Vista Pathology Laboratory User’s Guide

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2020Vista Pathology LaboratoryUser’ s GuideWelcomeThis manualoutlines information about Vista Pathology Laboratory,including a summary of services and information aboutsubmitting specimens.Vista Pathology Laboratory, LLC1032 E. Jackson StreetMedford, OR 97504Phone: 541.770.4559Fax: 541.770.4511www.vistapathology.com

ContentsWho We Are . 1What We Do . 2How to Submit a Specimen . 4I.Submitting a Surgical (Tissue) Specimen. 4II.Completing a Vista Surgical Pathology Requisition Form . 6III.Submitting a Body Fluid Specimen for Cytology Examination . 6IV.Completing a Vista Non-Gynecologic Cytology Requisition Form . 7V.Submitting a Gynecological Specimen . 8VI.Completing a Vista Gynecological Cytology Requisition Form . 8VII.Completing a Vista Gynecological Cytology (Pap/HPV) Test Requisition Form . 10VIII.Hematopathology Specimen Requirements and Handling . 10FAQs .12Laboratory Supply Order Form . 16

Vista Pathology Laboratory – User’s GuideWho We AreReedy, Michael MDPathologyNixon, Randal MD, PhDPathologyNeuropathologyLoudermilk, Allison MDPathologyHematopathologyWu, Bryan MDPathologyBreast PathologyDermatopathology1Pike, Robin MDPathologyCytopathologyHuang, Anne MD,MPHPathology

Vista Pathology Laboratory – User’s GuideSteidler, Nichole MDPathologyHematopathologyKyle, Michael MDPathologyCytopathologyNewBill, Colin MDPathologyBreast & GynecologicKahn, Melissa MDPathologyGrange, Jacob MDPathologyCytopathologyTran, Thu MDPathologyGenitourinary PathologyGailey, Michael DOPathologyWhat We Do2

Client Orientation ManualVista Pathology Laboratory, LLC, provides surgical pathology and cytology services for hospitals, surgerycenters, clinics, and independent health care providers throughout Southern Oregon. As board-certifiedpathology physicians with sub-specialty certification in diseases of the skin, brain/nervous system,breast, medical chemistry, blood and bone marrow, body fluids and Pap tests, we take pride in providingtimely and comprehensive medical diagnostic services for the regional medical community.Below is a graphic that represents the process of specimen analysis, from collection to reporting:Case materials are given to anassigned pathologist Specimen is collectedinto a container withappropriate fixativeand placed in abiohazard bag withaccompanyingpaperwork.Courier transportsspecimen to Vista Lab Slides are viewed with amicroscope by thepathologist. A diagnosis or otherinterpretation rendered. A report is generated. Upon receipt , thespecimen is : Entered into oursystem and assigned aunique identifyingnumber Processed Stained for pathologistreview.Reports distributed toprovidersFaxInterfaceHard Copy3

Client Orientation ManualHow to Submit a SpecimenCorrectly submitting a specimen for surgical or cytological analysis is one of the most important things aclinic can do to help ensure patient safety and accurate test results. A mislabeled specimen orincomplete requisition can delay a diagnosis, creating anxiety for the patient at a time when promptresults are most needed. Please follow these directions in order to ensure timely results:I.Submitting a Surgical (Tissue) SpecimenSpecimen Container Labeling: Regulatory agencies require that all containers be labeledwith two unique patient identifiers, typically the patient’s name and date of birth. It isimperative that the container itself, and not the lid, be labeled, as lids can be easilyswitched. The container label must also include the specimen source, with specific siteinformation such as “left” or “right”, and date of collection. If more than one specimen on agiven patient is submitted, number the specimen containers as #1, #2, #3, etc., in additionto the above information. An example of available labels is shown below: Specimens submitted in formalin: Most routine biopsies and other surgically-removedspecimens are submitted in the tissue fixative, formalin, a formaldehyde-based solution.Formalin preserves the tissue and prevents deterioration. For optimal preservation,specimens must be placed into formalin as soon as possible after excision from thepatient. For adequate tissue fixation, please ensure that the specimen floats freelywithin formalin in the container. If in doubt, use a larger container, especially whenhandling large specimens such as from a mastectomy or colectomy. Never force a largespecimen into a small container, as the tissue will deteriorate and may not be suitablefor microscopic examination. If a container of sufficient size is not available, please callVista Pathology for additional options. Secure the lid to prevent formalin leakage.Formalin is toxic and should be handled with care. Specimens submitted out of formalin: Some tissues must be submitted unfixed(“fresh”), or in an alternative fixative or preservative. These include specimens forfrozen section, muscle and nerve biopsies, or a specimen for immunofluorescence. If4

