Specimen Collection

All specimens removed during surgery must be submitted to Surgical Pathology for gross and/or microscopic examination. This includes major surgery performed within the hospital, ambulatory surgery, or satellite surgical suites and minor surgeries performed in outpatient clinics or hospital units. Refer to "Tissues Exempt" section for approved list of surgical specimens exempt from routine or mandatory submissions to Surgical Pathology.

The specimen label must contain the patient's name, medical record number, and identity of the tissue. Unlabeled or unidentified specimens will NOT be processed until properly labeled by physician or their designee. The specimen must be accompanied by a Surgical Pathology Order (requisition). Completion of ALL essential information will optimize tissue interpretation and patient care. The following information MUST be legibly completed:

1. Patient Identification (either EMR-generated demographic label or legibly handwritten at top of requisition) must include at least:
   1. Patient's Full Name (Last, First)
   2. Medical Record Number/Unit Number
2. Name or designation of Unit/Ward/Clinic submitting specimens.
3. Name and PI # of Attending Physician.
4. Name and PI # of Requesting Physician/Surgeon
5. Name and Pager number of Requesting Physician/Surgeon.
6. Date and Time of specimen collection.
7. Suspected Diagnoses.
8. Relevant clinical information.
9. Legible, specific and concise anatomic description of each specimen.
10. Name or designation of Unit/Ward/Clinic where written report is to be sent.
11. Special requests or instructions, such as:
    1. Special stains or IHC requests
    2. Molecular Genomic testing/patient enrolled in Clinical Trials

The turnaround time for uncomplicated biopsy case is 2-3 days after receipt in lab. Complex cases requiring extensive dissection, decalcification, special stains, and consultations will require additional time. High-priority specimens received at any time may be processed rapidly by special consultation with the Pathologist on call. Preliminary verbal reports from the attending pathologist or pathology resident can be obtained by calling AP Client Services at 916-734-2525 between 8 a.m. and 4:30 p.m., Monday through Friday. The patient's name and medical record number must be supplied.

Once the report has been finalized and signed electronically by the staff pathologist, results are available on the Laboratory Information System.

Limbs should be securely wrapped, correctly labeled and delivered to the Frozen Section Suite (SESP Room 3P508) during working hours, Monday -Friday, 8 a.m. - 5 p.m. After hours and on weekends and holidays, deliver to SESP Room 3P508 and place in refrigerator. The accompanying Surgical Pathology Order (requisition) should be kept with limb at all times.

Core biopsy and aspirate clot specimens should be placed in 10-percent neutral buffered formalin fixative and delivered promptly to Frozen Section Suite, SESP Room 3P508. Contact the Hematology Laboratory at 916-734-2490, or the Pathology resident on call for adequacy and collection requirements.

Advance arrangements with the neuropathologist or the Pathology resident on call should be made to discuss the appropriate specimen size, location and studies required and to provide frozen section confirmation that the lesion has been sampled adequately. Small specimens should be placed directly on a smooth, firm surface such as Telfa to avoid loss of tissue in porous material such as gauze. If an infectious disease is suspected, a duplicate specimen should be sent directly from the operating room to the microbiology laboratory with a separate order for Microbiology.

Submit in formalin and Michels solution (if immunofluorescence is desired) and deliver to the Frozen Section Suite, SESP Room 3P508. Requests for special stains, suspected diagnosis and clinical history should be indicated on the Surgical Pathology Order (requisition), with the formalin-fixed biopsies listed as Part A and those in Michels solution as Part B.

Any specimen requiring an intraoperative consultation (or frozen section), ancillary studies (e.g., flow cytometry, chromosome analysis and/or special send out testing), and muscle or nerve biopsies should be submitted "fresh" without fixative. Such tissues should be delivered immediately to the Frozen Section Suite, SESP Room 3P508 between the hours of 8 a.m. and 5 p.m, Monday-Friday. After hours, and on weekends and holidays, contact the Pathology resident on call for handling of these tissues.

Between 8 a.m. and 5 p.m., Monday through Friday, page 916-816-6409 and then  deliver specimens to the Frozen Section Suite, SESP Room 3P508. After hours and on weekends and holidays, contact the Pathology resident on call, 916-816-2400,to arrange this service. Specimens for frozen section must be submitted without fixative in an appropriately-sized clean container. Do not suspend the tissues in saline or other fluids. The specimen must be accompanied by a Surgical Pathology Order (requisition), including the following information:

1. Patient demographic label including patient’s full name, medical record number, account number, age and sex.
2. Requesting physician, physician index number, operating room site, and phone number.
3. Date and time of collection.
4. Suspected diagnoses, clinical history, including previous biopsies, surgeries, prior therapy, or prior fine needle aspiration biopsy.
5. Special requests, including special stains and consultations.

Complex specimens should be clearly oriented and identified regarding the location of surgical margins and other significant anatomic structures.

The attending pathologist will contact the submitting surgeon by intercom or telephone to deliver a verbal report expeditiously. Additionally, the pathologist will complete the diagnosis portion for each specimen submitted and sign the report. The original copy of this form will be scanned into the patient's electronic medical record.

Advance arrangements with the neuropathologist or Pathology resident on call should be made if special studies such as enzyme histochemistry or electron microscopy are required. Sufficient clinical information should be supplied to determine which special studies are indicated. For enzyme studies, the biopsy should be done early in the day to allow transport of the specimen to UC Davis Campus for special processing. A 2 x 1 x 1 cm specimen is adequate for all studies. Specimens should be sent unfixed, untethered, and in a screw-top container, chilled and wrapped in saline moistened gauze (wring out all excess saline) to the Frozen Section Suite (SESP Room 3P508) for subdivision. Muscle clamps, sutures, or tongue depressors are not to be used to tether the specimen.

Prior to additional surgery or therapy at UC Davis Medical Center, pathologic material from prior biopsies and surgeries must be reviewed by surgical pathology. These should be delivered to the Pathology Building, AP Client Services between 8 a.m. and 4:30 p.m., Monday through Friday.

Advance arrangements with the neuropathologist or the Pathology resident on call should be made if special studies such as high-resolution light microscopy, electron microscopy or immunostaining are required. A biopsy of adequate length (minimum 4 to 5 cm) should be placed directly on a cardboard or notecard, loosely wrapped in saline-moistened Telfa, then transported immediately to the Frozen Section Suite (SESP Room 3P508) for subdivision. Clamps, sutures, or tongue depressors are not to be used. Frozen section confirmation that the specimen is truly a nerve may be required.

Tissue should be submitted in a specially marked metal-free container which can be obtained from the Frozen Section Suite (SESP Room 3P508).

For image guided renal biopsies contact the Cytology Laboratory at 916-734-3031 and request for a Cytologist. For all other renal biopsy collection questions, contact AP Client Services at 916-734-2525 for more information.

Tissue not requiring special handling should be placed in 10-percent neutral buffered formalin. Use adequately-sized containers to allow formalin:specimen ratio of at least 10:1 whenever possible. Please ensure that the container is closed securely.  Large specimens that do not fit into pre-filled formalin containers, as well as specimens in formalin containers, should be delivered to Pathology and  placed in the Frozen Section Suite refrigerator located at SESP Room 3P508.

Renal and bladder stones should be submitted for chemical analysis in a clean, dry container with a "Calculi, Stone Analysis" order. Deliver to the Send Outs Laboratory located in the Specimen and Report Center (SARC), SESP 2nd floor.

The tissue submitted must be sterile and unfixed. Prior arrangements with the Department of Pathology are necessary. Please contact AP Client Services 916-734-2525 for more information.