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General Procedures Flashcards

1
Q

What does MDT stand for?

A

Multi Disciplinary Team

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2
Q

Who attends MDT meetings?

A

Surgeons and advanced practitioners
Radiologists and radiographers
Pathologists
Oncologists
Cancer care nurses
Research nurses
MDT coordinators

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3
Q

What is the aim of MDT meetings?

A

To discuss the diagnosis and treatment for a patient. This will include the patient follow-up

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4
Q

What determines the block selection at dissection?

A

Clinical history
Specimen type
Orientation of specimen
Hollow/solid organ

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5
Q

How can clinical history influence block selection?

A

Incisional biopsies for alopecia
WLE for MM
Hard descended gall bladder for gall stones

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6
Q

How can Orientation alter block selections?

A

Punch biopsies for alopecia. In correct orientation can affect the dioagnosis
If trimming is required some information may be lost

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7
Q

How would you dissect a hollow organ?

A

Longitudinal margins en face x2
Tumour and relationship to organ
Radial margins if present
Background/normal tissue

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8
Q

How would you dissect a solid organ?

A

Tumour x2
Tumour in relation to the margins
Lymphatic/vascular/perinural invasion

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9
Q

What is the aim of Datasets and tissue pathways?

A

Standardise practices
Allows for statistical analysis of treatments
Ensure minimum standards
Ensure collection of relevant information for diagnosis
Are not rigid in obscure cases

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10
Q

What is the purpose of SOPs?

A

Ensures uniformity
Ensures correct procedures are performed
Standardised training

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11
Q

It is important to always keep SOPs…?

A

Up to date
Inline with datasets
For every type of procedure

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12
Q

What is important for competency documents?

A

UKAS requirement
Ensures everyone’s practice is current
Highlights areas for training

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13
Q

Why are photographs helpful in dissection?

A

Can be printed and annotated at dissection
Help during MDTs
Teaching purposes
For part of medicolegal cases
Allow Pathologists to see specimens if not at dissection
Record of appearance before the specimen is damaged and no longer fully visual

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14
Q

How can specimens be orientated for embedding?

A

Double agar embedding
Bags
Foam inserts in cassette
Metal inserts in cassette
Inking margins
Orange dots up

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15
Q

How does orientation at dissection help embedding?

A

Specimen shrinks during processing may be difficult to orientate
Specimen can twist/bend during processing so may be difficult
Speeds up the process making orientation easier

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16
Q

How can we prevent tissue loss during processing?

A

Sponges in cassette
Wrap the tissue
Tissue bags
Embed in agar first

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17
Q

How do you approach dissection of a random specimen?

A

Check pots and form for identifiers
Check pots and form for specimen type
Check pots and forms for orientation
Describe specimen type
Meansure/weigh
Orientate
Describe outer surface/appearance
Photograph
Ink margins
Slice perpendicular to surface
Describe cut surface/walls/inner surface/lumen
Measure lesions and margins
Select blocks
Trim if necessary
Wrap if necessary
Ink for orientation
Place in cassette and lid

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18
Q

How many identifiers should match on specimen form checks?

A

3

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19
Q

Give examples of patient identifiers?

A

Name
Date of birth
MRN (medical record number)
NHS number

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20
Q

Name 3 specimen types that require weighing?

A

Breast lumps
Parathyroids
TURPS

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21
Q

What can you use as descriptors in Macroscopic descriptions?

A

Colour
Shape
Contour
Size
Regular/irregular
Homogenous/heterogeneous
Effect (structures etc)

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22
Q

How do you measure a specimen?

A

Use SI units
Measure length, width and depth

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23
Q

Give examples of ways to Ink margins?

A

India ink
Alcian blue and water
Commercial marking dyes

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24
Q

Why do we mark margins?

