Lymph node biopsy

When submitting a lymph node, do not wrap in gauze. The pathologist will determine if frozen sections are indicated. Touch preparations will be performed as necessary. If lymphoma is suspected, a lymph node protocol may be performed.

 If cultures are requested in addition to histopathology, the lymph node should be submitted to Histology in a sterile container with the properly completed culture request forms. Additional material should be submitted whenever possible in a separate sterile container with the appropriate tissue culture requests completed. Coordination with the pathologist responsible for the case, in advance of the surgery, is encouraged in order to prioritize allocation of tissue for various studies based on the clinical scenario.
Please contact the Histology department at 953-1526 or 1527, or contact the duty pathologist by pager, and ask to speak with the Pathologist on Frozen Sections for the day the biopsy is to be taken. The pathologist will determine what studies are indicated based on the clinical findings. Touch preparations, frozen section examination, immunophenotype by flow cytometry, and molecular studies will be performed as indicated. A full lymph node protocol generally requires at least one cubic centimeter of tissue. Less material will result in “triage” of tissue with some studies left out.  

Lymph Node biopsy

All specimens will be submitted with either a CHCS order entry document or a Tissue Examination Request
[NAVHOSPPTSVA 6510/44 series
It must be completely filled out with:

1. The provider’s full name.
2. The patient’s first and last name.
3. Social security number with FMP.
4. Age.
5. Ward/clinic/MOR.
6. Specimens anatomic site.
7. Two submitting staff initials.
8. Specimen identifier (A, B, C, etc) if more than one container / specimen is to be submitted.
9. Duty station with phone number for active duty personnel.
In addition, pre-operative diagnosis should be included with pertinent clinical data.

Note: All tissue specimens submitted to Histology from internal NMCP sources must have 2 verifying initials on the specimen containers. If they don’t, the specimen will not be accepted. This is command policy. In addition, all patient and specimen source information must be on the specimen container and exactly match the specimen source indicated in the order.
 

1. When placing the order in CHCS, the ordering provider must verify that the Patient’s name, FMP, social security number, date of birth and specimen source on the specimen container are correct. Specimens from different body sites must be placed in separate, completely labeled, containers.
2. Surgical Pathology specimens must be labeled and requisitions prepared in the room where the surgical procedure is performed. The ordering provider must ensure that the specimen container(s) are correctly labeled with complete and correct patient information, including full name, FMP, SSN, and date of birth, and with the correct specimen identifier (A, B, C, etc) and specimen source (body site). The provider should verify that the specimen identifier(s) (A, B, C, etc) and body sites in the orders correspond to the identifier(s) and body sites on the specimen container(s.)

Note:Routine specimens should be submitted in adequate fixative (10% neutral buffered formalin). A volume of fixative 10-20 times the volume of the tissue specimen submitted is required for optimal fixation. In cases where fixative has not been added, the histopathology technician or laboratory technician will add fixative to the container after consulting with a pathologist.

For ships and branch clinics that mail surgical specimens to Naval Medical Center, Portsmouth, a leak proof screw top container that seals tightly must be used in addition to some type of absorbent material in order to avoid fixative leaking during shipment. Fixative leakage results in inadequate tissue preservation, and histological detail is destroyed. Tissue submission request chits should be separate from the tissue container to protect from leakage.

Lymph nodes submitted to rule out metastatic carcinoma, including sentinel nodes, can be submitted in formalin.  Sentinel nodes must be clearly labeled as such.

Lymph nodes submitted to rule out lymphoma should be sent to the histology laboratory in a sterile container without fixative.

If cultures are requested in addition to histopathology, the lymph node should be submitted to histology in a sterile container with the proper completed culture request forms.

Missing or incomplete patient name on container or lab order form.
Missing or incomplete patient FMP and /or social security number on container or lab order form.
Missing or incomplete anatomic site on container or lab order form.
No double initials on container (two staff members from the submitting clinic must initial the specimen container).
Illegible container label or lab order form.
Patient information on container different from patient information on lab order form.
No lab order form submitted with specimen.
No specimen submitted with lab order form.