The histology department is based on the Cheltenham General Hospital site with a hotlab for frozen sections on the Gloucestershire Royal Hospital site. The department is accredited to ISO 15189:2012. Accreditation is limited to those activities described on our UKAS schedule of accreditation found at UKAS.com. Our UKAS reference number is 9577.

The Histology Department

The histology department is based on the Cheltenham General Hospital site with a hotlab for frozen sections on the Gloucestershire Royal Hospital site. The department is accredited to ISO 15189:2012. (Please note: our accreditation is limited to those activities described on our UKAS schedule of accreditation found at UKAS.com') It provides a fully comprehensive diagnostic service, handling around 40,000 requests per annum, sent from a variety of locations within the region; including hospital theatres, clinics, GP surgeries and private hospitals. The vast majority of these are sent as routine histopathology specimens, for which no prior arrangements need be made.

Technical staff are on site Monday to Friday, 08:00 to 16.30, with the office manned under normal circumstances until 17:00. To contact the laboratory please see the Contacts & advice service page.

If an emergency arises outside these hours then please refer to the Out of hours services section.

Death advice

A death advice service is available, please contact the histopathology office on 0300 422 4075/3316/3313

Example of a completed Histology request form

Guidance and an example on a completed Histology request form is available here.

Specimens

Histopathology specimen requirements:

The majority of specimens for histopathological analysis require fixation by formalin. Please be aware that this is a hazardous chemical and requires the correct personal protective equipment. If you require any COSHH or risk assessment data please contact the laboratory, or read this formalin health and safety data sheet. We are happy to discuss any training requirements with you or your team. Please contact our training officer for further information.

For smaller specimens, pre-filled yellow pots containing formalin can be obtained from pathology stores. A selection of larger pots and buckets, which are not pre-filled, are available for larger specimens; these can be obtained by contacting histology reception.

To ensure adequate fixation and to avoid any delays, please ensure that the pot is big enough for the specimen. Allow enough room for the specimen and an adequate amount of formalin to cover the specimen. Once received in the laboratory, fixation times will vary depending on the specimen type and size of the specimen, but in most instances, requires a minimum of 24 hours prior to analysis. This can affect turnaround times.

We aim to have a turnaround time of 14 days for routine histology specimens. If you will need a report urgently please contact the laboratory.

*PLEASE NOTE, TURN-AROUND TIMES MAY BE AFFECTED BY COVID-19.*

For instructions on correct sample labelling please refer to the sample labelling and request form. Please note that inadequately/insufficiently labelled specimens will not be accepted. This will cause delays in obtaining a patient result.

For instructions on the correct use of cell safe capsules for small biopsies please refer to the Cell Safe SOPcell safe SOP

For information on transport of Histology specimens please refer to Specimen storage and transport to laboratories

If you require information regarding the uncertainty of measurement please contact the laboratory.

Frozen sections

A service for frozen sections is provided on both the Cheltenham General and Gloucester Royal sites. The hotlab at Gloucester Royal is not routinely staffed so whenever possible frozen sections must be booked in advance; If this is not done there may be a delay whilst a member of staff travels from Cheltenham General Hospital. In order to book a frozen section, please telephone the histology office with patient and specimen details. (NB – high risk biohazardous tissues are not suitable for frozen sections. These include tuberculous lesions, specimens from patients with viral hepatitis and patients who are known HIV positive). Please contact the laboratory if there is uncertainty regarding this procedure.

It is realised, however, that occasions will arise when the request is unforeseen. In these cases the laboratory must be informed before the specimen is sent, and if outside normal laboratory working hours an “out of hours” consultant must be contacted via switchboard prior to taking and sending the sample

Tissue must be sent fresh and unfixed: DO NOT PLACE IN FORMALIN.

Specimens must be delivered into the hands of a member of the histopathology staff. Do not leave frozen sections at pathology reception as delay may ensue.

A verbal report will normally be given within 30 minutes of the arrival of the specimen, although complex cases may take longer.