A

Help with measuring
Help with orientation
Useful once specimen is cut smaller
Helps consultants
Helps if you need to return to a disected specimen
Helps embedders
Aid in evaluating the distance of a lesion from the margin/invasion
Distinguishes between margins and cut aurfaces

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25
What is a margin?
A boundary of a specimen made by the surgeon cutting through something
26
What does an en face block demonstrate?
Show the entire margin of a specimen Full face of specimen
27
What does a cruciate demonstrate?
Part of the margin.
28
What are the benefits and limitations of en face blocks?
Benefit Shows all margins and the lesion in that plane and their relationship to each other Allows for accurate measurements to be taken Limitations Only one plane Mayneed to be a mega block with those limitations
29
What are the benefits and limitations of cruciate blocks?
Benefit Can show the same margin at several points without trimming/cutting out Small blocks benefit ancillary testing Limitations Only accurate for that point Can lead to lots of blocks
30
What equipment is needed for dissection?
PPE Extraction Sharpes Forcepts Rulers/scales Computer Dictation devises Inks Disposable rolls Cutting board Ink/fixatives/brushes Camera Processor racks Formalin Tissue wraps Cassettes/lids
31
What are the key points to describe in a Macroscopic description?
Location (Central/apex) Appearance (nodule/ulceration) Boarders (regular/irregular) Surrounding tissue appearance Photos/drawing Medical terminology (lateral/superior)
32
What is the purpose of block IDs?
Record where the tissue comes from Records the number of blocks for the dataset Form part of the final report Record if tissue is remaining
33
Why is it important to know if any tissue is remaining?
Helps if more information is needed from the specimen Generates the specimen disposal lists Important in PM cases as the coroner must record what is taken (Full paper trail for HTA)
34
How would you describe a hollow organ?
Length Circumference Wall thickness Description of background serosa/mucosa Length, width and thickness of tumour Depth of invasion through wall Distance from longitudinal margins Distance from radial margins
35
How would you describe a bag like hollow organ?
3 perpendicular diameters Wall thickness Length and diameters of input tubes Thickness of encasing soft tissue Description of background serosa/mucosa Length, width and thickness of tumour Depth of invasion through the wall Distance from longitudinal margins Distance from radial margins
36
How would you describe a solid organ?
3 dimensions of organ +/- surrounding fat Ink margins different colours 3 dimensions of tumour Relationship to margins and anatomical structures Sequencial slices Sample tumour, +/- margins if close Sample background
37
How can you prevent carry over?
Only deal with one sample at a time Clean bench Clean equipment Clean between specimen and deep clean at end of the day
38
What are the implications of specimen carryover?
Can lead to upstaging of a diagnosis Patients may receive treatments they do not need Patient anxiety/stress False positive results Legal case
39
What should you be aware of if a fresh specimen is received?
Some sent for appraisal before fixation May be for frozen section/electron microscopy/research
40
If a specimen is sent for electron microscopy how is it treated?
Specimen requires fixing in gluteraldehyde. May need dissection first
41
What is a radial margin?
A margin that exists around the Circumference of an organ
42
What is a pedicle?
Connective tissue also containing vessels, lympatics and nerves that holds an organ in place within the body
43
Give 3 examples of where a pedicle can be found?
Spine Brain Attaching a skin tag to the body
44
What does TNM grades stand for?
Tumour Nodes Metastases
45
How is TNM staging determined?
By how far the tumour has spread through the organ/surrounding organs/Lymphatic spread/distal organs
46
What are the general sections of a hollow organ?
Mucosa Submucosa Muscularis propia Serosa Attached peritoneum/organs/connective tissue/ fat
47
How are the six sides of a solid organ referenced during dissection?
Superior Inferior Medial Lateral Anterior Posterior
48
Are solid organs actually solid?
No they often have a network of spaces that relates to their function
49
Give 4 examples of a solid organ?
Kidney Liver Breast Thyroid
50
Give 4 examples of a hollow organ?
Gall bladder Bowel Oesophagus Fallopian tube
51
Give 13 examples of hazards in the lab?
Biological Chemical Radiation Toxic Flammable Allergic Carcinogenic Electrical Sharps Mechanical (stainers/cover slipper) Trip Corosive Manual lifting Infection
52
Name 11 things that can help prevent hazards?
Good lighting Good ventilation Safety equipment PPE Disinfectants Spillage kits Training Tracking/barcodes No absorbant surfaces Wipe clean surfaces Only 1 specimen at a time