Client Orientation Manualyou are unsure as to whether or not the specimen can be placed into formalin, pleasecall us to discuss. Once in formalin, the tissue fixation process cannot be reversed.oFrozen Section: A frozen section provides a rapid, intraoperative diagnosis, witha turnaround time typically of 20 minutes or less from the time of receipt in ourlaboratory. It is useful when surgical margins require intraoperative assessmentor in other situations that would affect the subsequent course of the surgery orprocedure. Please call Vista Pathology at (541) 770-4559 if you have aprocedure that may require a frozen section. Once the procedure is scheduled,please call Vista Pathology prior to specimen collection to schedule a STATcourier pick-up. Once collected, DO NOT PLACE THE SPECIMEN INTOFORMALIN. Instead, place the fresh tissue on the smooth side of a lightlymoistened Telfa to prevent the tissue from drying out, and then place the Telfainto the specimen container. Refer to appropriate specimen labeling above.oMuscle or Nerve Biopsy: Due to the delicate nature of this tissue and specialhandling requirements, please call Vista Pathology at (541) 770-4559 toschedule a muscle or nerve biopsy. Once the procedure is scheduled, please callVista Pathology at the time of collection for a STAT pick-up. For properprocessing, the specimen must be received by Vista Pathology Laboratorybefore noon on the day of specimen collection. The specimen should bewrapped in a gauze sponge that is lightly moistened in saline. The specimen andgauze then should be placed in a sealed container, and the container placed onwet ice in a zip-lock bag. Refer to appropriate specimen labeling above.oSpecimens for Immunofluorescence: Providers requesting immunofluorescencetesting on tissue are advised to call ahead, before scheduling the procedure, andspeak with one of our pathologists to discuss the appropriate test. Once thetesting procedure has been established, place the tissue in Michel’s transportmedium. Michel’s is necessary to preserve immuno-antigenicity of the tissue sothat the fluorescent stains can be visualized. Michel’s transport medium issupplied by our laboratory. Please call (541) 770-4559 to place an order. Thespecimen must be received by noon on the day of collection.oMicrobiologic Culture: Vista Pathology does not perform clinical laboratorytesting, including specimen cultures. These must be submitted to a hospital labor other clinical laboratory. If cultures are needed on a surgical pathologyspecimen, we recommend that these be submitted from the site at the time ofthe procedure, as this lessens the risk of contamination. If you have questionsabout a specimen that may require a culture, please contact one of ourpathologists at (541) 770-4559.5

Vista Pathology Laboratory – User’s GuideoII.Completing a Vista Surgical Pathology Requisition FormRequisitions are supplied by Vista upon request. In addition, PDF versions are accessiblethrough our website (www.vistapathology.com) under the tab “Referring Providers.” Allareas of the requisition form must be completed legibly. Please include the followinginformation: Patient first and last name and date of birth.Gender.Submitting provider.Date collected.For biopsies and other surgical specimens, time into formalin (required for breastspecimens and recommended for all others). If there is a greater than one-hour delay inplacing the tissue into formalin, this should also be noted.Specimen source and specifications such as “Left” or “Right.” Avoid the abbreviations“L” or “R” as these descriptors are often illegible.Brief clinical history.ICD-10 code.Attach the patient demographic and insurance information to the requisition slip.III.Submitting a Body Fluid Specimen for Cytology ExaminationSpecimen Container Labeling: Laboratory compliance standards require that that eachcontainer (not the lid) be labeled with two unique patient identifiers, typically name anddate of birth, as well as the specimen type and submitting provider.As a general rule, never place a cytology specimen into formalin. Urine/ Bladder wash/Loop urine: In general, a first morning urine specimen producesan inferior specimen for cytological examination, as the cells present in the urine haveextensively degraded. The best specimens typically are from a well-hydrated patientwho has already voided at least 1-2 times on the day of collection. Specimens can besubmitted unfixed, or in Cytolyt preservative solution, which is an alcohol-basedfixative. If the specimen is not placed into Cytolyt preservative, it must berefrigerated until it is picked up by the courier. Submit the specimen with a completedVista Pathology Laboratory’s non-gyn cytology requisition form and include theinformation listed below in “Completing a Vista Non-Gynecologic Cytology Requisition.” Body Fluids and Washes (Pleural, Pericardial, Ascites, Joint Aspirate, Bronchial Wash,BAL, etc.) and Sputum: Specimens typically are submitted fresh (unfixed) in a sterile6

