Cytology
Histopathology is the examination of biopsy or excision material taken from a patient to detect and diagnose disease, disease progression or response to treatment. The Histopathology department at University Hospital of North Durham receives over 35,000 requests a year. It serves three acute hospitals and GP's from the County Durham region, as well as samples from dental practices and private healthcare facilities. The laboratory holds UKAS accreditation for ISO 15189:2012.
Routine specimens
All routine specimens for histological examination should be placed as soon as possible into 10% neutral buffered formaldehyde solution (this can be obtained from the Histology Department). The specimen to fixative volume ratio should be approximately 1:20, therefore specimens should always be sent in an appropriately sized container. Please note that this ratio may not be achievable for larger specimen types. Specimens unable to be sent to the laboratory the same day should be left in fixative at room temperature (not in a refrigerator). Please note that specimens unable to be placed in fixative should be stored in a dry pot and kept in a refrigerator (not at room temperature) for a maximum period of 72 hours. Instructions for completing request cards can be found here. Ice forms can also be used and must be completed in full.
Turnaround times
- For urgent frozen section specimens - results will be telephoned back, usually within 30 minutes of receipt of the specimen within the laboratory (a typewritten report will follow subsequently).
- For formalin fixed specimens turnaround time depends upon several variables including the specimen size and type, time of receipt etc. These affect fixation and processing schedules. Please discriminate very carefully any specimen on which an urgent report is required - specimens identified as such have a marked knock-on effect onto ALL of the rest of the laboratory activity and will therefore affect turnaround time for the rest of your biopsies.
The histology department works towards the following turnaround times
- 7 days - Urgent cases
- 14 days - Cancer two week wait
- 21 days - non-urgent cases
The above times relate to the interval between the specimen being taken and the report being signed and verified by the pathologist.
Quality assurance schemes
The department participates in number or EQA schemes for routine, special stains and immunocytochemistry.
Specimen packaging & transport
Histology containers should be placed in either the sealed wallet attached to the request card, or within a clear bag. The request card and the first sealed bag should be placed into a second bag and sealed to avoid contamination of the request card.
At Bishop Auckland General Hospital and Darlington Memorial Hospital, yellow top specimen containers are able to be carried (without the use of a trolley) to the pathology reception where they will be placed in the inter-site transit bags.
At University Hospital of North Durham, all specimens should be directly delivered to Cellular Pathology during opening hours, or Pathology Specimen reception outside of opening hours.
At all sites, pathology specimens in a white specimen bucket must be transported to the pathology laboratory via the use of a solid wheel based trolley. Formalin containers should not be transported within patient/visitor lifts, and if large quantities, should be transferred in an unoccupied lift to prevent over exposure to Formalin.
Histology Specimens must NOT be transported through the Air POD system.
Specimens should be placed in a central area and will be collected via the trust courier system who use dedicated pathology transit containers
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Transit via DMH |
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Monday-Friday Shotley Bridge - 08:30 and 17:00 Chester-Le-Street - 10:00 and 14:30 Saturday Shotley Bridge - 11:45 Chester-Le-Street - 11:00 Richardson - 09:45 Sunday No dedicated transport from community sites. A request can be made for to the Trust Courier service by contacting 01325 743552
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Monday - Friday Richardson - 16:45 Sedgefield - 11:30 and 15:30 Weardale - 13:30 and 15:45 Saturday & Sunday No dedicated transport. |
Note: If a courier is not available, provided the samples have been placed within Formalin, they are stable to wait for the next transit.
Histology samples are classified as a Category B Biological Substance and as such should be packaged as follows:
- Histology Pot sealed (Primary Packaging).
- The Primary Package should be placed within another bag or container with sufficient absorbent material to absorb the blood / formalin that can leak from the container (Secondary Packaging).
- The secondary packaging should then be placed within a box or rigid outer container that clearly shows the UN 3373 Hazard Diamond with the phrase Biological Substance Category B visible. The size of the diamond must be a minimum of 50mm on each side.
Cellular pathology turnaround times
What are turnaround times and how are they measured?
The local cellular pathology turnaround time (TAT) for each specimen type is defined as the time of the receipt of the specimen into the cellular pathology laboratory (located at UHND) to the time when the initial report is available to the requester. Cellular pathology TATs targets are agreed with our service users.
Why are cellular pathology turnaround times longer than other areas of pathology?
