within two hours of production.
The male partners name should be given as the person from whom the sample has been obtained.
It should state clearly if the sample is for post vasectomy check or infertility investigations. Reports are usually issued within one week.
There is a room available on site for specimen production. This room is located at East Surrey Hospital, directions and the room key can be obtained from Pathology Reception.

Referral centres

Liquid based cytology vials are processed off site at Royal Surrey County Hospital in Guildford.

Her-2 requests are sent to the Molecular Biology Laboratory at the Royal Surrey County Hospital in Guildford for SISH testing.

Specimen retention

All specimens are stored in accordance with the Royal College of Pathologists guidelines. Any unprocessed residual material is retained for the following times: