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Diagnostic and Molecular Pathology

The Diagnostic and Molecular Pathology (DMP) department includes Histology, the Molecular Cell Biology Unit and Cytology. Our service is consultant-led with approximately 70 medical, scientific and support staff.

Opening times

Laboratories

Monday to Friday: 08:30 to 17:00

DMP Office

Monday to Friday: 08:30 to 17:00

Rapid on site evaluation (ROSE) service

Adequacy of the sample is assessed within the clinical setting. Sampling includes; EUS / EBUS (Endoscopic and endobronchial ultrasound) adrenal, gastrointestinal lesions, liver, pancreatic and head and neck (Including Thyroid) and superficial nodal sampling.

Clinic times	Clinic
Clinic times Mondays 09:00 to 11:00	Clinic Thyroid and neck nodes suspicious of lung cancer
Clinic times Tuesdays 14:00 to 17:00 Thursdays 09:00 to 12:00	Clinic EUS
Clinic times Tuesday 14:00 to 17:00 Thursday 09:00 to 13:00	Clinic EBUS
Clinic times Tuesdays 8:30am to 12:00pm	Clinic ROSE
Clinic times Thursdays 14:00 to 17:00	Clinic Head and Neck (ENT)

Out of hours

There are no provisions for consultant cover out of hours within DMP.

Histology

The Histology service analyses samples to help diagnose, predict and screen, including:

Surgical
Frozen sections including Mohs
Post mortem tissue specimens
Special stains
Electron microscopy, in conjunction with the University of Plymouth
Screening service as part of the NHS Cancer Screening Programmes (Bowel, Breast and Gynae Cervical histology).

Key Factors affecting performance or interpretation of histology

Insufficient volume of fixative
Inappropriate fixation time (24-48hrs optimal)
Specimen for frozen section/direct immunofluorescence MUST NOT be placed in formalin.
Dry specimens left in reception areas.
Renal specimens being placed in formalin or incorrectly stored Hanks.
Extreme hot/cold temperatures of formalin.

Molecular & Cell Biology Unit

The molecular and cell biology unit provides specialist testing in the following areas:

Routine immunohistochemistry

UKAS accredited testing of approx. 100 primary antibodies to aid with prognosis, diagnosis and therapy outcomes. ~30,000 samples tested per year.

Direct immunofluorescence

For diagnosis of skin and renal abnormalities. Specialist sample requirements (Hanks/Michels medium).

HER2 testing for the Far South West Peninsula

Service provision of the breast Her2 testing and reporting service for the South-West Peninsular.

Molecular in-situ hybridisation (CISH, DDISH)

Automated CISH testing for Kappa, lambda light chain restriction along with Epstein-Barr virus and Human Papilloma Virus (low and high).

Rapid molecular testing to predict therapeutic response

Fully automated rapid real-time PCR molecular testing for prognosis and determining treatment options using the IdyllaTM platform on blood, liquid and solid tumour samples. Repertoire includes EGFR, KRAS, NRAS-BRAF, BRAF and ctEGFR.

Full molecular profiling and NGS commissioned service – material referred to Bristol SW genomics hub – reference their website.

Support for Research, Development, and Innovation

Including clinical trials

Diagnostic Cytology

Diagnostic Cytology provides a comprehensive and rapid diagnostic service that works collaboratively with the histology and molecular departments. The following services are provided:

Fine Needle Aspiration Cytology (FNAC) for head and neck, breast and soft tissues.
Liquid Based Cytology (LBC) for respiratory, oesophageal and common bile duct samples.
Serous effusions and peritoneal washings.
EUS/EBUS (Endoscopic and endobronchial ultrasound) samples.
Rapid on site evaluation services (ROSE) for EBUS, EUS and head and neck / Thyroid.
Joint fluids for crystal arthropathy.
ctDNA for EGFR testing on blood plasma samples.
Bronchoalveolar lavage assessment for interstitial lung disease.
Anal cytology.

All NHS Cervical Screening programme samples are referred to Southmead Hospital Cytology Department in Bristol.

Specimen transport for DMP specimens

Histopathology samples must never be delivered from GP’s or hospitals via Public Taxi’s. Only to be transported through NHS Couriers.

