CONTACT INFORMATION FOR SPECIMEN COLLECTION

Intra-Operative Consult (frozen Section) Resident:  102-10375

Hot Seat Resident:  102-10376 (7 AM to 5:00 PM)

Pathology Resident On-Call (After 5 PM, weekends, holidays): (301) 496-1211 (NIH) Page Operator)

Surgical Pathology Office: (301) 480-8470

Clinical Laboratory Manager: (301) 480-7177

Tissue Procurement Technical Laboratory Manager: (301) 480-7178

Hematopathology Laboratory: (301) 480-8462

Hematopathology Office: (301) 480-8040

Histology Laboratory: (301) 480-8060

Frozen Section Laboratory: (301) 402-9219

Gross Room: (301) 435-3544

Operating Room Front Desk: (301) 496-5646


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 after 5 PM or on weekends or holidays by calling the NIH Page Operator at (301)496-1211


SPECIMEN COLLECTION POLICY

PURPOSE

The specimen management procedures in the Histopathology laboratory are intended to support the research mission at The National Institutes of Health while also preserving samples for clinical diagnosis.  The procedures that follow are intended for the Histopathology laboratory, but there are other procedures that involve specimen handling in the operating rooms and procurement laboratories.  For a more detailed description of procurement procedures, refer to the Specimen Collection Guide and Surgical Pathology Rotation procedures.

PRINCIPLE

The National Institutes of Health is a research institution and as such, it is common to have specimens removed from the Operation Rooms (OR) without fixative.  This practice allows for sampling fresh tissue for research studies that are not possible on chemically fixed tissues.  As a consequence of this mission, the Histology laboratory receives specimen that may be fresh or in fixative. The laboratory also receives specimen from clinics throughout the building and consult cases that usually consist of paraffin blocks and glass slides.

COMMONLY USED TERMS

The following terms are frequently used in this procedure:

  • Specimen:  any product of a medical procedure.  These can be soft tissues, boney tissue; fluids, foreign bodies, surgical appliances/hardware.  The terms “sample”, “specimen”, and “tissue” are often used interchangeably.
  • Fixative:  a solution used to stabilize cellular components in preparation for histological examination.  Proper fixation is essential for histology, but it kills cells and acts in other ways that limits many research applications. 10% neutral buffered formalin is the most common routine fixative.
  • Fresh:  no fixative has been used.  Fresh tissue samples must be frozen, placed in a transport media to keep the cells alive, or stabilized in some other way as soon as possible to prevent autolysis.
  • Frozens:  specimens that are or have been frozen for rapid microscopic exam during an interoperative consultation.  Frozen section slides are cut on a cryostat for rapid microscopic analysis.  The remaining tissue is placed in fixative to be made into permanents.
  • Permanents:  specimen that have been treated with fixative and processed to a paraffin matrix that permanently preserves them at ambient temperature.  “Paraffin block” is an equivalent term.  “Permanents”, or paraffin blocks, are specimen for which a microscopic histological exam can be performed. The histology of permanents is superior to that of frozens.
  • Gross only examination: a descriptive exam of the macroscopic features of the specimen that does not include a microscopic exam.  Specimens for “gross only” are usually foreign bodies or otherwise not practical to be made into permanents.
  • Procure:  the process of allocating portions of the specimen to fulfill the research protocol requirements while preserving representative portions for clinical diagnosis.

SUPPLIES

  • 10% neutral buffered (NBF) in prefilled specimen containers
  • 10% neutral buffered (NBF) in 5-gallon cube containers
  • 10% neutral buffered (NBF) in 2.5-gallon cube containers
  • Plastic containers, non-sterile, various sizes, no particular vendor requirement (example: Cardinal Health #ES3704)
  • 10% formalin hazard label (EMS #77060-16)
  • Specimen refrigerator set 0 to 80C.  The colder setting is to counteract the effect of large, warm samples.

