Specimen collection, handling, and results reporting are critical to the accuracy of results and patient safety. Surgical Pathology Section of the Department of Pathology at UMMC in Jackson, MS will only accept biological specimens from qualified personnel. Our definition of qualified personnel is to include only the following individuals: Physicians, nurse practitioners, and other persons, as authorized by institutional policy and Mississippi law, i.e., in possession of a valid Mississippi license issued by the Mississippi Board of Medical Licensure.
- Specimens must have a valid order submitted and collected
- Adequate patient identification information, at least two unique identifiers (e.g. name, MRN, location or a unique specimen accession code), patient sex, date of birth or age.
- A brief clinical history, operative diagnosis, surgical procedure
- The date and time specimen was removed, source or site of the surgery.
- Name and telephone/pager numbers of the physician, legally authorized person ordering the test, or name and address of the laboratory referring the specimen.
- Test requested (frozen/ intraoperative consult, electron microscopy, immunofluorescence, cytogenetic work up and others
Routine surgical specimens will be submitted in properly labeled containers completely filled with 10% buffered formalin. The volume of formalin should be at least 10 times the volume of the specimen. Large specimens which are difficult to fix should be carried to the laboratory as soon as possible. The 10% buffered formalin can be obtained from Surgical Pathology. Each formalin container must have formalin warning labels affixed, proper patient identification labels, type of tissue and any BIOHARZARD precautions.
Specimens Submitted for Rapid Diagnosis / Intraoperative Consultation
Frozen sections, touch preparations, gross examination of specimens should be delivered fresh in a separate labeled container. These must be delivered immediately to the laboratory. The time of removal together with the proper information must be included on the order form.
Specimens needing other than routine fixation
Hematopathology triage should be submitted immediately after removal and in the fresh state to the pathologist-on-call. Examples of this include: lymph nodes for lymphoma workup, kidney and muscle biopsies.
Labels on the specimen containers will have the following information:
- Patients name (Last, first, middle initial).
- Patient’s identification numbers (Medical Record Number is essential; Encounter Number is desirable).
- Origin of specimen.
If multiple specimens are removed, each should be placed in a separate container with proper labeling.
The specimen container(s) will be brought to the Surgical Pathology section of the Anatomic Pathology Division, Room N208. Specimen(s) will be inspected as quickly as possible upon arrival. Complete information, as outlined above, is required before specimens will be accepted for processing.
A rush biopsy is a specimen in which the clinician needs a diagnosis on the same day as submission. Indicate clearly on the order if rush results are desired.
A STAT biopsy is a specimen that the clinician needs a diagnosis before 8:30 am on the morning following tissue submission. Indicate clearly on the order if a STAT result is desired.
Muscle Enzyme Histochemistry: call the laboratory before specimen delivery (see below)
- The laboratory should be notified 24 hours before delivery of the specimen. Please call (984-1543) between 8:00 AM and 1:00 PM, Monday through Friday. Inform the UMC technologist about the patient's name, the biopsy site, the originating institution or laboratory, laboratory phone number, the name of the person giving technical information, the name of the patient's physician, and how the specimen will be shipped (e.g. couriers, Federal Express, etc.)
- Desirable Specimen Size
- Two strips of muscle, each 1cm in diameter and at least 2 cm long, should be submitted. To optimize the appearance of the muscle in section, the biopsy surgeon should fasten these strips of muscle on a tongue blade with sutures at each end of the tissue. Notches can be made in the rounded ends of the blade to facilitate the stabilization of the muscle in a slightly stretched position. This is done to prevent any contraction. Contraction artifact, especially at the ultrastructural level, is a major hindrance to biopsy interpretation.
- Preparation for Shipment:
Tongue blades with the two strips of muscle should be -placed on a saline moistened gauze and wrapped to prevent drying.
Be sure to SQUEEZE excess saline solution out of the gauze before wrapping the specimen. DO NOT TOTALLY IMMERSE THE TISSUE IN SALINE OR PLACE DIRECTLY ON DRY ICE. Severe artifacts will result.
Please DO NOT ATTEMPT TO FREEZE THE TISSUE IN THE FREEZER (i.e. at 4o centigrade), because ice crystallization artifact will c occur.
Place the tissue, wrapped in the saline-moistened gauze, into a specimen cup.
Label the specimen cup with patient's name, date, institution or laboratory, and insert the cup into a polyethylene bag.
Keep the bag on crushed ice (NO DRY ICE!) to keep cool during transportation.
DO NOT EXPOSE THE SPECIMEN DIRECTLY TO FORMALIN, OR EVEN TO FORMALIN VAPORS, OR THE DETECTION OF HISTOCHEMICAL ENZYMES WILL BE IRREVOCABLY ALTERED.
Paperwork - Please complete the form provided, including any pertinent historical, laboratory (e.g. CPK enzyme levels), and EMG data. Enclose this form with each muscle biopsy sent to our laboratory.
Specimen Delivery - Muscle biopsies from local hospitals are delivered by courier. The courier should bring the specimen to the University Of Mississippi Medical Center, Department Of Pathology, Gross Room, located on the second floor of the north wing of the main hospital. Laboratory is in Room N208.
ADDRESS SPECIMEN TO:
UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
DEPARTMENT OF PATHOLOGY
2500 NORTH STATE JACKSON, MS 39216
If at any time you have questions, please call the histology laboratory, between 8:00 and 1:00 p.m. Monday through Friday.
Breast Specimens: The following information must be clearly stated on the orders:
- Collection date and time
- Time in formalin
- Clinical history
Kidney Biopsies: Place biopsies on a saline dampened Telfa pad and deliver immediately to N208.
Hardware: Formalin is not required. Hardware will be returned to the orthopedic service upon request
Bullets: Bullets, bullet fragments, and pellets are not received in the laboratory. Call campus police for retrieval.
Lymph nodes: Deliver fresh to N208 immediately after collection if lymphoma protocol is desired.
Frozens: Deliver immediately to N208 in a fresh state. Clearly indicate on the order that the specimen is for frozen sectioning.
Fresh Samples: If the sample requires testing that indicates a sample must be received fresh, place small tissue fragments on a saline dampened talpha pad to prevent the drying and hardening of the tissue.
- Advise patient that possible pain, numbness and infection may result from the procedure.
- Remove the sural nerve from the ankle starting at the lateral malleolus and extending 2.5 inches superiorly. Avoid biopsy of the adjacent saphenous vein.
- Avoid traumatizing the nerve during dissection.
- Cut the nerve using a scalpel while placing a tongue depressor under the nerve.
- Remove a 1.5 inch piece and signify the proximal portion by tying a suture on it.
- Place nerve on the tongue depressor.
- Cut off 0.5 inch from each portion of the nerve.
- Identify distal and proximal ends and place on a saline MOIST 4x4 sponge.
Specimen rejection criterion
Accurate patient identification must be established along with accurate date of collection and name of the person collecting the specimen must be provided before the specimen can be processed in the laboratory. The clinician must be able to validate the criteria that can establish uniqueness and secure linkage to the correct patient.
Specimens will not be accepted for processing in the laboratory under the following situations:
- Lack of Surgical Pathology orders
- Specimen container lacking patient name and/or unique identification numbers. At least two patient unique identifiers must be present on all specimen labels and containers. Acceptable identifiers include but are not limited to patient name, date of birth, medical record number, social security number, and accession number
- Epic order lacking patient name and/or unique identification number
- Specimen container and specimen order labeling discrepancy
- Lack of requesting authorized physician or other authorized medical provider
- Unlabeled specimen containers
- Unclear test orders