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3.1 What are the minimum criteria for specimen reception and why are they essential?
Answer: Patient name, date of birth and unique identifier such as hospital unit number/Community Health Index number or National Health Service number is essential to positively confirm patient identity. Details must be given on both the request form and specimen pot to prevent mismatch and ensure correct diagnosis is given to correct patient. A clinical history is required enabling the appropriate investigations to be carried out. Assessment, dissection and selection of tissue for examination is based on the information given. Nature of specimen submitted confirms correct sample and dictates the standard operating procedure for handling. Specimens must be submitted in suitable container and fixative for investigations. Any risks to staff must be indicated on pot and request card allowing all safety precautions to be taken during transportation, specimen reception and subsequent handling.
3.2 What personal and environmental safety precautions should be in the dissection area?
Answer: All laboratory staff should be immunised against possible pathogens. They must use personal protective equipment which should be readily available and discarded after use in clinical waste bins provided. Gloves need to be changed regularly and hands washed before leaving the area. You should be aware of the Health and Safety issues of all chemicals in use and how to deal safely with spillages of chemicals and bodily fluids, chemical spill kits must be accessible. Downdraught ventilation is essential in the dissection area and must be monitored and maintained to ensure safety of all working within the area. All sharps must be disposed of in sharps containers. The area should be kept clean and tidy; adherence to safe working practices ensures safety of all staff.
3.3 What is the purpose of applying ink to specimens?
Answer: Surgical margins are critical to assessment of the disease process and the true margin may only be microscopically visible if marked in some way at time of dissection. This is usually by inking. Different colours can be used to identify different margins. For example different colours for anterior, posterior, inferior, superior, medial and lateral margins.
3.4 Do you understand common descriptive terms such as trabeculated, pedunculated, telangiectatic?
Answer: Trabeculated- a bridge or crossbar of tissue which forms an internal support or division within an organ, rod shaped projection. Pedunculated-supported on or growing from a peduncle/stalk. Telangiectatic- Vascular dilation of red/purple clusters giving “ spidery vein” appearance. NB. You may find it useful to build a glossary of universal terms used to describe commonly seen features.
3.5: Can you list the common benign and malignant lesions that occur in the breast? Do you know what surgical procedures are used to diagnose and treat these conditions?
Answer: Common benign lesions include fibrocystic change, fibroadenoma, hamartoma, papilloma, radial scar, complex sclerosing lesion, benign Phyllodes tumour, gynaecomastia (in men). Common malignant lesions include Invasive ductal carcinoma not otherwise specified is the most commonest followed by invasive lobular carcinoma. Rarer types exist including metaplastic, micropapillary, apocrine, secretary, malignant Phyllodes, angiosarcoma.
Procedures used to diagnose these conditions include fine needle aspiration, core biopsy, vacuum assisted biopsy, punch biopsy and diagnostic excision biopsy. Procedures used to treat benign conditions include vacuum excision and surgical excision. Procedures used to treat malignant conditions include wide local excision, mastectomy (which can be skin sparing, nipple sparing or simple in type), sentinel lymph node biopsy, lymph node sample, axillary lymph node clearance.
3.6 Why is it helpful to have a methodical approach to specimen dissection?
Answer: A methodical approach to specimen dissection is an important means of ensuring that specimen measurements, features and block taking are consistently recorded and that important items are not overlooked. Following SOPs for dissection of specific specimens gives guidance for how they should be handled methodically, which helps with subsequent microscopic assessment and writing of histology reports. It is also helpful should there be a need to re-visit a specimen for extra blocks as it will be easier to attempt to reconstruct the specimen. More succinct aide memoires are also useful in dissection, such as templates to follow for dictating measurements of lesions, distances from closest margins, the appearance of lesions and the presence of features such as necrosis. Photographs will give a visual record and can be used to annotate sites of block taking. It is also important to note down crucial information by hand, as a back-up, so that information is still available should the electronic dictation system fail.