SPECIMEN ACCEPTABILITY IN THE HISTOPATHOLOGY LABORATORY:

The attending pathologist, in collaboration with the grossing resident, directs the handling of each specimen on a case-by-case basis. A general guideline is as follows:

The following ARE ACCEPTABLE specimens for pathological evaluation:

  1. OR specimens, previously procured, fixed in 10% formalin
  2. OR specimen, previously procured, fresh.  Smaller fresh specimens should be kept moist in saline or a transport media such as RPMI.
  3. Frozen Section specimens, consultation completed, in 10% formalin
  4. Clinic biopsies fixed in 10% formalin
  5. Hematopathology lymph nodes, previously procured in Hemtopathology, in 10% formalin
  6. Autopsy cassettes, labeled with the autopsy number, in 10% formalin
  7. Breast protocol specimens in HistoChoice fixative
  8. Any foreign bodies such a ports, stents, etc. for which a Surgical Pathology CRIS order has been received.  In general, these will be handled as “gross only” cases for which no samples are submitted for microscopic evaluation.  These can be submitted in dry specimen containers.  If there is adherent tissue, that material may be submitted for paraffin processing at the discretion of the resident and attending.  These should be submitted in formalin to prevent decay, even if the tissue will not be processed for examination.
  9. Consult materials consisting of fixed wet tissue, paraffin blocks, and/or glass slides
  10. Frozen material if requested by an attending Laboratory of Pathology (LP) pathologist only. 
  11. Teeth.  Usually these will be for gross examination only, but adherent tissue may be submitted for microscopic examination at the attending’s discretion.


Exclusions

All NIH patients are admitted under a clinical research protocol. Consequently, the principal investigator of the service submitting specimens to the Laboratory of Pathology in conjunction with the attending pathologist is responsible for deciding which specimens to exclude from submission to the Laboratory of Pathology to satisfy the requirements of the patient’s clinical research protocol.

The following are generally NOT acceptable specimen unless otherwise directed by the attending pathologist:

  1. Bone marrow cores. Direct to the Department of Laboratory Medicine.
  2.  Ocular specimens.  These go to the Ocular Lab.
  3. Any specimen fixed in gluteraldehyde.  These are forwarded to the Department of Laboratory Medicine to send out for Electron Microscopy  (EM).
  4. Any fresh specimen for which flow cytometry or cytogenetics samples must be taken. These must be brought to the attention of the resident or attending immediately and before any fixative is added.
  5. Blood and other fluids [such as bronchoalveolar lavage (BAL), pleural, peritoneal, cerebrospinal (CSF), sputum] and smears made from these. These should go to the Clinical Pathology lab or Cytology, depending upon the sample and test requested.
  6. Frozen aliquots of anything (see the exception above)
  7. Radioactive specimens are not expected.  If anything is received that is marked as radioactive, place in a refrigerator and contact the attending pathologist immediately.  See Histology policy for radioactive materials.

TRANSPORTATION

All fresh specimens received from the Operating Room should be received in Room 2C533 with the proper identification labels.

Wet specimens are transported to the Histopathology laboratory by Escort Services, clinic staff, or LP staff.  General institutional policies for specimen transportation apply and include that containers are properly closed to prevent leaks. Secondary containers such as specimen bags and/or transport buckets marked with the biohazard symbol are used.  Containers that contain fixative are labeled as such. All transportation can be done at room temperature.  Fresh samples must be transported to refrigeration without delay.  If this is not possible, transport in a container on wet ice so as to keep the sample cold, but without contaminating the sample with the ice.

Samples brought by Escort Services must be logged into the log book at the laboratory entrance.  This documents the time of delivery and allows laboratory staff to identify samples that are mis-delivered (see Specimens Acceptability, above).

No infectious, frozen or wet tissue is routinely shipped to off-site locations.  If shipping is required, it must be done by staff that has current training in IATA Dangerous Goods Regulations. 

SPECIMEN PRESERVATION

  1. Specimens in 10% formalin:  Anything received in 10% formalin can be held at room temperature until grossed by the resident.  Refrigeration (2-80C) is not needed and should be avoided so as not to slow down the chemical reaction. These specimens may be received in pre-filled formalin containers, which the Histopathology laboratory provides, or in generic specimen cups to which 10% formalin has been added.  The latter must be labeled with a 10% formalin hazard label. If the volume of fixative does not cover the sample, or the sample is squeezed into a container that does not allow enough formalin, contact the resident to add more formalin or transfer to a larger container.  The volume of fixative should be at least two times that of the specimen.
  2. Specimens received fresh:  Anything received fresh (without a fixative such as formalin or alcohol) must be brought to the attention of the resident to ensure proper handling.  In the interim, fresh specimens must be refrigerated (0-80C) until the resident makes sure the sample has been procured.  Large samples from the OR must be covered with Parafilm or similar material.  Smaller samples should be kept moist with a Tyvec or similar pad moistened with saline or RPMI and submitted in a sealed specimen container.  

