cyto 2

• Anatomic pathology


  Study of the structure of abnormal, diseased, or injured tissue
• Quality assurance programs in the histology laboratory

  Involve evaluations of the qualitative characteristics of tissues rather than quantitative figures
• Quality assurance programs


  Deal with procedures that are based on interpreting subjective and qualitative characteristics of examined tissue
• Goal of QC


  • To detect significant errors rapidly
  • Report out good results in a timely manner
  • Be cost effective and simple to use
  • If there is an error, identify the source of the error
• Quality improvement


  Carried out on every major aspect of the job, namely in specimen receiving, histology slides, surgical report preparation, and turnaround time
• QA begins


  Once daily process controls, such as maintenance logs, temperature charts, special stain control slides, and solution-changing records are totally adapted in all areas
• Specimen Discrepancy Log


  When an incident occurs, the gross room assistant logs the details in the book and calls the area of origin. The accountable party must physically come to Pathology to correct the error and sign the log sheet, thereby assuming responsibility for the change.
• Routine slides


  1. Maintain a daily quality control of histology slides with a log sheet for listing deficiencies

  2. Before filing, randomly chosen slides representing all cutters are set aside daily and reviewed by the QA "Pathologist of the Month"

  3. The pathologist grades all criteria and subsequently determines the ability to diagnose
• Each technologist should have no more than

  20% deficiencies overall
• Special stains


  1. The performing histotechnologist keeps a daily log to grade special stains

  2. The control slide is the process control to determine the effectiveness of the stain

  3. The log provides a monitor for problem reagents, ineffective control sections, and technical skill
• Surgical reports


  Two reports per transcriptionist may be pulled weekly at random and checked for correct spelling and grammar (98%), typographical correctness (98%), clear, brief, and adequate content (100%), matching of gross description on report with requisition (100%), matching of specimen in gross description with specimen in microscopic description (100%), correct surgeon receiving report (100%), grading and staging of tumor diagnoses (100%)
• Turnaround time


  Daily distribution of slides to the pathologists, frozen section diagnoses, and delivery of surgical reports
• Our schedule demands that all slides be delivered to the pathologist by 12.30 p.m.
• Turnaround time for frozen section diagnosis is 15 minutes
• The majority of surgical reports be delivered within 48 hours
• Continuous quality improvement (CQI)

  1. Persistent monitoring of the frequency and category of errors

  2. An Incident/Discrepancy Report for use in all areas by all staff members

  3. Occasional audits conducted to assess the degree of performance

  4. Mini-reviews and compilations also help keep the department flowing smoothly

  5. Meeting with members outside the walls of the laboratory, the ancillary and support services to better satisfy the needs of clinicians, surgeons, nurses, and patients

  6. Review requisitions for legibility of patient name and number, birth date and age, specimen type, and surgeon's full name
• Process controls must be thoroughly adapted before attempting true quality assurance
• A written plan that is well documented and shared with all staff members is half the battle
• Beneficial changes must be measurable, such as cost cuts, reduced errors, or shortened turnaround time and conclusions should be reported through established channels
• Frozen section procedure


  A pathological laboratory procedure to perform rapid microscopic analysis of a specimen, used most often in oncological surgery
• Intraoperative consultation


  The whole intervention by the pathologist, which includes not only frozen section but also gross evaluation of the specimen, examination of cytology preparations taken on the specimen, and aliquoting of the specimen for special studies
• Cryostat


  The key instrument for cryosection, which is essentially a microtome inside a freezer
• Frozen sectioning


  1. Specimen mounted on a chuck with OCT compound as the base

  2. Flat sections are lifted off by pressing a glass slide against the cold knife
• Advantages of frozen section biopsy

  • If more tissue is needed to make an accurate diagnosis, the surgeon is able to obtain an additional sample, avoiding a second operation
  • If the tissue is determined to be cancerous and is amenable to surgery, the mass can be removed at that time
  • If the tissue is determined to be benign, the mass may not always need to be removed and the surgery can end
  • It can help ensure that the entire mass and its surrounding borders are removed
  • It allows for the collection of proper tissue samples for further scientific research
  • The surgeon and pathologist are able to collaborate to care for the patient
• The quality of the slides produced by frozen section is of lower quality than formalin fixed, wax embedded tissue processing
• When operating on a previously confirmed malignancy, the main purpose of the pathologist is to inform the surgeon if the surgical margin is clear of residual cancer, or if residual cancer is present at the surgical margin
• The method of processing is usually done with the bread loafing technique, but margin controlled surgery can be performed using a variety of tissue cutting and mounting methods, including mohs surgery
• The usual histology slide is cut at 5 to 6 microns, while the surgical specimen is cut at 1 micron for frozen section
• The preparation of the sample is much more rapid than with traditional histology technique (around 10 minutes vs 16 hours)
• The entire frozen section laboratory can occupy a space less than 9 square foot, and minimal ventilation is required compared to a standard wax embedded specimen laboratory