Client Orientation Manualcontainer. These should be refrigerated until picked up by the courier. Use VistaPathology Laboratory’s non-gyn cytology requisition and include the information listedbelow in “Completing a Vista Non-Gynecologic Cytology Requisition.”IV. Nipple Discharge: Nipple discharge is expressed directly on to a charged glass slide andgently spread with a second slide. The slide with the specimen can then be either fixedin 95% alcohol or air-dried. Use Vista Pathology Laboratory’s non-gyn cytologyrequisition and include the information listed below in “Completing a Vista NonGynecologic Cytology Requisition.” CSF: This is a delicate specimen that requires careful handling. It is generally submittedunfixed so that low cellularity is not further diluted by fixative. CSF must be refrigerateduntil courier pick-up. If a CSF is collected on a Friday, please contact Vista PathologyLaboratory to arrange a same-day pick-up. Use Vista Pathology Laboratory’s non-gyncytology requisition and include the information listed below in “Completing a VistaPathology Laboratory Non-Gynecologic Cytology Requisition Form.” Fine Needle Aspiration Biopsy (FNA): A specimen is collected with a thin (23-27) gaugeneedle attached to a syringe. The aspirated material is then expressed onto a chargedglass slide and gently spread with a second slide. These slides can be fixed in 95%alcohol or air-dried. Cyst fluid and needle rinses may be collected into saline orCytolyt ; specimens in saline must be refrigerated. Each glass slide must be labeledwith two patient identifiers. Providers unfamiliar with FNA techniques are encouragedto contact Vista Pathology Laboratory for more detailed specimen collectioninstructions. Use Vista Pathology Laboratory’s non-gyn cytology requisition and includethe information listed below in “Completing a Vista Non-Gynecologic CytologyRequisition.”Completing a Vista Non-Gynecologic Cytology Requisition FormAll areas of the requisition slip must be completed legibly. Please include the followinginformation: Patient name and date of birth. Submitting provider. Gender. Date collected. Specimen source and specifications such as “Left” or “Right.” Check theappropriate box describing the specimen you are submitting. Pertinent clinical history. ICD-10 code.Attach the patient demographic and insurance information to the requisition slip.7

Client Orientation ManualV.Submitting a Gynecological SpecimenPap tests can be collected from vaginal or cervical sites into ThinPrep Pap vials provided byVista. The vial(s) must be labeled with the patient’s first and last name, date of birth, anddate collected, and then submitted with a Vista Gynecologic Cytology (Pap) / HPV TestRequisition that includes all the necessary patient information and indicates requestedancillary testing.VI.Completing a Vista Gynecological Cytology Requisition FormAll areas of the requisition form must be completed legibly. Please include the followinginformation: Patient first and last name and date of birth.Gender.Submitting provider.Date collected.Menstrual status/LMP.Pertinent clinical history.ICD-10 code.Cervical or vaginal specimen site.Ancillary testing desired, such as: HPV, Chlamydia, Gonorrhea, Herpes, etc.Attach the patient demographic and insurance information to the requisition slip.Use the following as a guide for requesting the proper testing. Refer to complete cervicalcancer screening guidelines available at www.asccp.org. Pap hr-HPV co-testing: Regardless of Pap diagnosis an HPV test will be run and theresults will be printed on the Pap report.Reflex to HPV genotyping: If the HPV result is positive and the Pap result is “Negativefor Intraepithelial Lesion or Malignancy,” genotyping for HPV types 16 and 18 will beperformed. All results will be included on the pathologist-signed Pap report.Pap Reflex HPV: An HPV test will be run only if the Pap diagnosis is ASC-US and theresults will be printed on the pathologist-signed report.Pap only: No ancillary testing will be performed and only a Pap test will be performed.Molecular Ancillary Testing:1 N.gonnorrhea/C.trachomatis: This molecular test can be performed on the ThinPrepvial or on the Aptima Multitest swab. Results are reported with the Pap test resultswhen ordered together.1HSV & CT/NG testing must be ordered in conjunction with other testing on a single specimen, as it cannot beperformed on material previously processed.8