FIXATION TIMES 

In general, biopsies are submitted for processing to permanents the same day as received if they were received in formalin.   Larger specimens may or may not be cut into cassettes the same day as received depending upon the tissue type and how long it has been in formalin.  Some specimen types have specific handling requirements to optimize fixation times as follows:

  • Brain, larger than a biopsy:  Since brain is particularly soft and formalin penetrates slowly, the grossing procedure is designed to cut the tissue into cassettes as quickly as possible and allow them to fix overnight before they are submitted for processing.  See the grossing procedures.
  • Hematopathology lymph nodes:  at the direction of the hematopathologist, most larger nodes are cut into cassettes and allowed to fix overnight before they are submitted for processing.
  • Radical prostatectomies:  The glands are allowed to fix overnight before being breadloaved the following working day.  The breadloaves are allowed to fix an additional day before processing.  See the grossing and prostate procedures.

Fixation Guidelines for Submitting Specimens Requiring Her2; ER/PgR Testing

  1. Specimens must be immersed in fixative within one hour of the biopsy or resection.  The cold Ischemia time must be listed on the requisition. 
  2. If delivery of a resection specimen to the pathology department is delayed (e.g. specimens from remote sites), the tumor should be bisected prior to immersion in fixative. In such cases, it is important that the surgeon ensure that the identity of the resection margins is retained in the bisected specimen;   alternatively, the margins may be separately submitted.
  3. The time of removal of the tissue and the time of immersion of the tissue in fixative must be recorded and submitted to the Laboratory of Pathology.  Stating that the cold ischemia time was less than (<) or greater (>) than one hour will suffice. 
     

CRIS REQUISITION and LABELING REQUIREMENTS

  1. CRIS Requisitions:  All cases must be accompanied by a requisition form (CRIS). Verbal test orders are not accepted.  There must be one CRIS requisition per patient and per procedure.  The only exception is specimens from an on-going surgical procedure.  It is expected that the CRIS is generated as soon after completion of the surgery as possible and no later than 0900 hours the following morning.  This requisition is electronic and will include essential information such as the CRIS number (which is used to accession the case in the LIS); patient demographics; collection date; specimen description; the submitting physician’s name; and other physician contact information.  Significant clinical data/diagnosis is expected, but does not constitute a specimen deficiency if not provided.  The form itself prints from two printers, one in the Histopathogy lab and one in the Frozen Section room.  Only cases for Surgical Pathology print at these locations and this defines the type of examination requested.  If the CRIS is not on either printer and not with the specimen(s), it is considered missing.
  2. Container labels:  All specimen containers must be legibly labeled with the following:
  • The primary container must include at least two (2) patient identifiers.  The first identifier must be the patient name and the second may be the medical record number (MRN) and/or date of birth (DOB).  A computer printed patient demographic label is preferred whenever possible.
  • SECONDARY CONTAINERS, including Softpath aliquots slides and digital images contain patient name, case number, and 3D barcode. Tissue blocks include printed case number and 3-D barcode that encodes the patient name, accession number and block designation.
  • The anatomic source of each specimen on each container.
  • A fixative label, once the sample is in fixative.  Most often this will be a 10% formalin hazard label.  
  1. CRIS/Specimen agreement:  The patient identifier labeling on the specimen containers must match that on the corresponding CRIS.  The anatomic source descriptions between the specimen containers and the CRIS will usually not match word-for-word, but the descriptions must be consistent.  The resident or attending pathologist must be consulted if there is a question about matching source descriptions.  During accessioning, the CRIS and all associated specimen containers are compared for proper labeling.  When either the specimen container label or the CRIS is missing or mislabeled, some corrective action is required.  See Specimen Problems below.
  2. Pathology case number:  At accessioning, a pathology number is assigned to the patient sample. That pathology number becomes the unique identifier for that patient, sample and date of procedure.  The pathology number is placed on the CRIS and any other paperwork, all specimen containers, tissue cassettes, and slides.  It therefore becomes the link to identify the patient and every sample taken from that patient per date of service.  See the SoftPath procedures for accessioning instructions.

