Surgical Specimen Preparation

KDL Pathology is committed to providing rapid, accurate pathologic identification of surgical biopsies for breast, hematologic, gynecologic and other soft tissue diseases by partnering with our clients to deliver quality patient care. Proper biopsy techniques and specimen storage transport are fundamental to rapid, superior diagnostics. Below are recommended guidelines for specimen preparation and shipment. Please contact client services for assistance.

Routine Histopathology (H&E and IHC)

  • Promptly place tissue biopsies and excisions in fixative solution (10% buffered formalin or similar).

  • Specimen container should be large enough to hold the tissue sample AND enough fixative solution to entirely surround the specimen (optimal ratio of fixative to tissue volume is 10-20:1).

  • Label specimen container with patient’s name and anatomic site of biopsy or excision and place in plastic bag with requisition. Requisition should include the patient’s name, date of birth, social security number, submitting physician, date specimen obtained, clinical history and diagnosis. Billing information and results reporting requests should also be included.

Immunopathology, Molecular Diagnostics & Special Studies

Lymphoma workups, FISH, flow cytometry, gene rearrangement studies, and electron microscopy are available. Please call the laboratory for instructions.

  • B Cell and T Cell Gene Rearrangement, DNA mutational analyses- formalin-fixed tissue, frozen tissue & whole blood acceptable may be acceptable.

  • Flow cytometry- whole blood, bone marrow & some tissues, shipped ambient (NO Fixation). Specimen must be received within 24 hrs. of collection.

Review of Slides for Consultation

Microscopic slides prepared elsewhere may be submitted for review. They should be labeled as above. Previous pathology reports must accompany the slides.

Peripheral Blood Smears

  • Prepare peripheral blood smear on glass microscope slide labeled with patient name and date. Smear is prepared on one side with a thin layer of fresh blood or venous blood collected in a purple or green top blood tube. The smear should be prepared as soon as possible and less than 2 hours from time of blood draw.

  • Use wedge slide technique: Place a drop of blood close to frosted end and use a second slide at 30-40º angle to make the smear.

  • Air dry for 10 minutes and place in cardboard slide holder for transport at room temperature.

  • Submit specimen and completed requisition following labeling instructions as described above in Routine Histopathology.

Fine Needle Aspiration/Biopsy

  • Confirm patient identification with two identifiers. Confirm site of procedure.

  • Prepare and label 10 slides with patient name. Complete and label specimen containers and requisition as described above in Routine Histopathology.

  • Expel a few drops of aspirated material over one slide. Use a second slide and place it over the material on the first slide and gently pull the slide to make a smear. Allow 2 or more of the slides to air-dry and place the remainder immediately in 95% alcohol container.

  • If a lymphoma is suspected, place part of the sample in RPMI transport medium for flow cytometry studies.

  • At the end of the procedure, rinse out the needle and tubing into a Cytolyt solution.

  • If an infection is suspected, save material for culture and sensitivity.

Bone Marrow Aspirate and Biopsy

  • Confirm patient identification with two identifiers. Confirm site of procedure.

  • Complete and label specimen containers/slides and requisition as described above in Routine Histopathology. Label 14 slides with patient name. Label one EDTA (purple top) blood tube, one bone marrow transport tube and two B-Plus Fixative containers with two identifiers.

  • After the first syringe of bone marrow aspirate is obtained, prepare 5 bone marrow aspirate smears and air dry. Place remaining bone marrow aspirate in a 10% Formalin container.

  • The second syringe of bone marrow aspirate: Place half in an EDTA purple top tube and the rest in a Bone Marrow transport solution tube. Invert purple top tube gently to mix with anticoagulant.

  • Bone marrow core biopsy is placed on a slide, remove any blood clot and then place the biopsy on a new slide. Use a second slide to roll the biopsy gently to make a touch prep. Make 4-5 touch prep slides and air dry. Then place the bone biopsy in a B-Plus Fixative container.

  • Send CBC and peripheral blood smears collected from patient as well.

  • Indicate special studies to be performed (e.g.; Flow Cytometry, Cytogenetics for Chromosome Analysis , FISH for MDS, myeloma, CLL or molecular studies as needed).