53
Name 20 things a dissection room should have?
Good lighting Good ventilation Non-absorbant wipe clean surfaces PPE Camera Disposal bins Different size knives Forcepts Rumlers Scales Quiet Processor racks Cassettes Cassette lids 10% neutral buffered formalin Sinks Ink brushes Fixing spray Absorbant cloths Dictation device Access to LIMS
54
What is a proforma?
A guide to Dictation that includes all the relevant details for a specific specimen Aide memoir
55
What are the benegits/limitations to prformas?
Benefit Promote standardisation Ensure key information is included Aide memoir Limitation Prevent free thicking Help loose skill set
56
What types of genomic studies are there?
Cytogenetic Biochemical Molecular
57
What doez a cytogenetic study consider?
Entire chromosomes
58
What does a Biochemical study consider?
Proteins produces by the genes
59
What does a molecular study consider?
Mutations in DNA
60
What does a diagnostic study aim to do?
Diagnose disease
61
What does a predictive study aim to do?
Predict if the patient will suffer from a disease, a concern in hereditary conditions
62
What does a carrier testing study aim to do?
Access if the patient will pass on a disease
63
What does a pharmogenetic study aim to do?
Determine helpful medications or dosage
64
What does a prenatal study aim to do?
See if the fetus is likely to develop symptoms after birth
65
Give 2 examples of a diagnostic study?
Cystic fibrosis Huntington's disease
66
Give 2 examples of a predictive study?
BRAC 1 and 2
67
Give 2 examples of a carrier testing study?
Cystic fibrosis Sickle cell anemia
68
Give 2 examples of a prenatal study?
Down syndrome Trisomy 18 syndrome
69
What sample types can be involved in genetic testing?
Blood Swabs Amniocentesis Chronic villus sampling Curls from FFPE block
70
Give 2 examples iof a newborn screening study?
Sickle cell anemia Hypothyroidism
71
What is the aim of newborn screening tests?
To test the baby's DNA
72
What is the aim of preimplantation testing?
Test the embryo before in vitro fertilisation
73
What is bio-banking?
Storage of tissues/biological material or data in connection with the above
74
What must be in place before bio-banking can take place?
HTA licence Patient consent (pending or given)
75
What are the benefits of bio-banking?
Increase research pools Can be fixed or frozen, prolonging the life Large pool can help understand genetic links to disease
76
What are the limitations of bio-banking?
Maintaining privacy is difficult High cost (setting up and maintaining) Difficult to encourage donations especially if the patient doesn't see the benefits themselves
77
Name 6 intervention Al clinical trials
Pilot Feasibility study Prevention Screening Treatment Multi arm multi stage
78
What is a pilot study?
Small version of the main study
79
What is a feasibility study?
To see if it will be possible to carry out the main study
80
What is a prevention study?
To see if the treatment can prevent the disease
81
What is a screening study?
To test for early signs of the disease
82
What is a treatment study?
Set in stages Early stages look at side effects and safety Late phases look at is treatment better than current practice
83
What is a multi arm multi stage study?
Will have a control group and a treatment group
84
Name 3 types of observational study?
Cohort Case control Cross sectional
85
What are the 2 types of clinical trial?
Interventional Observational
86
How does a cohort clinical trail work?
Follows a group, usually disease free, overtime to identify risk factors
87
What are the limitations of a cohort clinical trail?
Expensive Time consuming
88
How does a case control trial work?
Considers a group with a disease and a group without and considers risks and exposure
89
What are the benefits and limitations of a case control clinical trial?
Benefit Cheap Limitations Can be unreliable (relies on memory)
90
What are the benefits and limitations of a criss sectional clinical trial?
Benefit Only take a short period of time Can identify causes and links Limitations Can be unreliable (often used to find initial cause/link and used to form the basis of the main study)
91
What considerations are needed when dealing with high risk specimens?
Lots of viruses survived formalin All specimens are potentially high risk Specimens from IV drug users are high risk Be aware, normal procedures are enough to protect Leave for 24hrs Do not process/dissect cat 4 specimens (ebola/haemorrhagic fever) send to specialist centres
92
Give examples of communication within the lab?
Pathologist Dissection assistant Secretaries Clinician/nurses
93
How do you approach dissection?
Check bench is safe Check branch is clean Check required equipment is too hand Check request form, specimen pot data Record patient name, case number and specimen type Check specimen is fixed Check orientation Describe and measure specimen Photograph or draw Ink Follow procedures for specific specimen type or clinical information