SPECIMEN and CRIS REQUISITION PROBLEMS (Specimen Rejection Criteria and Suboptimal Specimen Handling)

Problems include: no CRIS requisition received; specimen container with no label; mismatching demographics; mismatching specimen source between the CRIS and one or more specimen containers; no tissue identified; etc.  In general, anatomic pathology specimens are not rejected for testing because they are irreplaceable and/or cannot be easily recollected.  However, any problems must be documented and corrected as the in-house resident, attending pathologist, and/or the Head of Surgical Pathology see appropriate.

a.     Missing CRIS orders: 

Verbal test orders are not accepted and it is not possible to accession cases until the CRIS number is received.  Therefore missing CRIS orders should be handled as follows:

The in-house resident and Histology staff will work together to identify cases with missing CRIS orders.  The resident must page the appropriate staff to get missing CRIS orders as follows.  Note:  make sure the responsible staff entering the CRIS know to designate the order for Surgical Pathology.

      1. OR samples:  page the Fellow listed on the OR schedule or page the On Call Surgery Fellow
      2. TIL samples: page the On Call Immunotherapy Fellow
      3. Urology (UOB) samples:  page Dr. Metwalli, Dr. Pinto, or the On Call UOB Fellow.
      4. Heme/Onc samples:  page the hematopathologist or her staff so they can contact the relevant parties.
      5. Clinic specimen: these are dropped off to the Histopathology lab by Escort Services and they cannot help with CRIS problems.  Look up the patient in CRIS via the MRN.  Contact the primary physician listed.
  2. If the physicians cannot be reached or they do not generate a CRIS order, the resident must notify the attending surgical pathologist.  Histopathology cannot discard a specimen once it is in the laboratory unless approved by the Director, but the specimen can be returned to the clinic/OR if repeated attempts to get a CRIS fail.
  3. When the CRIS is received, the Histology staff will accession as usual, but the delayed CRIS problem will be documented in SoftPath as specified in the SoftPath procedures.

b.     Mislabeled or unlabeled specimens:

For practical considerations, if a case consists of one specimen container, and it is otherwise complete except for the anatomic source on the specimen container, the case is not held for verification.  The Histology staff will accession using the specimen source listed on the CRIS and flag the labeling problem in SoftPath.  The in-house resident should include in the dictation that the specimen container was labeled with the patient’s name, but not with an anatomic source. 

All other labeling problems should be handled as follows: 

  1. The Histology staff will hold the specimen (s) aside without accessioning it and notify the grossing resident and/or attending pathologist immediately.  Keep unfixed samples refrigerated.   
  2. The Hotseat resident must contact the service that generated the sample.  Use the same contact list as for a missing CRIS orders (see above).  Most problems like left side/right side discrepancies will require that the surgeon, clinic physician, or designee come down to the Histology lab to fix the error and initial the correction.  Specimens with the wrong or missing patient label must be corrected with new patient labels supplied by the service that generated the sample.
  3. If the physician cannot be reached or they do not correct the problem, the resident must notify the attending pathologist.  If the specimen is not fixed, the pathologist may opt to place in 10% formalin, even if it is unclear what testing was intended.
  4. When the labeling is fixed, the Histology staff will accession as usual and flag the problem in SoftPath as specified in the SoftPath procedures.

c.     Specimen Quality Problems:

Such problems include inappropriate fixation; delayed fixation; delayed delivery; leaking container; desiccation; no tissue seen in the specimen container; badly damaged blocks; shattered slides; etc.  Receipt of such specimen does not necessarily preclude its histologic examination, but may limit its suitability for ancillary studies and diminish its clinical utility.   Such problems should be handled as follows:

  1. The Histology staff will notify the in-house resident and/or attending pathologist immediately.  Keep unfixed samples refrigerated.
  2. The resident, together with the attending pathologist, will be responsible for determining how the specimen should be further processed.  In all cases, the requesting physician should be notified of the problem.  If applicable, Escort Services (301-496-9295) must be contacted and educated so as to avoid repeat errors.
  3. If the pathologist wants to proceed with case, the Histology staff will accession as usual and flag the problem in SoftPath as specified in the SoftPath procedures.
  4. The resident must document the specimen condition as it was received and what corrective action was taken.  This should also be dictated with the case so as to become part of the medical record.  If no tissue is present in the specimen container, the specimen is dictated as “no tissue received in the container.”

d.      Unclear test orders:

The Histology staff will notify the in-house resident and/or attending pathologist immediately.  The pathologist will be responsible for clarifying any unclear orders, including contacting the service that generated the sample, if needed.  The resident must document the corrective action taken and may include this in the case dictation.  Use the same contact list as for a missing CRIS orders (see above). 

