LYMPHOMA PROTOCOL, LYMPH NODE OR TISSUE

Test Code: SURG

Test Indications: Tissue biopsy procedures are performed for primary diagnoses or follow up diagnoses, in which lymphoproliferative disorder is included in the clinical differential diagnostic consideration. 
Expected specimens from the procedure include: Needle core biopsies, incision and excision biopsies.  For diagnosis of lymphoproliferative disorders incision and excision biopsies are preferred. Needle core biopsies are advised for anatomically complicated and difficult to reach areas only.
Final determination of choice of biopsy procedure is predicated by clinical presentation and surgical guidelines.

Recommendations: For the diagnosis of lymphoproliferative disorders incision and excision biopsies are preferred. Needle core biopsies are advised for anatomically complicated and difficult to reach areas only.  Guidelines for needle core biopsies are ideally 6 cores collected using 18 guage needles.  All needle cores are submitted to pathology in formalin. 

For questions pertaining to adequacy of tissue biopsy sampling, in which lymphoproliferative disorder is included in the clinical differential, pre-operative consultation between the surgeon and the Lymphoma pathologist on service is recommended in complex cases.  Please refer to lymphoma SOP #170-10-11 Lymphoma Protocol for tissue adequacy details.

Contact HSC Pathology Lab:  204-787-4611 prior to collection if any questions. After hours:  Contact: Pathology Resident on call. 

List of known previous specimens (if any), detailed pertinent clinical history, pervious ancillary study report numbers (if any)

Requisition must contain the time the specimen was placed into formalin.  Add all relevant clinical data.  Use a STAT or URGENT sticker.  Legibly indicate "Query Lymphoma" or check off LYMPHOMA PROTOCOL (found at the bottom of the HSC pathology requisition)

Lymph Node Measurement Example

Adequacy of tissue is defined using ‘volume of tissue’.  A single lymph node specimen, multiple fragments of lymph node samples, extra-nodal tissue specimens, less than or equal to 2 cm in maximum dimension/or in aggregate dimensions, and needle core biopsies are categorized as adequate for morphology and immunohistochemistry analysis only. 
These specimens should not be triaged for additional ancillary studies.  Lymph node biopsies (incision or excision) greater than 2 cm MUST BE triaged for morphology and immunohistochemistry first, followed by submission of additional ancillary studies, under the supervision of the lymphoma Hematopathologist on service. 

_SH Pathology Services SBH Laboratory Requisition (R250-10-39)

Pathology Lab Test Requisition (Form #BRH 012) - Westman Lab

Pathology Services HSC Laboratory Requisition (80993)

A descriptive report will be issued.

24/7 Routine / OR / PAC / STAT

Pathology lab hours: 0630-1715 hrs After hours handling (1715-0630), contact pathology resident on call. Resident will contact the Hematopathologist on Lymphoma Service to discuss the case.

All “Query lymphoma’ samples should be labeled with a STAT or URGENT sticker
 
Sites outside of HSC:
-All needle core biopsies are submitted in formalin.
-Lymph node protocol samples MUST be measured length x height x width and indicated on the requisition. Staff measuring should include their initials on the requistion.
-If the node is less than 2 cm, bisect the specimen and place immediately into 10% neutral buffered formalin (minimum volume of 10 x the tissue ratio). 
-If the node is greater than or equal to 2 cm, perform fixation cuts every 3-4 mm and place immediately into 10% neutral buffered formalin (minimum volume of 10 x the tissue ratio). 
-Mark the time sample placed in formalin on the requisition.   
-Tissue should never dry out.
 
HSC:
-All cores needle biopsies are sumitted in formalin. 
All other specimens that are "Query lymphoma" are sent in saline or RPMI as STAT samples.
 
Requirements for ALL SITES:
All specimens must be properly labeled with the appropriate patient identification.  Ensure all pertinent information including patient demographics, clinical history, physician’s signature and specimen type are completed on the requisition as per 10-50-03 Specimen Acceptance Policy