Cellular pathology

Our cellular pathology service is based at Worcestershire Royal Hospital. All specimens should be sent directly to the laboratory at the Worcestershire Royal hospital.

We provide a comprehensive histology and cytology (including a consultant led FNA service), together with an operating mortuary.

The laboratory at the Alexandra Hospital provides a pre-booked frozen section service and an operating mortuary.

We have a consultant pathologist as our designated Human Tissue Act (HTA) individual for the trust.

Who's who and contact details

Lab locations and opening times

Availability of Clinical Advice 

Tests available

Surgical Histopathology

The majority of cases are reported by pathologists within the trust but the high workload in the laboratory sometimes requires us to send work out to an external source for reporting to enable turnaround times to be achieved. The work is sent to an agency known as Backlogs (where cases are reported by Pathologists based at UKAS accredited laboratories). The laboratory sends routine, non-urgent work only and reports issued will state where the cases were reported. Cases requiring molecular testing are sent to regional tertiary referral centres. Full details of which molecular tests are carried out and where can be obtained by contacting the lab directly. UKAS accredited HER-2 testing is now carried out in-house. Any formalin fixed tissue should be stored at room temperature prior to transportation to the lab - refrigeration is not required.

Please see the A-Z directory of tests.

Autopsy

We provide an autopsy service for the Alexandra and Worcestershire Royal Hospitals, and H M Coroner. These are performed at the Worcestershire Royal Hospital mortuary. Please ensure that the correct procedures are followed in obtaining permission for autopsy and transfer of the body to the mortuary. 

Clinical cytology

Sputum, urine, pleural fluid, ascitic fluid, fine needle aspirations, CSF(for tumour cytology). See test directory for further test information. If cytology is required from material from another origin it is advisable to discuss the case beforehand with the Cytology Laboratory to ensure optimal collection of the specimen. Any cytology specimens collected outside of routine laboratory hours should be refrigerated until they can be delivered to the laboratory during its normal operating hours and must be received within 48 hours of collection.

Fine needle aspiration cytology

Ward visits for the purpose of FNA can also be arranged. Technician attendance for slide preparation in ultrasound can be arranged by contacting the lab on ext. 39625. Provision of technical staff for the head and neck adequacy clinic is also available.

Frozen Sections Requests

These must always be arranged in advance with the WRH laboratory to ensure that staff and equipment are available. Frozen section specimens should NOT be placed in formalin but transported to the laboratory as soon as possible in a sealed and appropriately sized sterile container.

Biopsies for Immunofluorescence

Containers with the transport medium are available from the WRH laboratory.
Please place the specimen into special transport medium for immunofluorescence studies and send directly to the WRH laboratory.

Renal Biopsy

Tumour samples are processed in the lab. Electron microscopy biopsies are referred by the clinician to the Cellular Pathology Department at the University of Birmingham Medical School. Advice and instructions for taking, preservation and transport of the biopsy may be obtained from the medical school. The current request form for submitting these samples can be obtained here.

Early pregnancy loss

Products of conception – any tissue which may contain foetal parts, including ectopic pregnancies. The specimen and request form must be accompanied by a completed ‘Consent for Pathological Examination and Disposal of Tissue following early Pregnancy Loss’ form. Specimens received without a correctly completed consent form will not be examined.The link below will allow you to download a copy of the required consent form.

Products of Conception Consent Form

To ensure adequate fixation, the specimen bag must be opened before immersion in formalin.

Placenta

Worcestershire Royal Hospital - The department does not offer a diagnostic service for placental tissue. These specialist investigations are undertaken at the Pathology Department, Birmingham Women’s Hospital. The requesting clinician is responsible for ensuring that arrangements are made to transport the specimen.

Fetuses

Worcestershire Royal Hospital - The department does not offer an autopsy service for fetuses, or a diagnostic service for fetal tissue. These specialist investigations are undertaken at the Pathology Department, Birmingham Women’s Hospital. The requesting clinician is responsible for ensuring that arrangements are made to transport the specimen. The Bereavement Office arranges transport for the fetus to BWH via the Mortuary at WRH using contracted Funeral Directors.  It is expected that the Clinician has completed all the necessary paperwork and made arrangements at BWH for the autopsy. 

All requests for post mortem require both: 

• A Birmingham Women’s Hospital Consent Form for Fetal and Perinatal Autopsies. 