INCIDENT REPORTING

As indicated in this procedure, many problems can be flagged in SoftPath by the person accessioning the case.  These flags are captured and reviewed by the QM Committee so as to identify trends that can be corrected.

Any problems that cannot be adequately captured in SoftPath must be brought to the attention of the Histology supervisor.  These will generally be labeling and specimen quality problems.  The supervisor is responsible for reporting such problems using the Quality Improvement and Assessment Log.  The incident report must be submitted to the Clinical Laboratory Manager as indicated in the QA/PI Problem and Variance Report procedure.

SPECIMEN RETENTION TIMES

Empty specimen containers are held in the event that the demographics need to be checked.  These contain no remnant tissue or formalin.  They are kept in burn boxes labeled with the resident’s name and the date they can be discarded.  The boxes are held for one month after the resident’s rotation is complete.

Specimen containers with remnant tissue in fixative are stored in the Histology lab storage room for the month that the resident is on grossing rotation, as well as a minimum of another month before being discarded.

Paraffin blocks and glass slides are not discarded. CRIS orders and associated accession paperwork are kept for two years.

Additional information regarding specimen collection of fresh and fixed specimens as posted in the LP website is abbreviated as follows:

FRESH SPECIMENS

  • All fresh specimens received from the Operating Room should be received in Room 2C533 with the proper identification labels.
  • Each specimen must be recorded in the log book.  All paperwork should be placed with the specimen or with the specimen log book
  • The labels should include: name of the patient, unit number, tissue type, number of the specimen and site.
  • Each container should have two identification labels.
  • Fresh specimens should be placed in the refrigerator labeled “For Surgical Pathology Specimens” in Room 2C533.
  • For specific questions regarding specimens, contact the General Surgical Pathology Office (301) 480-8470.
  • For any questions after 5:00 PM, please contact the On-Call Resident through the page operator (301) 496-1211. The Resident may instruct you to place the specimen in 10% formalin (see instructions below)

 PREVENT SPECIMEN AUTOLYSIS:

  • To prevent autolysis of fresh samples (without fixative) or drying out too quickly, it is important to keep them cold (20C to 80C).
  • 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.
    1. To prevent small samples, such as needle core biopsies from drying out too quickly, place in Teflon pad and wet with cold (20C to 60C) saline.
    2. Small curettage collections may be wetted with a very small volume cold saline, if necessary, if there is no blood of body fluid present from the collection process.

      NEVER USE WATER OR WARM SALINE!

    3. During transport, place the specimen container in a zip lock bag 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.

FIXED SPECIMENS

  • Specimens obtained in the clinics should be fixed in formalin unless otherwise specified and brought to the Histology Laboratory, Room 2S259.  Specimens without requisition forms will not be processed until proper identifications of the specimen are received in the laboratory.
  • Containers should be properly identified with labels showing name, unit number of patient, type of specimen, site of biopsy.
  • Containers filled with formalin should have a label identifying the fixative (10% of formalin).
  • Infectious Specimens should be properly labeled and bagged.

