Intro to Pathology Flashcards
What does a QNS result mean?
The requested assay could not be completed due to insufficient quantity and or/ quality of nucleic acid.
Resection definition:
Surgery to remove all or part of the tumor. Typically along with surrounding normal tissue.
Core (needle) biopsy definition:
Removal of tissue using a small hollow needle.
Bone marrow aspiration/biopsy
bone marrow is both solid and liquid. Aspirate the liquid portion and biopsy the solid. Very critical to have both included on the sample**
Liquid Biopsy
Evaluating blood for circulating tumor cells.
Fine Needle Aspiration (FNA)
A thin needle is used to draw cells or fluid from a mass and can be performed with or without image guidance.
Endo-Bronchial Ultrasound (EBUS)
Bronchoscope w/ultrasound probe and a biopsy needle is inserted through the mouth and into the windpipe/lungs.
Endoscopic Ultrasound (EUS) FNA
Endoscope with a probe and a biopsy needle is inserted through the mouth into the esophagus, typically used along the GI tract
Rapid Onsite Evaluation (ROSE)
When pathologist reviews a sample during a procedure
Who is involved in these procedures?
- Surgeon (resections)
- Interventional Radiologist (FNA and core biopsies)
- Pulmonologist (EBUS)
- Gastroenterologist (EUS)
- Dermatologist (“punch biopsy”
H&E stain
used for morphologic interpretation of tissue (pink and purple)
IHC stain
Immunohistochemistry- uses antibodies to check for tumor markers
Micro-dissection
Process of dissecting the malignant tissue from the block or slide. (think: rice paper. that thin)
FFPE
Tissue that’s been fixed in a formalin solution and embedded in paraffin
Cell block
blood clots or small pieces of tissue that are embedded in paraffin.
FNA
Fine Needle Aspiration
Should there always be two samples on the slide?
Yes
FNA products
- slides
- needle rinse or fluid collection
- core biopsy
Jelly donut theory
- jelly = malignancy (cutting through the tissue (dough) to get to the inside jelly (tumor).
What is the preferred collection method?
Blocks** but the other is, slide
Tissue requirements for the samples
- At least 20% of the sample by ratio of tumor nuclei to benign nuclei
- Tumor size must be 25mm or minimum of 5mm
Common causes of a sample failing (QNS)
- ) numerous IHCs performed
- ) biological or treatment challenges
- ) heavy cytology practice (?)
- ) small samples
when the biological or treatment challenges occur, what can I recommend?
suggest concurrent testing with xF
1.) Cold ischemia (time to fixation)
60 minutes or less
2.) type of fixative
10% neutral phosphate-buffered formalin
3.) formalin fixation time
not to exceed 72 hours
xT (DNA) QNS rate:
5%
xF QNS rate:
2% or less
Order level reporting- where the QNS is reported
only one QNS report is sent, even with multiple samples
Rates vary
Cytology cases have a high rate of QNS
TAT
5 days longer than average
Reports and terminology and importance
Don’t use words like: “failure” “rescraping” and “QC2 failure”
Pathology Report. What does it include?
- ) Patient and clinical information
- ) Gross description
- ) diagnosis section
- ) microscopic description
Other sections of the report:
1.) Synoptic report
What is a Synoptic report?
lists all the most important findings in the case, summarized as one table. Pathology staging information is also provided in the synoptic report.
Other sections of the report:
- ) Synoptic report
2. ) comment section
Key Takeaways
1) understand pathology terminology (who, what, how) process.
2) understand fine needle aspiration** (common with Tempus tests)
3) understand QNS, what it means, why it happens and how to overcome it.
What’s the Medicare 14-day rule?
if it’s been 14 days or less since the patient has been discharged, we have to bill the hospital. More than 14 days= billing medicare.
Do we always ask how they want to go about this?
Yes