94
Name 3 techniques that can mark the tissue when dissecting
Ink margin in a single colour Multiple ink colours to represent the orientation of the margins Using seperate cassettes for different margins and note in the block ID Orange dot to denote which side should be embedded downwards
95
5 main purposes of tissue pathways
Standardised practices Ensure diagnostic and prognostic information is recorded Allows for consistent handling of specimens Allows for clinical audits to be preformed Promotes quality and evidences the practice
96
What should a clinical history included?
Tissue type Number of pots Method of sampling Clinical impressions Orientation sutures If specimen is high risk If specimen is part of cancer pathway Specific requests
97
5 measures that can be used to audit dissection practice
Datasets/pathways Comparison to department templates SOPs Comparisons of why EBs are taken Questionnaires to colleagues/consultants/Secretaries
98
4 criteria to accept a specimen at reception
At least 2 matching identifiers between pot and form Appropriate pot Appropriate fixative Correct specimen type on pot and form
99
What steps are taken when a specimen fails the acceptance criteria?
Phone the requestor/requestor explain error Ask for them to attend the lab, identify the specimen and rectify the issue Document all changes and staff details on request card and LIMS
100
What must be documented as well as the Macroscopic description when dissecting a case?
Procedure type Orientation Specimen type Inking guide Block ID
101
What should be included in the Macroscopic description?
Patient name Unique identifier Specimen type Specimen location (left/right) Orientation Size Weight Outer surface description Cut surface description Description of lesion Size of lesion Margins from lesion Invasion Inking key Block ID
102
Why is fixation important?
Stops purification Preserves tissue Produces known artefacts that can be accounted for Benefits ancillary testing
103
How can clinical history influence block selection?
Suspicions - guides actions to aid in diagnosis eg MM levels at dissection History - eg Fast growing extensive sampling Type of specimen - eg inc bx would be handled differently from exc bx High risk - leave in formalin for an additional 24hrs eg HIV Cancer pathway - prioritise case eg endoscopic biopsies Orientation - ink margins with different colours
104
What are the principles behind gross examination?
Formal documentation of specimen Measurement of the lesion Opinion of the lesion Can influence further surgery Block selection Record of atypical features Allows audit of a surgeons practice
105
What actions would you take if a specimen was partially dissected by a surgeon?
Describe findings If possible sample arround altered tissue If unable to exclude, sample and note as part of the block ID
106
What are the advantages of a template for dissection?
Ensures inclusion of essential information Standardises practices Allows for additional information to be included Training prompt
107
What are the disadvantages of a template for dissection?
Reduction in lateral thinking Encourages lazy descriptions De-skilling Free thinking decreases Require surveillance and updating
108
What does PMB stand for? And it's clinical implications
Post menopausal bleeding Common symptom in malignancy and not normal, requires investigation
109
What does SLNB stand for? and it's clinical implications?
Sentinel lymph node biopsy First lymph node that drains the tumour site. Indicates metastatic spread
110
What does RIF pain stand for? and it's clinical implications?
Right iliac fossa pain Can indicate appendicitis
111
What does BBT stand for? and it's clinical implications?
Basal body temp If raised may indicate fever/infection
112
What does MF stand for?
Myofibrosis
113
What does CRSWP stand for?
Chronic rhinosinusitis with nasal polyps
114
What does TAH BSO stand for? and it's clinical implications?
Total abdominal hysterectomy and bilateral sphingoophectomy Removal of cervix, uterus, both tubes and both ovaries
115
Give examples of when residual tissue should not be kept at dissection.
Biopsies Lymph nodes Both all put through at dissection as important to sample it all. Appendix when it looks healthy important to demonstrate entire specimen for hidden pathology
116
How do you prevent carry over at dissection?
Clean bench, equipment, blades and cutting board One specimen at a time Wrap small/friable specimens
117
What is the important of weighing some specimens?
Allows for assessment against normal ranges. Indicates how dense a specimen is. Enlarged by cyst is less dense than enlarged by cells Part of dataset Breast lumpectomy, needs to be 20g or below or biopsy is required first
118
