[Histonet] margins without frozen

If the margin is grossly close, then re-excision without a frozen is entirely appropriate. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025 bill.te...@pph.org Voice: 760- 739-3037 Fax: 760-739-2604

[Histonet] cassette labelers, etc

The response by M. Mihalik nails the problem. Anything that is batched (cassette labeling, slide labeling, case labeling) is known to be high risk for mistakes even though it may seem to be more efficient. On-demand-labeling is the key to significantly reducing identification errors. Bill Tench

[Histonet] Procedure manual review

All procedures must be reviewed annually (and that means WITHIN 12 months, not just once a calender year) This may be done by the appropriate supervisor or pathologist, not necessarily the Director (Director must review all new or changed procedures) The review should confirm that the procedure in

[Histonet] rapid h and e

We have never noticed any significant cell loss if dehemoglobinzing is done on bloody smears either before or after regular staining (as noted, this is used ONLY when the smear is very bloody. If it is very bloody there can be very significant obscuration. This is especially true of liver

[Histonet] rapid h and e

We use the same materials and timing we use for a frozen section, which as a cytopathologist works just fine for me. Approx 1 min Hematox, several dips wash, dips in blueing UNTIL BLUE (people tend to shorten this critical step), no more than 5 dips in eos, 100 ETOH X 2, xylene dipped until runs

[Histonet] Saponin

Lots of blood can be a problem in cyto specimens, especially smears. If you are making smears from fresh specimens in particular you may elute the obscuring hemoglobin by dipping the smear directly in acid alcohol (i think 5% hcl-95% etoh). We do this frequently for CT guided FNA's (particularly

[Histonet] eosin

I think the use in a processor becomes a local culture. I think everyone in my community does it (someone spread the word), so now we all do. I believe that we are all putting it in the last alcohol. It really makes facing a block on minute pieces a whole lot easier. We found marking the

[Histonet] formalin containers

We haven't heard anything about this (and we were inspected at the end of July). If you have any additional information, please post it. It is a little hard to image a locking Lid on a disposable plastic container of reasonable cost that is large enough to hold a a total colon resection or large

[Histonet] FX

it's too cold. set your cryostat at 20. put your tumb on the block Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025 bill.te...@pph.org Voice: 760- 739-3037 Fax: 760-739-2604 [None] made the

[Histonet] fx

that's suppose to be put your thumb on the block. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025 bill.te...@pph.org Voice: 760- 739-3037 Fax: 760-739-2604 [None] made the following annotations

[Histonet] clinical trial blocks

The fundamental philosophy that we have is that we do not want to stand in the way of the patient receiving any kind of treatment. That being said, we also have the policy that whether or not we own the material (patients are actually suppose to sign an admission consent that says they give up

[Histonet] change in CPT coding rule

The change in place now allows for billing multiple blocks from the same specimen for the same special stain (it isn't just immunos) BUT you must justify this (should be done by a statement in the report micro). You are not permitted just because you wanted to stain multiple blocks to increase

RE: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

Have you validated this processing? Leaving the tissue in 70% alcohol for 48 hours is not standard, and thus requires all of the hassles associated with validation. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido,

[Histonet] relaxation of her2 standards

Don't hold your breath. I have had multiple conversations with at least one of the primary individuals who set the standards and i have not detected ANY willingness to modify the standards and that includes a hard and fast insistence on good validation for ANYTHING that differs from standard

RE: [Histonet] Quality Assurance for Histology

Why would you want to have the pathologists fill out a QA sheet for a function you have already performed (and should document). This would seem to be a meaningless exercise (ie, waste of time) for the pathologist. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services

RE: [Histonet] Quality Assurance for Histology

Escondido, California 92025 bill.te...@pph.org Voice: 760- 739-3037 Fax: 760-739-2604 -Original Message- From: Laurie Colbert [mailto:laurie.colb...@huntingtonhospital.com] Sent: Monday, October 11, 2010 9:07 AM To: Tench, Bill; Podawiltz, Thomas; Rene J Buesa; histonet

[Histonet] CAP programs

There are now online CAP PIP programs. I have done one on prostate. Also there are online programs for the cytology part. Review the catalogue. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025

[Histonet] change in immuno machines

If you changed machines, you need to validate the staining on that machine just as if you never had the first machine. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025 bill.te...@pph.org Voice: 760-

[Histonet] giving back tissue

In all of this discussion, it is important to understand that there are significant variations in state laws that relate to this issue, so if this problem arises, have your hospital/lab attorney check into state laws very carefully. In California, the laboratory may not own the tissue (again,