• A request for Pathological Examination of the Fetus/Neonate (form 2).

The above should both be sent to the Mortuary.

The WRH laboratory will investigate products of conception if a histology request form and consent form has been completed appropriately. 

Cytogenetics

The laboratory at WRH does not process or manage specimens for cytogenetics. For information about the requirements for genetic testing (type of specimen, etc) please contact the Regional Genetics Laboratory Service at the Birmingham Women’s Hospital. Please contact their department before sending; bwc.genetis.lab@nhs.net

REPORTS ARE ONLY AVAILABLE FROM THE REGIONAL GENETICS LABORATORY.

Specimen Transport

All specimens must be packaged in a sealed bag together with the appropriate ICE order form. If specimens are sent from outside WRH they must be packaged in a sealed bag and then transported in a sealed box conforming to UN3373.

There must be no interference with the specimen from source to the laboratory. 

Request forms

All cellular pathology requests must now be made on ICE.

Clinicians should ensure that the appropriate ICE request and specimen container are available before undertaking any biopsy procedures.

Request forms for Cytology

All cytology requests must now be made on ICE.

Urgent Requests – If this is required the requesting doctor should discuss with a Consultant Pathologist beforehand.
All specimens should be clearly marked Urgent for the laboratory to fast track.

Urgent Reports - WRH - If results are required urgently, the Consultant Pathologist should be contacted BEFORE the specimen is sent to the laboratory. Urgent results may be obtained by telephone from the Consultant Pathologist.

Completion of Request Forms

All requests must be made on ICE using the cellular pathology page or by using the options that have been added to your speciality page. Please ensure all essential fields are filled out correctly and that all patient identifiers are correct.

• Relevant clinical details are important
  It is essential that each specimen be accompanied by an appropriate clinical history. More detailed information may be required for specific specimen types and some of the more common are outlined below. Complex cases often benefit from discussion and the Pathologists are always happy to be consulted in advance.                                                     

• Previous operations and biopsies                                                               All previous requests for Histopathology should be listed even when their relevance to the current investigation is unclear. Such previous investigations are often crucial and are easily overlooked. The dates of these investigations should be given accurately together with the Laboratory number whenever possible.                                                                                                              

• Extra Copy to - The Laboratory will provide extra copies of reports to any destination indicated where these are necessary due to shared care by Consultants. The Laboratory will not be responsible for communication with GPs regarding the results of Hospital Investigations, this remains the duty of the Clinician.

The specimen must be clearly identified, with full patient and specimen details. Where a multi-part specimen (for example, endoscopic biopsies) are received with a single ICE request, individual specimens must be clearly labelled, to indicate the site from which each biopsy was taken.

Criteria for non-compliant specimens are as follows:

• ICE request and specimen container details do not correlate

• Patients name on ICE request form does not correspond with name on specimen container

• The specimens received do not correspond to those stated on the ICE request

• Insufficient clinical/specimen information on request form / specimen container

• Specimen container leaking

• Specimen received without a printed ICE request form

• ICE requests received without a specimen

• Specimen container empty

If the information on the ICE request form and/or specimen is inconsistent or incomplete, the specimen WILL NOT BE examined and the sender advised.

Turn Around Time

It is the departments aim to report at least 80% of all cases within 7 days of reciept and 90% within 10 days of reciept.  Major resections, complex cases and specimens requiring special techniques may take longer. Some cases require external referral to specialist centres which necessarily increases turnaround time; the department will endeavour to issue a provisional report in these circumstances as soon as possible.

High risk cases may take longer due to a delay in processing as they are left to fix for a further 24 hours upon receipt.

Protection of Personal Information

Worcestershire Acute Hospitals NHS Trust takes the security of personal information very seriously. Everyone working for the NHS has a legal duty to keep information about patients confidential.

Patients’ health information is protected through a number of measures; all Trust staff are required to:

a. Record patient information accurately and consistently

b. Keep patient information private

c. Keep patient information physically secure

d. Disclose and use information with appropriate care

Any breaches of security or incidents relating to Information Governance are investigated, actioned and reported via the Trust’s Governance Structure.

In order to support our staff in ensuring personal information is kept securely the Trust have a number of policies which set out the requirements staff must fulfil when accessing or sharing personal information. Furthermore, all staff receive Information Governance Training which includes topics such as information security, confidentiality and data protection.