What do you do if tissue is missing at embedding?
Check embedding centre and surrounding areas incase specimen has flipped out. Check all around cassette, processor racks and wax bath Check processor and dissection bench Note on LIMS and request form Incident If found embed seperately. Explain to consultant and they can assess, same tissue type/ same pathology. Clinician informed
119
What does BXO stand for and what it's the definition?
Blantis Xerotica Obliterans - chronic inflammatory condition that affects the male genitalia
120
What does EMR stand for and what it's the definition?
Endoscopic Mucossal Resection - removal of GI cancer and precancerous tissue using an endoscope
121
What does BCC stand for and what it's the definition?
Basal Cell Carcinoma - epithelial cancer that originates in the basal cells that lie in the deepest level of the epithelium
122
What does UC stand for and what it's the definition?
Ulcerative Colitis - inflammatory condition of the large bowel and rectum
123
What does IBD stand for and what it's the definition?
Inflammatory Bowel Disease - inflammation of the bowel that is longstanding and chronic
124
What does MM stand for and what it's the definition?
Malignant Melanoma - malignant tumour that originates in the melanocytes of the epidermis
125
Give 3 examples of marking techniques used at dissection
Using one colour to mark the resection margin Using multiple colours to identify different margins Orange dot up to aid embedding Different cassettes to distinguish the different parts
126
If writing a dissection SOP, what needs to be included in order to comply with the recent ISO:15189 changes?
127
If writing a dissection SOP, what needs to be included in order to comply with the recent ISO:15189 changes?
Purpose Principle Equipment required Reagents COSHH Risk assessments especially to the patient Staff responsibilities References Document control Author Authorisation Location of copies
128
What would you include in a dissection template?
Patient name Case identifier Nature of specimen as on pot Specimen number Orientation of specimen Site of sample Size of specimen +/- weight Description outer surface Description of inner/cut surface Description of lesion Size of lesion Distance of lesion to margins
129
What factors determine block selection?
Clinical history Where a specimen is from Orientation of a specimen Specimen type (Inc, exc, punch) Visual apperance
130
What block selection would you use for hollow organs?
Resection margins en face Lesion/tumour and the relationship to the organ Any other pathology Radial margins Background tissue
131
What block selection would you UAE for solid organs?
2 blocks of lesions/tumour Tumour and their relationship to the margin (cruciate) Lymphatic /vascukar/perinural invasion
132
What is the aim of clinical history?
Gives clinical impressions Guide best way to dissect inorder to best demonstrate Examples : incisional biopsies for alopecia Re-excisuon following melanoma
133
What are the reasoning behind staff competency documents?
UKAS requirement Ensure current practices are up to date Reminds staff of key points that may not be encountered often
134
What are the benefits of Macroscopic photographs?
Can be printed and annotated at dissection A record that cab aid reporting or MDTs Teaching aide Form part of medicolegal cases Helpful for Pathologists as they may never see the intact specimen
135
What can be done to help orientate a specimen at embedding?
Double agar embedding Tissue bags Foam/metal inserts in the caasette Inking margins Orange dot up Note for embedding sheet
136
What is the point of orientation for embedding?
Allows embedded to embed the specimen so that they show the correct area of the specimen on the slide for consultants Incorrect orientation could lead to loss of vital information that can mot be retrieved once trimmed. Eg alopecia
137
What equipment is needed for dissection?
PPE (lab coat, apron, gloves, safety glasses/visor, spillage equipment) Sharpes (knives various sizes, scissors) Forceps Ruler/scales Computer/Dictation device Ink/fixative/brushes Blunt ended probe Camera/pencil Cutting board Ventilation
138
How are margin distances measured?
In SI units Length, width, depth/height
139
What counts as a margin?
Can be natural or acquired. A boundary made by a surgeon cutting through the tissue Surface that is preexisting as an outer part of the specimen
140
Why do we ink margins?
Aids in the measurement microscopically Aids in orientation Aids in evaluating the relationship between the lesion, is further surgery required Not always clear on the slide which is a cut at surgery or a cut at dissection.
141
How can resection margins be demonstrated at dissection and what are their advantages or disadvantages?
