Histopathology

Histopathology Laboratory, Level 2, Sarawak Daycare Centre of Sarawak General Hospital

Contact number

Receiving counter: 082-276804 or ext no. 3304

Monday to Friday: 7.45 am to 4.45 pm

Saturday/ Sunday/ Public holiday: Closed

Laboratory Turnaround Time (LTAT)

1. Reports for histopathological examination (HPE) and specialised histopathological service/ second opinion: 14 calendar days

2. Reports for intraoperative frozen section consultation: 60 minutes for verbal report of each sample, followed by formal report in 14 calendar days

3. Reports for molecular tests: 10 working days

4. Reports for clinical autopsy: 60 calendar days

5. Requests for digital pathology slide scanning: 7 working days

6. Requests for microscopic images: 14 working days

7. Requests to retrieve patient's sample(s)/ tissue block(s)/ slide(s): 3 working days

Note:

LTAT depends on the number of pathologists on duty and workload, and may not be achieved due to the following circumstances:

1. Cases requiring additional processing such as regross, special stain, and immunohistochemistry

2. Electricity or water supply disruption

3. Natural disasters

4. Disruption of Internet access

5. Technical issues with equipment/ reagents

6. Other issues that may affect optimum operating conditions in the laboratory

I. Histopathological Examination (HPE)

1. All tissue specimens shall be accompanied by request form Kementerian Kesihatan Malaysia Perkhidmatan Patologi (PER-PAT-301) (in one copy).

2. The following information should be included:

   1. • Patient’s name

      • Identification number or passport number with date of birth

      • Ward/ Clinic/ Hospital

      • Relevant clinical summary/ procedure

      • Operative findings and treatment rendered, if any

      • Previous HPE findings, if any

      • Clinical diagnosis/ Provisional diagnoses

      • Nature of specimen and anatomical site

      • Date and time of collection

      • Requesting doctor’s name, signature, and contact number

      • Name of specialist in charge

      • Clinic follow-up appointment date

3. All urgent requests must be clearly indicated on the request form by writing an “URGENT” word at the top of the form.

II. Intraoperative Frozen Section Consultation

Frozen section request is by appointment only, and the on-call pathologist must be referred to at least one day prior to the procedure. Frozen Section Appointment Form (HUS/PAT/HISTO/WI-11/APP-02) (in one copy) must be submitted separately to the lab counter prior to the procedure. Frozen section can only be performed during office hours, latest by 3 pm.

III. Ancillary Tests

1. Ancillary tests include:

• Immunohistochemistry (see list of antibodies available)

• In situ hybridisation (see list of antibodies available)

• Special stain (see list of special stains available)

• Molecular test (see list of molecular tests available)

2. Clinical teams requesting for ancillary tests must fill in request form Kementerian Kesihatan Malaysia Perkhidmatan Patologi (PER-PAT-301) (in one copy) or Molecular Test Request Form (HUS/PAT/HISTO/WI-18/APP-01) and attach a copy of relevant HPE report.

3. Outsourcing laboratories requesting for molecular tests must fill in the Molecular Test Request Form (HUS/PAT/HISTO/WI-18/APP-01) (in one copy) and attach relevant sample for test.

4. Outsourcing laboratories requesting for ancillary tests such as immunohistochemistry (IHC), in situ hybridisation (ISH), and special histochemistry (HC) must fill in Ancillary Test Request Form (HUS/PAT/HISTO/QP-01/APP-01) and attach relevant sample for test. Once completed, the laboratory will be informed via email and the stained slides will be available at the digital pathology website for review.

IV. Clinical Autopsy

1. 1. All requests for clinical autopsy must be referred to the on-call pathologist.

   2. Clinical autopsy: Consent Form (Consent Form for Clinical Post-Mortem Examination)

V. Retrieval of Patient's Sample(s)/ Tissue Block(s)/ Slide(s)

Fill in the request form Request to Take Away Specimen, Slides and Blocks (HUS/PAT/HISTO/QP-02/APP-04) and send to the lab. The requestor would be notified once the requested item(s) are ready for collection. If the item(s) need to be sent to another site, courier service has to be self-arranged and inform to the lab personnel.