INSTRUCTION FOR SUBMITTING OUTSIDE MATERIAL

  1. Please make sure you have all the material (slides and/or blocks) and corresponding outside pathology reports.
  2. Please place a CRIS order ONLY, if the patient has an NIH Medical Record Number.
  3. Fill out an outside material requisition form ONLY, if the patient does not have an NIH Medical Record Number.  Forms are available in the Central Accessioning Area (2S262).
  4. Provide all the pertinent information requested on the outside material requisition form.
  5. Leave material (slides and/or blocks with the accompanying paperwork on the front desk in the receiving trays, in the Central Accessioning area (2S262).
  6. Specimens should be submitted unfixed, in a sterile container, suspended in sterile normal buffered saline or tissue culture media (RPMI). The container should be labeled with the patient’s name, NIH identification number, and the identity of the tissue biopsy site. The specimen should be adequate in size to permit preparation of routinely fixed and processed material for histological examination, as well as frozen section, histochemistry and/or flow cytometry.
  7. A CRIS Requisition for Anatomic Pathology Services must be completed for all submitted specimens, according to NIH guidelines. Under "Special Instructions", indicate the need for Lymphocyte Surface Marker studies and state the NIH protocol and need for evaluation of particular antigens, if required; e.g. please evaluate for expression of CD20 or CD25.  
  8. In order to facilitate expeditious processing of fresh tissue specimens, biopsies may be delivered in person to the Hematopathology Section Laboratory by NIH clinical staff or the NIH Tissue Procurement staff prior to completion of the CRIS requisition. In such instances, the NIH protocol and need for special studies may be communicated verbally.
  9. The CRIS requisition should be completed as soon as the operative procedure is completed, within 1 hour.
  10. Physicians are encouraged to consult with the staff of the Hematopathology Section regarding any specialized testing required. (Dr. Elaine S. Jaffe, Chief of Section and Medical Director, 480-8461, or Dr. Stefania Pittaluga, 480-8465).  The Hematopathologist on service can be reached through the Hematopathology Section Office, 3S235, 301-480-8040.  Questions regarding delivery of specimens may also be directed to Medical Technologist, Theresa Davies-Hill, 480-8462. The Hematopathology Fellow on Service may be reached through the Section Office, 480-8040.  The Hematopathology Fellow will assist in the preparation of specimens for analysis. Therefore, special requests should be discussed with the Hematopathology Fellow prior to submission of the tissue specimen.
  11. Results of Immunohistochemistry will be considered in the context of the routine histological findings, and included in surgical pathology report.

Processing of Outside Fresh Lymph Node Biopsy
Specimens for Immunohistochemistry for Protocol Evaluation

Under certain circumstances, biopsies may be performed outside of the NIH and submitted for surface marker analysis for NIH protocol evaluation. Fresh or snap frozen tissue specimens should be accompanied by routinely processed slides and/or paraffin blocks for routine histological evaluation, in concert with special studies.

If the biopsy is performed in the Washington, D.C. area, it may be submitted in sterile saline or tissue culture media, according to the guidelines outlined above for NIH biopsy specimens. The tissue should be delivered to the Hematopathology Section, Building 10, Room 2S237 within 6 hours of removal. If it cannot be submitted fresh within the time limit, it may be snap frozen according to the procedure listed below.

Snap Freeze procedure:

1. Intact lymph node (or other involved site) should be sectioned at 2-3 mm intervals.  For immunohistochemical confirmation of phenotype in a patient with an established diagnosis, needle core biopsies may be used if an excisional biopsy cannot be performed. LP/NCI must have the original diagnostic biopsies for review, if needle biopsies are to be used for protocol evaluation.

2. A representative cross section of the lymph node should be snap frozen in OCT embedding compound (using a cryomold, if possible).

3. Freezing should be performed in liquid nitrogen bath or freezing bath of dry ice and 2-methyl butane (temperature -70 °C or less).

4. Wrap frozen block in aluminum foil and place inside zip lock bag.  Label specimen with patient's name and institutional surgical pathology number.  Hold at -70° C until shipping.

5. Ship specimen by overnight express on dry ice. Pack securely in styrofoam shipping container containing 15-20 lbs of dry ice.

6.  In addition to snap frozen specimen, submit:

    1. H&E stained slides of fixed, paraffin embedded tissue to be retained by NCI.
    2. Representative paraffin block or 12 paraffin embedded recut slides on charged slides for immunohistochemistry/ in situ hybridization.
    3. A copy of the outside surgical pathology report for all specimens submitted.

In order to avoid delay in performing immunohistochemical studies, please submit the above materials at the same time as the frozen tissue. We cannot perform immunohistochemical studies until we have reviewed the routine H&E stained slides of the submitted material.

7. Notify NIH staff physician in advance of shipping, and indicate that someone will be available to receive tissues. .

        8. Complete an NIH Tissue Examination Form and submit with all materials to the Hematopathology Section Office,
        10/3S235.  