**En face** Shows the entire margin Eg - ureter in kidney resection Considerable limitations Still not true due to trimming Only a snap shot One side if same lesion or seeding/skip lesion **longitudinally** Only shows part of the margin longitudinally, not all of it **cruciate** Only shows part of the margin longitudinally, but more than just longitudinal margin Leads to more blocks, workload
142
What must be included in a description?
Required information for datasets and tissue pathways Tissue type Tissue size Orientation Appearance
143
How should lesions be described?
Location (Central, apex, marginal) Appearance (nodule, ulcerated) Boarders (regular, irregular, well circumscribed) Surrounding tissue appearance Photos, drawings if necessary Medical terminology
144
What is the purpose of a block ID?
Record of where the r tissue in a block is from Record of the number of pieces taken Part of the final report May record the orientation Record of tissue remaining
145
Why is it important to know if there is retained tissue after dissection?
Part of the block ID If more information is required let's the consultant know if it's available Generates specimen disposal lists Important in CP cases as a record is a legal requirement, HTA - audit trail
146
How would you approach the dissection of a hollow organ?
Length Circumference/diameter Thickness of wall Description of serosa, mucosa Length, width and depth of tumour, pathology Depth of invasion through the wall, accessory tissues Distance from margins Sequential slicing Sample - margins, tumour, background
147
What is the general anatomy of hollow organs?
Serosa Muscularis propria Submucosa Mucosa
148
How would describe bag hollow organs?
3 perpendicular lengths Thickness of wall Length and diameter of input tubes Thickness of encassing soft tissue Description of background serosa, mucosa Thength, width and depth/height of lesion Depth of invasion of wall, encassing soft tissue Distance from margins
149
How would you describe solid organs?
3 dimensions of organ 3 dimensions of surrounding soft tissue Ink margins 3 dimensions and relationships to margins or architecture of any kesions Sequential slices Sample tumour, background and margins The six sides can be referred to by the anatomical directions if orientated If ducts, vessels and nerves are present they are all a margin for invasion Lymph nodes also need processing
150
What is a solid organ and examples?
Has no lumen other than any inlet/outlet tubes May have a network of spaces Kidney Liver Breast Thyroid
151
Give examples when a specimen would not be retained after dissection.
Biopsies - entire specimen processed Lymph nodes - entire node sampled Appendix when unremarkable - tissue pathway Fallopian tubes, ovaries - prophylactic, risk reducing
152
How can you reduce the risk of carry over?
Only deal with one specimen at a time Clean bench, equipment are cleaned between specimens End of the day thoroughly clean bench and equipment
153
What are the implications of carry over between specimens?
Can lead to upstaging of diagnosis Excessive or unnecessary treatment Increased anxiety for patients and their families Medicolegal cases
154
Give examples of fresh specimens and how they are dealt with in the lab?
Rentals - in PBS. Small amount into glutaldehyde for up to 72hrs for electron microscopy Placenta - initial assessment before fixation and routine processing Frozen sections - frozen with the lab and rapid H&E. Allows for initial assessment and confirmation of tissue type whilst patient is still within surgery Skins for immunoflourscence - frozen within the lab then stained for antibodies
155
What does TNM stand for?
**Tumour** decided by size of tumour, relationship to adjacent organs. Decided by a combination of histology, radiology and clinical assessment **Nodes** lymph node involvement **Metastases** spread from initial organ to surrounding organs or regions
156
What are the advantages and disadvantages of proforma?
**Advantages** Promote standardisation Ensure all key information is included **Disadvantages** Prevent free thinking Allow loss of skill set Do not fit all cases
157
Name 10 hazards in the cut up room?
Biological Chemical Radiation Toxic Flammable Allergic Carcinogenic Electrical Sharps Mechanical (equipment) Trip Corosive Manual handling
158
How can you prevent or reduce the risk of hazards?
Goods lighting Ventilation Safety equipment Disinfectant Spillage kits Training Tracking/barcodes PPE Non-absorbant surfaces Wipe clean surfaces Only one pot at a time
159
What can genetic studies consider?
Cytogenetic - entire chromosome Biochemical - proteins the genes produce Molecular - mutations within the DNA
160
What tissue can be used to test in genetic studies?
Blood Cheek swabs Aminioncentesis Chronoinic villus sampling
161
What types of genetic studies are there?
Preimplantation testing Newborn testing Diagnostic Predictive Carrier testing Pharmogenetic Prenatal
162