[Histonet] decal arteries

We routinely decal these. Most often for part of a day, but if really dense, overnight. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025 bill.te...@pph.org Voice: 760- 739-3037 Fax: 760-739-2604

[Histonet] billing consults

we ask the consultant to bill the patient's insurance. If they don't do that, they bill the hospital and the hospital passes the charges on to the patient. we do not make any distinction based on where the request for the consultation came from (us, the patient, the treating clinician). The

[Histonet] returning tissue

We do not return any tissue to patient unless there is a religious request that must be initiated by the patient (ie, staff are not permitted to offer this option--we consider that coaching). Then it is a big hassle with the issues of hazard exposure, disposal, etc. Bill Tench Associate Dir.

[Histonet] caris and genoptix experience

We have had almost identical experiences with both organizations. Caris has been informed that it is not welcome; genoptix is on the same list Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025

[Histonet] tonsils

I have seen malignancy in tonsils that did not show a 5 cm difference in the gross size. I would be very concerned about missing a significant lesion using that criterion. Dr Bill Tench Assoc Dir. Lab Services Chief Cytology Palomar Medical Center 555 E. Valley Parkway Escondido, Ca

[Histonet] (no subject)

You need to review all of the notes that go with the standard: NOTE: Microwave devices should be placed in an appropriate ventilation hood to contain airborne chemical contaminants and potentially infectious agents. Before operation of the microwave device, flammable and corrosive reagents

[Histonet] cutting standards

I asked this question earlier in the spring. someone sent me some national standards from surveys, so if you go to the archives you should find this information. i will see if i can find the information. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical

[Histonet] gross specimen retention

We generally do not return specimens to patients, so this is not so much of an issue for us. We do retain processed specimens longer than 2 weeks (more like 2 months). Fresh placentas (requiring refrigerated storage) are an exception. Bill Tench Associate Dir. Laboratory Services Chief,

[Histonet] preparation of frozen sections

So as a pathologist, i have to ask you why you would want to air dry a section? From a diagnostic perspective, we consider air dried samples unacceptable in my lab. All of our standard histologic interpretation is based on fixed sections. So, why not drop the slide in a jar or ETOH and keep it

[Histonet] grossing manual

Yes, you do need a standard procedure manual for the management of all of your specimens. Life has gotten more complicated with the reporting standards now in place for reporting cancer which includes the gross examination. A good start for the non-neoplastic cases would be the appendix of a

RE: [Histonet] correct CPT code

You need to be more specific about what it is you are doing. If you are looking at imprints or smears intraoperatively then the correct code is 88333. I would say that neither a PA or HT is qualified for this job, but a cytotech is. If anyone other than a pathologist does it, however, you

RE: [Histonet] correct CPT code

...@nationwidechildrens.org] Sent: Monday, August 09, 2010 12:57 PM To: Tench, Bill Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] correct CPT code Bill, I'm specifically referring to visualization of a renal biopsy under a dissecting scope to see if the specimen is adequate for analysis (i.e

[Histonet] dissection aide

I don't see much advantage of this over plain old Carnoy's fixative, other than missing the wiff of choroform. Ethanol should not be a problem with IHC, but as you said, revalidation is required. The magic number of nodes is 12. Bill Tench Associate Dir. Laboratory Services Chief, Cytology

[Histonet] REFRIG FORMALIN

You must have a heck of a lot of space in the frig. I am envious. I don't think refrigerating your specimens would create any problems. Everyone i know stores them in some inconvenient corner of a morgue at room temperature. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services

[Histonet] special stain storage

The critical issue that your CLIA, or perhaps CAP, inspector is going to be asking is: is it necessary to storage stain reagent X in a refrigerator with a temperature range of Y. That answer lies in your procedure. If it says refrigerate (perhaps with a range) reagent X, then you must document

[Histonet] powder stain expiration

If the manufacturer has not included an expiration date for these, i think there probably isn't one. I would call the CAP LAP folks and ask them about that. When this kind of issue arises during an inspection, it is always better to call while the inspectors are still there. You can get an

[Histonet] hpv testing on head and neck ca's

We do p16 on squamous ca of the head and neck region routinely Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway Escondido, California 92025 bill.te...@pph.org Voice: 760- 739-3037 Fax: 760-739-2604 [None] made the following

[Histonet] decontamination of cryostat

I would suggest that if you are a CAP certified lab that you read the appropriate section in the current LAP standards list. The note associated with the standard is pretty specifiic. I believe that if you use the cryostat daily, you need to decontaminate once a week, but i don't have the