Specimen Type	Transportation details	Information / special handling needs
CSF	Hand deliver to member of staff within 1 hour of being taken and before 4pm on weekdays. Samples should not be taken at weekends. All containers but be placed into a specimen bag with a completed request form.	Specimen degrades quickly and must be prepared within the hour.
FNA samples without ROSE	Slides must be placed into a slide box to prevent the slides from breaking during transportation. All containers but be placed into a specimen bag with a completed request form.	Ensure sample site is written on form and all pots/slides. Needle washings in saline are essential for any ancillary testing and must be received within 12 hours to reduce sample degradation.
FNA samples with ROSE (including EUS/EBUS)	BMS attendance at the clinic – specimens transported to the laboratory by these staff.	As directed by staff in attendance at clinic.
Bronchoscopy Samples	The laboratory is sent a patient list for each clinic. Tuesday’s samples should arrive in the laboratory by 16.30. Thursday’s samples should arrive in the laboratory by 14.00. If samples have not been transported to the lab within the time frame, then a member of cytology staff contacts Endoscopy. This allows for processing time prior to Multi-Disciplinary Team meeting.	Brush samples are “mashed” into Preservcyt pot to remove cells and then the brush is disposed. (Nurse training can be provided by cytology department). Preservcyt samples are available from the cytology department on request. Washings are placed into a fresh pot and sent to the laboratory ASAP as samples quickly degrade in saline.
Bronchial alveolar lavage for interstitial lung disease	Hand delivered to a member of the cytology team to ensure this isn’t treated as a routine bronchial sample for malignancy.	Place sample into a sterile universal. Ensure front of the form states sample is for interstitial lung disease
Brushings (Anal and Bile Duct)	Transported via porter or tube to the laboratory. All containers but be placed into a specimen bag with a completed request form.	Brush (or swab for anal samples) should be “mashed” into Preservcyt pot to remove the cells. No additional fluid should be put into pot and brush head should not be left in pot. Preservcyt samples are available from the cytology department on request.
Serous fluids	Transported via porter or tube to the laboratory. All containers but be placed into a specimen bag with a completed request form.	Minimum volume for serous fluids is 50ml (60ml for pericardial) into a sterile universal. Send samples ASAP to prevent DNA degradation which may preclude molecular testing if required.
Synovial Fluids for Crystal analysis	Via porter (internal) or courier service (external). All containers but be placed into a specimen bag with a completed request form.	Place sample into a sterile universal and send a sample directly to cytology. Sending via microbiology can result in delays.
Circulating tumour blood testing (ctDNA)	*The lab must be contacted prior to taking the sample Hand delivered to a member of the cytology team within 1 hour.	Samples collected into 4 purple EDTA tubes. The request form must contain the reason for the request (T790M / unable to obtain tissue).
Urine Cytology	Transported via porter, courier or tube to the laboratory.	Please do not send early morning urine. Whole output second urine is required in a sterile suitable container. Please send to the laboratory within 24 hours to prevent degradation of the sample.
Sputum	Transported via porter or tube to the laboratory.	Sputum assessment can be limited. If necessary please send the sample in a sterile universal. Three consecutive samples over three days should be sent to the lab. Send the samples to the lab straight away. Do not batch the samples.
Routine Histology	All histology specimens should be transported in 10% neutral buffered formalin (DO NOT use Saline). 60ml pre-filled biopsy pots are available by calling the Microbiology Consumables Order Line. Telephone 01872 254966, 24hr answer phone service. The information requested will be your name, telephone number, location, items required and quantity. Hospital theatres, RAF St Mawgan, RNAS Culdrose and Bodmin Treatment Centre (BTC) can obtain a range of empty pots in various sizes from the histology department.	Volume of 10% formalin must be 5 x the volume of the specimen. Under no circumstances must specimens containing formalin be sent by the air transport tube or Royal Mail Postal Service. Histopathology samples must never be delivered from GP’s or hospitals via Public Taxi’s. Only to be transported through NHS Couriers.
Renal specimens	Lab staff will deliver the Hanks Medium ready for use on request. They will retrieve the specimen on phone call from the renal physicians. Un-used specimen pots must be collected by laboratory staff and NOT used.	Must be booked in advance by phoning ext. 2576. Samples transported in Hanks medium obtained from laboratory.
Products of Conception / Termination of Pregnancy	These specimens must be received in 10% buffered formalin.	Tissue samples less than 14 weeks gestation requiring histology should be sent to the histology department. Outside of working hours these should be stored in the ward’s specimen fridge and delivered to histology on the next working day. These must be accompanied by a histology request form and a ‘Certificate of Medical Practitioner or Midwife in Respect of Fetal Remains’ completed by doctor or midwife where written consent has been obtained for collective cremation or private arrangements. Tissue samples which are between 14 and 24 weeks gestation should be sent to the mortuary accompanied by the ‘Deceased Baby Care Record’, a unique Typenex ‘Mortuary Identification Band’, and a ‘Certificate of Medical Practitioner or Midwife in Respect of Fetal Remains’ completed by doctor or midwife where written consent has been obtained for collective cremation or private arrangements. These forms on completion indicate what funeral arrangements are required once the histology has been performed. These requirements are in accordance with the Human Tissue Authority. The forms are available on the RCHT document library as appendices of the Policy – Procedure for the Sensitive Disposal of pre-24 week Fetal Tissue.
Termination of Pregnancy	These specimens must be received in 10% buffered formalin.	Termination of Pregnancy specimen’s pre-24 week’s gestation which do not require histology must be sent to the histology department accompanied by a ‘Certificate of Medical Practitioner or Midwife in Respect of Fetal Remains’ completed by doctor or midwife where written consent has been obtained for collective cremation or private arrangements. All specimens must also be listed on a ‘Products of Conception Proforma’. Such specimen types will not be accepted/processed without the correct accompanying documents. These requirements are in accordance with the Human Tissue Authority. The forms are available on the RCHT document library as appendices of the Policy – Procedure for the Sensitive Disposal of pre-24 week Fetal Tissue.
Dental specimens	Make arrangements with local GP for specimens to be collected by RCHT courier service.	Specimen pots must be contained within sealed bag attached to specimen request card.
Skin Biopsies for Immunofluorescence	Transported in Michel’s medium obtainable from laboratory with 24 hours notice.	Must be kept at room temperature and NOT refrigerated.
Multiple bowel biopsies	Acetate strips are available from the histology department. (strips cut 12 squares on the longer edge and 10 on the shorter).	The biopsies should be placed along one edge of the strip placing the first biopsy at the diagonal end of the strip. Biopsies should be placed one per square and place acetate strip in labelled biopsy pot.
Small Biopsies	Cell safes are available from the histology department.	Biopsies should be placed in the deeper side of a cell safe and clicked shut and then place cell safe in labelled biopsy pot.
Needle cores (prostate, breast etc.)	Biopsy insert papers are available from the Histology department.	Needle cores to be placed directly onto cassette insert paper and then place paper in labelled biopsy pot.
Frozen sections	Must be booked in advance with histology department. Specimen Must be received dry (not in formalin). Must be delivered immediately to the histology department and handed to a member of staff.	Portering or Theatre staff delivering specimens must hand the sample to a member of staff in Histology. Specimens must not be left in reception areas. Telephone/Pager number must be on request form to enable immediate reporting of results by telephone.