Laboratory of Pathology

Specimen Collections:

1) Intraoperative Consults (Frozen Sections)

• Page the Intra-Operative Consult (Frozen Section) Resident: 102-10375 for assistance. The Hot Seat Resident may be paged at 102-10376, as a back-up. Please provide the patient information and Operating Room Number when calling.

• Please page the Pathology Resident On-Call if it is after 5:00 PM or on weekends or holidays by calling the NIH Page Operator at (301) 496-1211.

2) Fresh Specimens from the Operating Room

All fresh specimens collected in the Operating Room should be delivered to the Frozen Section Room (10/2C533) with the proper identification labels. Each specimen must be recorded in the log book at the time of drop-off. All paperwork should be placed with the specimen or with the specimen log book. All specimens must be placed in the refrigerator labeled "For Surgical Pathology Specimens".

Note:  If specimen is placed in the refrigerator after 4:00 PM or on weekends and holidays, please page the Pathology Resident on-call, through the NIH page operator at (301) 496-1211. The Resident may instruct you to place the specimen in 10% formalin (see instructions below in Preventing Specimen Autolysis).

3) Preventing Specimen Autolysis:

• To prevent autolysis of fresh samples (without fixative) or drying out too quickly, it is important to keep them cold (2°C to 6°C).

   

• It is usually best to place a fresh specimen directly in the specimen container and keep cool in the refrigerator as soon as it is collected. Exceptions are noted below.
  
•  To prevent small samples, such as needle core biopsies, from drying out too quickly, place in Teflon pad and wet with cold (2°C to 6°C) saline, (pH 7.0 -7.4).
• Small curettage collections may be wetted with a very small volume cold (2°C to 6°C) saline, (pH 7.0 -7.4), if there is no blood or body fluid present from the collection process.
• NEVER USE WATER OR WARM SALINE!
• IF TRANSPORT OF FRESH SPECIMEN IS DELAYED, place the specimen container in a specimen bag (double zip-lock bag) and place on ice. Do NOT allow the container or specimen to come in contact with ice, because as it melts, the water may enter the specimen container.

NOTES:

• For small biopsies, such as those collected during endoscopy, cystoscopy, and GYN procedures, please place specimens in 10% formalin fixative as soon as possible and affix a "10% formalin warning label". For questions about fixation, please see below or page the HOT SEAT resident.
  
• For Hematopathology specimens (lymph node biopsies) please contact the Hematopathology Lab at (301) 480-8462 or the Hematopathology Office at (301) 480-8480. Lymph node biopsies should be delivered to the Hematopathology Laboratory Section directly for fresh tissue procurement.
  
• DO NOT USE FIXATIVE ON LYMPH NODE SPECIMENS, UNLESS DIRECTED BY HEMATOPATHOLOGY.
• For more information on Hematopathology specimens, please see: http://home.ccr.cancer.gov/LOP/Clinical/hematopath/hem_spec.asp

4) Fixed Specimens
 

• Specimens obtained in the clinics should be fixed in 10% formalin unless otherwise specified and brought to the Surgical Pathology Service, Room 2S258 with a corresponding requisition form. Specimens without requisition forms will not be processed until proper identification of the specimen is received in the laboratory.
• Containers should be properly identified with labels showing name, medical record number, clinic location, type of specimen and site of biopsy (e.g., skin biopsy, left upper thigh).
• Containers with fixative should have a label identifying the fixative (10% formalin warning label).
• The amount of formalin should be at least TWICE the volume of the specimen, but preferably TWENTY (20) times the volume.

5) Specimen Labels (All Specimens)

• All specimens must be labeled with name of the patient, medical record number, date of birth, unit number or OR room number, description (site description, specimen number). The information on the labels MUST match the paperwork and CRIS order. Please PRINT the name of the submitting physician on the label.
   
•  ALL RADIOACTIVE OR INFECTIOUS SPECIMENS should be properly labeled and bagged.

Paperwork:

• Operating Room Specimen Record must be delivered by 4:00 PM. If patient is still undergoing surgery, please submit specimen record ASAP, but no later than 9:00 AM on the morning after surgery.
• Research Specimens: Request & Certification for Research Procurement of Human Biological Materials (NIH-2803-1). This form must be delivered with research tissue; see Tissue Procurement Facility section under Clinical Services.

Requistion Forms (CRIS Orders for All Clinical Specimens):

• CRIS requisition forms will print in 2S258: These forms must have the following information:
• Request number
• Name of patient, Medical Record number, DOB, Age, Sex, Unit Number
• Intitial diagnosis, Protocol number, Institute
• Name of Physician and Name of Physician entering the request
  Specimen and site of biopsy (e.g., skin biopsy, left upper thigh).
•  CRIS orders must be placed by the Surgeon or Surgical Fellow as soon as possible, and no later than 5:00 PM on the day of surgery. If the CRIS is down, you must submit a CRIS Downtime Requisition for Tissue Exam/Cytology Exam. The form is available here  (form room numbers should be updated).

• The specimen description in the CRIS must match the Operating Room Specimen Record and the specimen label as accurately as possible. 
  

• SPECIMENS WILL NOT BE ACCEPTED OR PROCESSED IN THE LABORATORY UNLESS PROPERLY LABELLED AND WITH THE CORRESPONDING REQUISITION FORM (CRIS ORDER). Specimens without a CRIS order will not be processed until proper identification of the specimen is received in the laboratory. In an urgent situation, the pathologist may place the specimen in fixative while waiting for the order. Unlabelled or mislabeled specimens will not be processed unless properly identified, resolved to the pathologist's satisfaction, and documented in the Clinical Center Occurrence Reporting System (ORS).

• ATTEMPTS WILL BE MADE IMMEDIATELY TO CONTACT THE RESPONSIBLE PHYSICIAN AND/OR PRIMARY CARE DOCTOR. IN URGENT SITUATIONS, THE CHIEF OF THE SURGERY BRANCH AND/OR INSTITUTE DIRECTOR MAY BE NOTIFIED.
  

• THE CHIEF OF THE SURGICAL PATHOLOGY SECTION WILL BE NOTIFIED IMMEDIATELY.

 6) Research Procurement. See Tissue Procurement Facility (TPPF)/Frozen Section Lab