[Histonet] workload limits

I am a little concerned about some possible misunderstandings regarding slide limits, so below is a CAP article written on the topic that still applies. Understand that the elevated limits for image related instruments (which now include the ThinPrep Imager and the SurePath GS systems) have

[Histonet] Re Grossing assistants

I would suggest that you review the archives on this topic. There has been much discussion recently. The short answer is that ANYONE performing ANY grossing in the AP laboratory must meet the requirements for high complexity testing. Bill Tench Associate Dir. Laboratory Services Chief,

[Histonet] afb contamination

We had a problem with contamination on our AFB stains, and we discovered that it was the control slide flaking off in the copland jar which was being used for staining the control and target slide at the same time (makes sense as a real control'). We identified these contaminants because they

[Histonet] charging for cytospins

Can you charge for two different stains for the urine cytospin? The answer to this question is a depends. If you are just doing any of the optional stains that may be used on a cytology preparation (namely Pap, HE, romanovsky) you are NOT permitted to charge for each of these (they are not

[Histonet] Grossing assistants-pathologist assistants

Yes, the Pathology Assistant national organization is a great resource as is the CAP. As I said before, please remember that the CAP inspection standards represent compliance with FEDERAL CMS standards. I would encourage contact with the CAP LAP in regard to these FEDERAL standards. Individual

[Histonet] urine cytology

I don't think I know of any labs that do air dried Diff quik type stains on urine cytologies any more. You need to use some sort of concentration technique, and the most frequently used for labs without liquid-base processing apparatus is the cytospin. Several companies make cytospin devices.

[Histonet] Grossing assistants

The rules are established by CMS through CLIA regulations. They are applied based on the complexity of the activity. Grossing is considered high complexity and thus is subject to rather stringent rules (which become more complicated because there are grandfather clauses). For years, the CAP

[Histonet] histogel technique

Next day, pellet cells and resuspend them in a small amount (100-200 microliters) of Histogel or Agar. When the gel cools cut the microcentrifuge tube open with a scalpel or razor blade. Now you have a nice cell pellet shaped like the bottom of your centrifuge tube, and you can treat it just

[Histonet] routine specials

Grumpy old pathologist trying to pay attention to costs: Livers: if the biopsy was for anything other than metastatic ca, then retic, trichrome, and iron are pretty much standard. If for met ca, you are wasting money. Gastrics for h pylori: Just because the GI guys asked for it doesn't mean

[Histonet] clo test

The Clo test is a clinical lab test. You need to go to that part of the CPT coding book (sorry I don't have it available). 88300 is an anatomic code (gross only, ie, it requires examination of a piece of tissue or foreign body) and is entirely inappropriate for this test. Bill Tench Associate

[Histonet] Cap guidelines and Clia

It is important to understand that CLIA is the driving force for most of the various regulations promulgated by CAP, and this is true of the issue regarding the requirements for Gross room assistants. The CAP simply tries to interpret the morass of regulatory garbage into understandable

[Histonet] Patient ID on cassettes

A statement was made in a previous posting indicating CAP requirements for 2 unique identifiers throughout the entire analytic process: To conform to CAP and state regulations that require two unique patient identifiers on a specimen at all analytical steps. The CAP standards GEN 40491, ANP

[Histonet] histotech positions in San Diego area

Life is uncertain, but We may have an opening in the future. You may send resumes directly to this email address and I will forward them on to the appropriate people. Bill Tench Associate Dir. Laboratory Services Chief, Cytology Services Palomar Medical Center 555 E. Valley Parkway

[Histonet] CLIA requirements

You may define whatever QA monitors for grossing that you wish. These are not CLIA mandated, but contribute to improved performance. When it comes to the individuals doing the grossing, you need to understand that this has been interpreted as a high complexity activity with strict CLIA

[Histonet] CPT coding question

Michelle, the example that you raised of having two tonsils, one with a stitch, isn't quite the same as your problem. The two tonsils would otherwise not be identifiable as left or right. That is not a problem with a fetus and a placenta. Each is separately identifiable and each should be

[Histonet] RE: [BULK] Histonet Digest, Vol 76, Issue 45

For placentas, you will find that you get consistently good sections if you gross the placenta fresh, take the samples you will want from the cord, disc and make a membrane role (which is easily done if they are not fixed). Fix your samples overnight and trim for blocks the next day. For the

[Histonet] technologist productivity

I apologize in advance if I offend anyone with this inevitably touchy question. In the last two years we have lost one older histotechnologist, and the routine reliable services of another of that group and are now facing the issue of what can be expected from their replacements. I have little