Every histopathology specimen must be examined macroscopically and dissected by an appropriate member of staff in the laboratory. After dissection, small pieces of the sample are placed into a tissue processor machine. These machines are vital for fixing the specimens in formalin and impregnating the tissue with paraffin wax. This is a process that usually occurs overnight and ensures the sample is stable enough to store and perform any kind of future testing.
What about urgent results?
Preliminary reports may be issued for urgent or partial results e.g. a simple report may be released within a couple days of receipt, but the results of any immunohistochemical testing or molecular testing may be available at a later date. If any further testing is pending, this information will be included within the preliminary report.
The department aims to release 80% of urgent results within 7 days.
The histopathologists examine every case prior to producing a report and may contact the requester when clinically appropriate. Andrology samples are examined and authorised by a Biomedical Scientist.
Any urgent request must be communicated to the laboratory by using the cellular pathology request card, or by phone call. See individual handbook pages for further details.
Turnaround Times in Cellular Pathology
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Pathway |
Average Measured TAT to completed report (based on June 2022) |
Average Measured TAT to completed report (based on June 2023) |
Defined TAT to completed report (agreed target) |
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Urgent Samples |
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Samples that have been triaged as "urgent" based on clinical details or following a clinician phone call to department |
73% in 7 days
95% in 10 days
100% in 21 days
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76% in 7 days
97% in 10 days
99.5% in 21 days
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80% 7 days
95% 10 days
100% 21 days
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Priority / 2 Week Wait |
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Samples that have been triaged as "Priority" or "2WW" based on clinical details |
76% in 14 days
92% in 21 days
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80% in 14 days
95% in 21 days |
80% in 14 days
100% in 21 days
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Routine Samples |
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Samples that have been triaged as "Routine" based on clinical details |
91% in 21 days
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85% in 21 days |
80% in 21 days |
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For more information regarding what types of specimens may be assigned a particular pathway, please see below:
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Urgent Samples - 7 day reporting target |
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Needle Core Biopsies
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Cervical Biopsies and LLETZ (CGIN, Invasive carcinoma, glandular abnormalities, SCC) |
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Endometrial for hyperplasia |
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Products of Conception - ectopic |
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Temporal Arteries |
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Vocal cord biopsy for cancer |
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?SCC on non-basic skin (e.g. anus, foreskin, genital, oral, etc.) |
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Incisional biopsies for ?MM |
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Melanocytic malignancy excisions (M5) |
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Cytology - e.g. Breast, lung, GI and head & neck (not urine and peritoneal washings) |
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Priority / 2WW - 14 day reporting target |
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Any specimen from under 16's (excluding appendix) |
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Any specimen labelled as 2WW |
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Bowel Cancer Screening Programme |
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M4, ?MM, LMM, Melanoma excisions |
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Incisional or punch biopsies for ?SCC, ?BCC |
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Vocal cord biopsy (non-cancer) e.g. Reinke's oedema, hoarseness |
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Bladder biopsies/chippings |
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Prostate core biopsies |
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Breast resection |
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Cancer colons |
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Cancer uterus |
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Cytology - urine and peritoneal washings |
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Routine Samples - 21 day reporting target |
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Appendix |
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Cervical biopsies and LLETZ (up to CIN3) |
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Endometrial biopsies |
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Endoscopic biopsies |
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Fallopian tubes and vas deferens (for sterilisation) |
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Femoral Head |
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Foreskin |
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Gallbladder (excluding malignancy) |
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Head and Neck biopsies (excluding malignancy) |
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Prostate chippings |
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Skin excision (including WLE MM Scar, BCC, SCC, benign) |
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Benign skin biopsies |
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Prolapsed uterus (resection) |
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Benign colon disease (resection) |
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Andrology sample for fertility |
Formalin-lite
UHND Histopathology have been making progress in delivering a system for eliminating large amount of formalin retained in theatres.
Formalin is a widely used tissue fixative that preserves tissue samples in as close to a life-like state as possible for accurate diagnoses. The major limitation of formalin is that it is hazardous (especially in large quantities) and is a controlled substance in the Trust.
To limit the amount of staff across the Trust exposed to formalin and produce a safer system of working, UHND Histopathology ran a trial period receiving benign organ resections and found the tissue received to be adequately preserved when it is refrigerated and reaches the department in no longer than 72 hours.
When sending samples to histopathology the specimen will require a yellow topped pot containing formalin or a white bucket.
If in doubt, please contact the department on: 0191 333 2446 to clarify which method would be most suitable for your specimen.