Renal biopsy

A renal biopsy service is operated from Gloucester Royal Hospital, which requires scientific staff to attend the procedure on the ward. This MUST be arranged in advance by contacting the histology office. A report will take at least 10 days as electron microscopy is required.

Immunofluorescence

Please note: this test is not currently included in the ISO 15189:2012 accreditation.

The department provides an immunofluorescence service for skin and renal specimens. The laboratory will provide the transport containers for these specimens – please contact histology reception to request these prior to taking the specimen.

DO NOT PLACE THE SPECIMEN INTO FORMALIN

Special Techniques

The histopathology department offers a special techniques service to enhance and assist in the diagnosis of disease.

For further information please contact the section lead

Immunocytochemistry

The department has an expansive repertoire of antibodies for routine testing to aid the diagnosis of disease. Any tests not offered in-house are sent away to an external ISO accredited laboratory for testing; this can therefore impact turnaround times.

For further information please contact the section lead

HER 2

Please note: this test is not currently included in the ISO 15189:2012 accreditation.

The department offers a HER 2 immunocytochemistry service for breast cancer, performing in excess of 700 tests per annum. All testing is performed in accordance with national guidelines. Reflex testing by FISH and HER 2 testing in gastric cancer is currently outsourced to an external ISO accredited laboratory for testing.

For further information please contact the section lead

ISH

Please note: this test is not currently included in the ISO 15189:2012 accreditation.

The department offers testing to detect the presence of Epstein Barr Infection (EBV) to aid in the diagnosis of some cancers. Testing is performed by in situ hybridisation (ISH).

For further information please contact the section lead

Non-gynaecological

The department offers a non-gynaecological service. This service involves processing and analysing samples taken from any body site (other than cervical) to provide a diagnosis for patients with suspected disease.

Rapid on-site evaluation of fine needle aspiration (FNA) cytology samples

The Histology department provides a rapid on-site evaluation of fine needle aspiration (FNA) non-gynaecological samples for the ear nose and throat (ENT) clinic. This is held at the ENT outpatient department at Cheltenham General Hospital every Friday between 8.30am and 12.20pm.

The ENT Clinic is responsible for the management of this service. If the clinic is cancelled, the Histology department must be informed on 0300 422 4219.

The clinic is attended by qualified biomedical scientist staff. Stained smears from FNA samples are assessed by the biomedical scientist for adequacy while the patient is in the clinic (minimum of 6 groups of 10 cells in thyroid and salivary gland FNA’s, or lymphocytes present in lymph node FNA’s). This enables the clinician to repeat the FNA if the sample is assessed as inadequate.

Adequate samples are taken to the Histology department by a member of staff from the clinic, to be assessed by a pathologist. A preliminary diagnosis is then given to the clinician over the phone if possible. This should enable the patient management to be planned the same day with the patient and clinician.

Reporting of routine non-gynaecological samples

Routine non-gynaecological samples will be reported within 5 working days.

In cases when more complex pathology requires further laboratory investigations or referral for expert opinion, a provisional report will be issued within the above time scale to be followed by a further complete supplementary report.

Reporting of urgent non gynaecological samples will be reported within one working day of receipt.

For a sample to be treated as urgent, the laboratory must be notified on 0300 422 4219.

Non-gynaecological (general) tests and samples

All samples must be accompanied by a yellow non-gynaecological cytology request form. The completion of the form and the labelling of the sample must conform to the pathology policy on specimen labelling. For full details please see Policy for the Labelling of Specimens and Request Forms By Pathology Service Users.

Useful links

The following links will take you to non-gynaecological sample specific information. If you do not think your sample falls in to any of these groups or are otherwise unsure, please contact non-gynaecological lead Richard Butt on 0300 422 3850.

Breast Fine Needle Aspiration Cytology

Bronchial Lavage/Washing/Trap Cytology

Brush Cytology

Cerebrospinal Fluid (CSF) Cytology

Sputum Cytology

Fine Needle Aspiration of Thyroid, Head and Neck and All Other Sites Except Breast

Fluid Cytology

Urine Cytology

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