What is the aim of preimplantation testing, give examples of these type of tests.
Testing the embryo before in vitro fertilisation Huntington's disease Sickle cell anemia
163
What is the aim of newborn screening, give examples of these type of tests.
Testing the fetus' DNA Sickle cell anemia Congenital hypothyroidism
164
What is the aim of genetic diagnostic testing, give examples of these type of tests.
To diagnose diseases Cystic fibrosis Huntington's disease
165
What is the aim of genetic predictive testing, give examples of these type of tests.
Used in cases where a family history is a concern BRAC 1 and BRCA 2
166
What is the aim of carrier testing, give examples of these type of tests.
Can a patient pass on a autosomal recessive disease Sickle cell anemia Cystic fibrosis
167
What is the aim of pharmogenetic testing, give examples of these type of tests.
Determine medication dosages Tamoxifen (breast cancer) Abacavir (HIV)
168
What is the aim of prenatal screening, give examples of these type of tests.
Testing during pregnancy Down syndrome Trisomy 18 syndrome (Edward's syndrome)
169
What is biobanking and what is required in order to do this?
Storage of tissues/biological material/data for future use A HTA 2004 licence Patient consent, can be stored without it as long as it is pending. If not given it must be disposed of
170
What is the purpose of biobanking?
Research Used to understand the genetic links to disease
171
How are tissues transported for biobanking?
Fixed I dry ice Depends on research protocol
172
What are the advantages and disadvantages of biobanking?
**Advantages** Pools resources from different sites Increased sample size Can bring in geographical/ethnicity differences to form patterns Increases statistical significance **Disadvantages** Maintaining privacy is difficult High costs - set up and maintaining Difficult to encourage donations - patients unlikely to see the result
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What forms of clinical trials are there?
Interventional Observational
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What types of observational clinical trials are there?
Cohort Case control Cross sectional
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What do cohort clinical trials consider? Are there any advantages or disadvantages?
Follow a group, usually disease free, over time and attempt to establish risk factors Expensive Time consuming
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What do case control clinical trials consider? Are there any advantages or disadvantages?
A group with a disease and a disease free group. Look back at experiences and risks that connect to the disease Quick Cheap Memory can be unreliable
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What do cross-sectional clinical trials consider? Are there any advantages or disadvantages?
Look at a short period of time to establish causes and links. Often used to find out initial data that can guide further studies Cheap Quick Can be unreliable
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What type of interventional genetic studies are there?
Pilot Prevention Feasibility Screening Treatment Multiarm
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What do pilot clinical trials consider? Are there any advantages or disadvantages?
Small versions of the main study. Pinpoints areas of interest Not statistically relevant
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What do prevention clinical trials consider? Are there any advantages or disadvantages?
Can be treatment to prevent the disease
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What do Feasibility clinical trials consider? Are there any advantages or disadvantages?
Considers if the main study is possible. Same as a pilot study. Can save money if not feasible Small groups
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What do screening clinical trials consider? Are there any advantages or disadvantages?
Testing for early signs of the disease Cheap Can help prevent progression Cheap Aim to treat the patient when it's likely to be more successful
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What do treatment clinical trials consider? Are there any advantages or disadvantages?
Carried out in phases. Early phase - considers safety and side affects. Late phase - if any improvement on current practice
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What do Multiarm clinical trials consider? Are there any advantages or disadvantages?
Multi stage trials with one control group. Other treatment groups change throughout the study
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How do you deal with high risk specimens?
All specimens are potentially high risk Lots of viruses survive formalin Specimens from IV drug users should be considered high risk Normal processes are enough Leave for an additional 24hrs Never process/dissect/deal with category 4 specimens (Ebols Haemorrhagic fever, CJD) send to specialist centres
