By: Annalisa Lopez, HTL (ASCP), QIHC
The histotechnologist plays a vital role in specimen processing from start to finish, and you may find yourself on the front end of this process. This requires the histotechnologist to be responsible for correctly triaging specimens for special studies that are either ordered or requested. Staying knowledgeable in specialties and ancillary testing outside of histology can be beneficial to both yourself, the pathologist, and of most of all, the patient.
CAP states an individual who is a non-pathologist or non-pathology resident must have an associate degree in a science related subject, or at least 60 semester hours, 24 of which must be science-based course credits, to be considered grossing personnel. In addition to that, training from a NAACLS approved program or 3 months of laboratory experience is also required. There is no specific list as to what a histotechnologist can or cannot gross when it comes to complexity. This leaves an open interpretation and is dependent on the policies of the institution to determine. Not only should the histotechnologist have a firm grasp on their own policies and grossing procedures, but specimen triage as well.
In an ever-changing field there are endless ancillary tests that can be performed in conjunction with histology. It helps to understand the “why” behind each test and below will provide a brief overview of common special studies and some strategies for preserving tissue for these purposes.
Bacteria, Viruses, and Fungi, Oh My!
Receiving an abscess? A bone biopsy that has a pre-operative diagnosis of osteomyelitis? Sinus contents? Think twice about submerging the specimen in formalin! In the case of microbiology, it is imperative to keep the tissue as sterile as possible.
This includes having a set of sterile tools to handle the portion of tissue that you are submitting to microbiology, in conjunction with a sterile container to place the tissue in.
Liver, heart, or renal biopsy? It is possible that electron microscopy can aid the pathologist in determining glomerular disease, fatty liver, or amyloidosis in these specimens. You may consider saving a small portion in a glutaraldehyde fixative. Time is of the essence as the ultrastructural detail begins to degrade quickly before being placed in glutaraldehyde, and a smaller portion, 0.1cm or less, will fix quickly to preserve these details.
Amplify your Antigens
Immunofluorescence is a crucial antigen detecting technique and you may see it most often utilized for skin and native renal biopsies. If you notice a skin biopsy where DIF, or Direct Immunofluorescence, is ordered and you perform this test in house, a fresh, saline moistened piece will suffice. However, if the specimen needs to be transported to a different facility, Michel’s Transport Media or Zeus fixative are the preferred media for the specimen, where it will remain viable in the fixative for up to 5 days.
Go with the Flow
Flow cytometry is a valuable technique for analyzing proteins or biomarkers and their characteristics. This is performed using lasers for detection and fluorescence to label them. It is a widely used tool for leukemias and lymphoma as it can aid in monitoring patient immune status. Fresh tissue must be submitted in RPMI media for transport, which can subsequently remain ambient for up to 24 hours.
Not only does the grossing histotech have the responsibility of preserving and submitting optimal sections for histology, but also ensuring that the specimen is adequately preserved and submitted for the appropriate special studies. You can learn more about specimen triage and dissection at the NSH Convention's, “The Gross Room: Specimen Triage and Grossing,” on September 16th.