TISSUE RESEARCH PROCUREMENT

All specimens removed during a surgical procedure must be reviewed grossly by a Pathology Attending, Resident or Pathologists' Assistant before being released for research to ensure that sufficient diagnostic material required for the clinical care of the patient has been submitted for clinical pathology evaluation.  This includes any specimens that are divided in the Operating Room, but does not include protocol-driven needle core biopsies.  Specimens must exit the operating room suite via the Frozen Section Laboratory (Room 10/2C533) and a representative from the pathology department should be contacted.

Please page the procurement pager (10332) to review the specimen in the Frozen Section Laboratory, before the research specimen is released.  If the specimen is time sensitive, please call early to coordinate quick release.  If a critical research specimen requires prompt transport to the lab, the pathologist can be notified prospectively to make appropriate arrangements.

The intra-operative consultation resident will serve as a back up in emergency situations and the on-call resident will assist after hours and holidays (NIH pager operator, 496-1211)

Research material will not be released unless a CRIS order has been placed for research.  This form must be signed by the researcher picking up the tissue and a representative from the pathology department who releases the tissue.  The Request & Certification for Research Procurement of Human Biological Materials (Medical Records form NIH-2803-1) is used during CRIS downtime.    Refer to Medical Administrative Series M01-2 for more details.


BIOLOGICAL SAFETY

UNIVERSAL PRECAUTIONS ARE TO BE FOLLOWED AT ALL TIMES

There is some danger of infection from handling the diseased tissues removed from patients that are examined in Surgical Pathology.  The danger is relatively small, however, in that the organisms are generally not aerosolized in the process of their examination.  Furthermore, the air turnover in the gross rooms is high and is designed to carry away any concentration of infectious agents.  The resident will have to use his/her own judgment as a physician about the degree of danger involved in handling an individual case.

The following suggestions are made for the safety of the house officer:

  1. Tissue should not be picked up with the bare hand.  Disposable gloves and aprons are available for use in the gross room.  Laboratory coats should be worn at ALL times when processing specimens.

  2. If there is some question regarding the infectious nature of a specimen, it is prudent to put on a mask.  Disposable masks are available in the gross room.  Ask the attending on rotation or the Histology Supervisor.

  3. Should a cut or any injury occur during processing, the histotechnologist and/or the resident should immediately notify the Section Chief, and in his absence, Dr. Barr should be notified.  The resident should go immediately to OMS to seek medical attention and to report the incident.

  4. The faculty member on service should be consulted promptly before the handling of a case that is considered to be highly contagious.  An example of this would be an untreated open tuberculosis cavity.

  5. After the handling of an infectious case, the resident is responsible for cleaning up the area in which the specimen was handled.  In general, one should try to spread out disposable materials prior to the grossing of the specimen so that they are readily available and may be disposed of promptly.

  6. The materials used for gross examination: razor blades, scissors, probes, rulers, photographic equipment, cryostats, etc. should be kept clean.  Disposable items should be used where feasible, and non-disposable items must be cleaned.  Disposable items should be discarded following Universal Precautions.  Special attention should be given to specimens from patients with tuberculosis, hepatitis or the acquired immunodeficiency syndrome (AIDS).  Instructions from the Center for Disease Control are to handle hepatitis B and C and AIDS specimens in a similar fashion.

Specimens from AIDS patients are to be transmitted to pathology only after being double-wrapped in plastic and labeled “CAUTION”.  These specimens are to be opened only under a hood.  Pathology personnel should employ masks, double gloves, and disposable aprons in the handling of all tissues and body fluids from the patients.  Tissues, smears, and slides are to be placed in formalin as soon as possible.

Tissue sections and/or slides should not leave the processing room and should not go to the histology laboratory without prior formalin fixation.  All gloves, masks, etc., employed in the tissue analysis should be disposed into plastic bags in the processing room (without exiting the room prior to de-robing) and placed into the biological waste disposable cans.  All surfaces and instruments used in processing the tissue should be cleaned with 10% sodium hypochlorite (bleach).

Although there is some biological hazard in the handling of fresh specimens, careful attention to detail should prevent any major infection in a healthy individual.  Indeed, generations of pathologists have practiced surgical pathology without a high rate of infections.
Last updated by Chinquee, Joseph (NIH/NCI) [E] on Dec 26, 2023