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During dissection, who do you communicate with?
Pathologista Secretaries Clinicials Nurses Dissection assistant
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How do you approach dissection?
Check bench is safe and clean Check equipment is at hand, safe and clean Check patient request form and specimen pot Check specimen types and orientation are as expected Check cassette and case/specimen number matches Check clinical history Record dictation verbally or written Check fixation Describe and measure specimen from the outside inwards Follow specific procedure for specimen type and clinical information Ink margins Photograph, draw Describe block ID Record specimen pieces per cassette and if specimen is remaining
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Dissection rooms need...?
Good lighting Clean/well organised Quiet/few distractions Downdraft ventilation Running water/sinks Processor racks Cassettes and lids Non-absorbant wipe surfaces PPE 10% buffered formalin Dictation device Access to LIMS (history/results) Sharps bins First aid kit Dissection bench Spillage kit Blunt ended probe Camera Ink and fixative Brushes Forceps Cutting board Scissors and knives of various sizes Rulers/scales Bins Specimen storage Absorbant cloths
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What key checks are required before beginning dissection?
Patient details on the pot and request form Specimen type against the request form At least 3 patient identifiers Accurately enter case details onto LIMS and dictation
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What should you consider before dissecting a case?
Review the case to be dissected ? Urgent ? Scope of practice Does it require opening Analyse clin info, history Is the specimen fixed adequately Is the work area clean Is the equipment clean and safe Is the PPE maintained, right size Do the patient, case details match
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What dissection equipment is needed?
Cutting board Ruler/scales Disposable knives, various sizes Forceps Blunt ended scissors Blunt ended probe Brushes Ink Fixative Specimen wraps/bags
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What should you consider when opening a specimen?
It should be done in a manner that does not compromise block selection Photographs/diagrams may be beneficial at dissection or reporting Breast and thyroid need measurements taking and brief description before, as opening distorts the shape Cysts may need a brief description making immediately upon opening as contents are lost if fluid.
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Important considerations of dictation?
Clear and concise Ben eficial as stored and accessed later An accurate record of description given System must be robust Information can be lost if devise breaks, also write vital information
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Who attend MDT meetings?
Surgeons Advanced nurse practitioners Radiologists Radiographers Pathologists Oncologists Nurses involved in patient care Research nurses MDT co-ordinators
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What is a MDT?
Multi departmental team meeting All staff involved in a patients care meet together to discuss the results and possible patient pathway
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What types of cases are discussed at MDT?
Cancer disgnoses Cases where results obtained in various departments vary. A conscious is required whether on a diagnosis or future tests Difficult cases Cases where the patient cannot underho the usual management and a new route is required, allows for assessment of the involved risks
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What do tissue marking dyes need to achieve and examples?
Permanent Used for orientation or margins Varied colours Aid reporting and embedding Distinguish between cuts made in surgery and those made at dissection Ensure specimen is dry for optimal adhesion Minimal tracking/penetration through the tissue Indian ink Alcian blue TMD tissue marking dyes Surface coating with starch
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What is the aim of histology?
Identify the tumour type based on tissue of origin or differentiation Degree of differentiation **grading** Extent of spread **staging** Prognostic factors (eg - ER, PR status)
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What is the aim of histology?
Identify the tumour type based on tissue of origin or differentiation Degree of differentiation **grading** Extent of spread **staging** Prognostic factors (eg - ER, PR status)

DEP Paper 1 (5 decks)

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