Client Orientation Manual Herpes Simplex Virus: If selected, this molecular test can be performed on the ThinPrepvial ONLY. Results are reported independently of the Pap test or other molecularresults.Vaginitis Panel: This molecular assay can be performed on the Aptima Multitest SwabONLY. Results are reported independent of other assays and reports either a positive ornegative result for BV, Candida spp., Candida gla., and Trichomonas.Collection KitSample TypeThinPrep (PreservCyt )Vaginal orCervical/endocervicalPapHPVHPV elAptima MultitestSwabAptima UrineCollection Vial*HSV/STI testing must be ordered in conjunction with other testing on a single specimen, as it cannot beperformed on material previously processed.9

Vista Pathology Laboratory – User’s GuideVII.Completing a Vista Gynecological Cytology (Pap/HPV) Test RequisitionFormAll areas of the requisition form must be completed legibly. Please include the followinginformation: Patient first and last name and date of birth. Gender. Submitting provider. Date collected. Pertinent clinical history. ICD-10 code. Indicate test Vaginitis Panel. Time collected.Attach the patient demographic and insurance information to the requisition slip.VIII.Hematopathology (Bone marrow, peripheral blood, lymph nodes, tissues/fluidswith possible or suspected lymphoma/leukemia) Specimen Requirements andHandlingConcurrent microscopic morphologic evaluation is required for subclassification oflymphoid/leukemic diseases. As such, the ancillary testing discussed in this section is inaddition to specimens submitted for pathology/cytology evaluations (ie, additional specimensshould be submitted in formalin or cytology fixative, and/or blood or bone marrow smearedslides, unless otherwise directed by a pathologist. Alternatively, submission of adequate freshtissue can be split by Vista Pathology staff for microscopy evaluation and ancillary testing.)Specimens submitted for flow cytometric analysis, fluorescent in situ hybridization (FISH), DNARNA molecular evaluation (eg, PCR), and/or cytogenetics require special handling, storage andtransport. Specimens should be received by Vista Pathology within 24 hours of collection forbest results. Fresh tissue is required for these tests, meaning these specimens should never beexposed to any fixative including formalin. Fresh tissue submissions should occur in RPMI, saline or anticoagulant, the latter only ifperipheral blood or bone marrow specimen.Keep specimens at room temperature, and avoid excessive heat; cold pack if necessary to avoidexcessive heat.RPMI tissue culture media may be obtained from Vista Pathology Laboratory for tissue/fluidsubmissions.10

Client Orientation Manual Specimens will not be rejected if received in less than 72 hours from collection. Whentissue cellularity allows, each specimen is tested for viability prior to analysis.Depending on the specimen type, cellularity and the atypical population of interest,specimens may show degeneration changes at different times aftercollection. Evaluation of specimens received and processed after 48 hours of collectionwill be limited as leukocyte and lymphocyte subset percentages andimmunophenotypic expression profiles may be affected.o Vista Pathology processes flow cytometry samples Monday - Friday, exceptmajor holidays.o On Fridays, we recommend that you call Vista Pathology for specimensrequiring flow cytometry. This gives us a chance to direct a stat courier to yourclinic for immediate delivery to Vista Pathology and timely analysis ofspecimen. If we cannot accommodate analysis in timely manner, we candiscuss analysis options with you to best preserve specimen integrity.The table below outlines specimen requirements for flow cytometry and ancillarytesting in hematopathology.Flow Cytometry Specimen RequirementsPeripheralBloodMinimum 2 - 10 mL in GREEN (Heparin) or LAVENDER (EDTA) tubes, see belowBone Marrow 1 - 2 mL in GREEN (Heparin) or LAVENDER (EDTA) tubes, see belowAspirateBone Marrow In RPMI -orCoreIn SALINE (minimum of 2mm3) , see belowConsider submitting a separate bone marrow core in RPMI or saline if bonemarrow aspirate is unobtainable. This separate bone marrow core is in additionto a bone marrow core submitted in formalin for pathology evaluation. Formalinfixed tissue is unacceptable for flow cytometric analysis.Fresh TissueBiopsyIn RPMI -orIn SALINE (minimum of 2mm3 or 100 mg, 3-5 needle core biopsies) Formalin fixed tissue is unacceptable for flow cytom

Vista Pathology Laboratory – User’s Guide 1 Who We Are Reedy, Michael MD Pathology Nixon, Randal MD, PhD Pathology Neuropathology Loudermilk, Allison MD Pathology Hematopathology Wu, Bryan MD Pathology Breast Pathology Dermatopathology Pike, Robin MD Pathology Cy

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