VI. Microscopic Images

To request for microscopic images for publication, presentation, and other purposes, fill in the request form Request for Histopathology Image (HUS/PAT/HISTO/QP-02/APP-05) (in one copy) and send the form to the lab or directly to the pathologist who reported the case. In cases where the pathologist has transferred out, the task would be assigned to another pathologist.

VII. Specialised Histopathological Service/ Second Opinion

To request for a second opinion, refer to the on-call pathologist before sending the specimen. All tissue block(s)/ slide(s) must be accompanied by properly filled request form Kementerian Kesihatan Malaysia Perkhidmatan Patologi form (PER-PAT-301) (in one copy) and relevant HPE report. 

Important: Specimen(s) would be put ‘on hold’ if the request form is incomplete or if there is dispute between the patient’s information in the request form and on specimen label. As such, please ensure that all information is correct to avoid delay in processing.

1. All tissue specimens (except those for frozen section) are to be sent in clean leak proof containers placed within sealed bags or double sealed leak proof bags completely immersed in 10% buffered neutral formalin (NBF). Multilayered sealable plastic bags may be used for medium to large specimens.

2. Rapid immersion of specimens in fixative is critical, and must occur within one hour of the biopsy or resection.

3. Specimens must be fully submerged with the optimal formalin-to-approximate specimen volume of 10:1 or higher, or if not feasible (e.g. large specimens) at least 4:1.

4. DO NOT place large specimens in small containers as this would result in suboptimal fixation and may distort the specimen.

5. DO NOT crush specimens with forceps, haemostats or other instruments. Avoid extensive cautery when possible.

6. Specimens should be delivered in the entirety without any removal of parts thereof without the approval of the pathologist.

7. Large specimens such as small and large bowel resection are to be cut opened along the mesenteric border with faecal contents removed prior to dispatch.

8. All specimen containers must be labelled clearly with patient’s name, identification number/ passport number, type of specimen, and date of collection.

9. The patient’s identifiers on the specimen containers and the request forms should be identical and clearly written.

10. Where possible, specimens from different anatomical sites should be sent in separate containers, properly labelled, and must be clearly itemized in the request form.

11. For specimens where orientation is important, mark or tag the specimen and resection margins with an appropriate marker (suture, bead, clip etc) and indicate the information in the request form, preferably with labelled diagrams.

12. Avoid soiling the request forms with formalin/ tissue fluid/ blood.

13. Skin and renal biopsy specimens for immunofluorescence study should be sent fresh in a clean container containing phosphate buffered saline (PBS).

14. For submission of prepared blocks/slides, please secure the blocks/slides in a container labeled with two identifiers, if blocks/slides only contain one identifier.

Important: Specimens should be collected and transported properly. Deviations from best practices may result in pre-analytical errors. 

1. Specimens should be sent to the laboratory as soon as possible after collection.

2. Specimens for routine histopathological examination should be sent directly to Histopathology Laboratory during working hours if possible, or in the morning of the next working day.

3. Urgent specimens may be sent to the Integrated Laboratory (at level 3) after office hours.

4. Fresh tissue specimens for immunofluorescence study should be sent immediately to Histopathology Laboratory. 

5. Fresh tissue specimens sent from outsourcing laboratories should be placed in a cool box.

6. Fresh tissue for frozen section should be sent immediately upon removal to the laboratory.

7. Wards/ Clinics from Sarawak General Hospital must bring the specimen dispatch book when sending the sample to the lab counter. Specimens sent from the other clinics/ hospitals must be accompanied by a specimen dispatch list. The laboratory staff will acknowledge receipt of specimens by signing the dispatch book/ list. 

1. Suboptimal specimen to perform analysis, i.e. only one fragment of tissue present, size <1 mm in largest dimension

2. Mislabelling of patient’s particulars and specimen type on specimen label and/or request form

3. Specimen unsuitable for examination e.g. no tissue present, inappropriate specimen type

4. Test not offered or test request cancelled by requesting team

All reports will be available on the web-based laboratory information system (LIS).

Please contact the laboratory administration for access if required.