Anatomical pathology laboratory processes
This article gives an overview of anatomical pathology laboratory processes, simply lab processes.
Processes
- Accessioning.
- Laboratory assistant:
- Data entry - clinical history.
- +/-Case assignment.
- Laboratory assistant:
- Grossing.
- Pathology assistant/pathology resident/pathologist.
- Gross report.
- Tissue blocks.
- Pathology assistant/pathology resident/pathologist.
- Processing of tissue.
- Embedding of tissue.
- Cutting.
- Histotechnologist.
- Slides.
- Histotechnologist.
- Staining.
- Routinue stains.
- Special stains.
- Immunostains.
- Case assembly and distribution.
- Diagnosis.
- Pathologist.
- Tasks:
- More tissue.
- Levels/deepers.
- Special stains.
- Immunostains.
- Write report.
- Consult other pathologists - in house of outside.
- Discuss with clinician.
- Tasks:
- Pathologist.
Data elements - sequential
Prior to arrival to the lab
- Patient identifier, i.e. medial record number (MRN) or medical care plan (MCP) number.
- First name.
- Middle name(s).
- Last name.
- Date of birth.
- Sex.
- Clinician identifiers.
- Who ordered the test.
- Where the case is sent to - ordering physician, other physicians.
- Specimen descriptors:
- How many parts, i.e. how many containers.
- One container = at least on diagnosis.
- Anatomical site of the parts, e.g. kidney biopsy.
- How many parts, i.e. how many containers.
The above information is all contained on the requisition.
Accessioning
- Case identifier, e.g. 12:SU123.
- 12 = year.
- SU = surgical case.
- 123 = case number.
Grossing
Main article: Grossing
- Description of each part:
- Specimen dimensions, +/-weight, type of tissue.
- Identification of gross pathology - and characterization/description.
- Submission of tissue - in "blocks".
- Each block is described in the gross report.
Tissue processing
- Tissue is sent through the tissue processor - processing dependent on tissue type.
- Date, time, batch recorded.
Embedding
- Tissue is oriented and surrounded by wax.
- Histotechnologist doing this is recorded.
Cutting
- Tissue is cut from the block.
- Pieces of tissue sent to the pathologist are tracked as "levels".
- Who cut the tissue is tracked.
Staining
- This is done with automated processors.
- When and by who they are run is tracked.
Case assembly
- Who does this is tracked.
The list of data elements
- Case identifier, e.g. 12:SU123.
- 12 = year.
- SU = surgical case.
- 123 = case number.
- Patient identifier, i.e. medial record number (MRN) or medical care plan (MCP) number.
- Demographics:
- First name.
- Middle name(s).
- Last name.
- Date of birth.
- Sex.
- Demographics:
- Clinician identifiers.
- Who ordered the test.
- Where the case is sent to - ordering physician, other physicians.
- Specimen descriptors:
- How many parts, i.e. how many containers.
- One container = at least on diagnosis.
- Anatomical site of the parts, e.g. kidney biopsy.
- Time/date.
- When the test was ordered.
- When the lab received the specimen.
- When the specimen was placed into formalin.
- Clinical history.
- How many parts, i.e. how many containers.
- Grossing report - description of each part:
- Specimen dimensions, +/-weight, type of tissue.
- Identification of gross pathology - and characterization/description.
- Submission of tissue - in "blocks" - tissue may be completely submitted (in toto) or incompletely submitted (representative).
- Each block is described in the gross report.
- Each block is tracked in the process.
- Block information:
- Number of blocks - for each part.
- Slides - generated from the block.
- Type of cut on each block (levels, deepers).
- Slides distributed to the pathologist are numbered.
- Type of stain/immunostain recorded.
- Pathologist - elements.
- Microscopic description.
- Diagnosis.
- Diagnosis comment.
- Synoptic reports.
- Date report signed.
- Internal messages:
- Clinician contacts (recorded).
- Intradepartmental consults.
- Addendums.
- Consultant reports.
- Additional tests.
- Additional opinions that concur with the primary opinion.
- Amendments.