Intro to Pathology

Question 1

What does a QNS result mean?

Answer 1

The requested assay could not be completed due to insufficient quantity and or/ quality of nucleic acid.

Question 2

Resection definition:

Answer 2

Surgery to remove all or part of the tumor. Typically along with surrounding normal tissue.

Question 3

Core (needle) biopsy definition:

Answer 3

Removal of tissue using a small hollow needle.

Question 4

Bone marrow aspiration/biopsy

Answer 4

bone marrow is both solid and liquid. Aspirate the liquid portion and biopsy the solid. Very critical to have both included on the sample**

Question 5

Liquid Biopsy

Answer 5

Evaluating blood for circulating tumor cells.

Question 6

Fine Needle Aspiration (FNA)

Answer 6

A thin needle is used to draw cells or fluid from a mass and can be performed with or without image guidance.

Question 7

Endo-Bronchial Ultrasound (EBUS)

Answer 7

Bronchoscope w/ultrasound probe and a biopsy needle is inserted through the mouth and into the windpipe/lungs.

Question 8

Endoscopic Ultrasound (EUS) FNA

Answer 8

Endoscope with a probe and a biopsy needle is inserted through the mouth into the esophagus, typically used along the GI tract

Question 9

Rapid Onsite Evaluation (ROSE)

Answer 9

When pathologist reviews a sample during a procedure

Question 10

Who is involved in these procedures?

Answer 10

• Surgeon (resections)
• Interventional Radiologist (FNA and core biopsies)
• Pulmonologist (EBUS)
• Gastroenterologist (EUS)
• Dermatologist (“punch biopsy”

Question 11

H&E stain

Answer 11

used for morphologic interpretation of tissue (pink and purple)

Question 12

IHC stain

Answer 12

Immunohistochemistry- uses antibodies to check for tumor markers

Question 13

Micro-dissection

Answer 13

Process of dissecting the malignant tissue from the block or slide. (think: rice paper. that thin)

Question 14

FFPE

Answer 14

Tissue that’s been fixed in a formalin solution and embedded in paraffin

Question 15

Cell block

Answer 15

blood clots or small pieces of tissue that are embedded in paraffin.

Question 16

FNA

Answer 16

Fine Needle Aspiration

Question 17

Should there always be two samples on the slide?

Answer 17

Yes

Question 18

FNA products

Answer 18

• slides
• needle rinse or fluid collection
• core biopsy

Question 19

Jelly donut theory

Answer 19

• jelly = malignancy (cutting through the tissue (dough) to get to the inside jelly (tumor).

Question 20

What is the preferred collection method?

Answer 20

Blocks** but the other is, slide

Question 21

Tissue requirements for the samples

Answer 21

• At least 20% of the sample by ratio of tumor nuclei to benign nuclei
• Tumor size must be 25mm or minimum of 5mm

Question 22

Common causes of a sample failing (QNS)

Answer 22

1. ) numerous IHCs performed
2. ) biological or treatment challenges
3. ) heavy cytology practice (?)
4. ) small samples

Question 23

when the biological or treatment challenges occur, what can I recommend?

Answer 23

suggest concurrent testing with xF

Question 24

1.) Cold ischemia (time to fixation)

Answer 24

60 minutes or less

Question 25

2.) type of fixative

Answer 25

10% neutral phosphate-buffered formalin

Question 26

3.) formalin fixation time

Answer 26

not to exceed 72 hours

Question 27

xT (DNA) QNS rate:

Answer 27

5%

Question 28

xF QNS rate:

Answer 28

2% or less

Question 29

Order level reporting- where the QNS is reported

Answer 29

only one QNS report is sent, even with multiple samples

Question 30

Rates vary

Answer 30

Cytology cases have a high rate of QNS

Question 31

TAT

Answer 31

5 days longer than average

Question 32

Reports and terminology and importance

Answer 32

Don’t use words like: “failure” “rescraping” and “QC2 failure”

Question 33

Pathology Report. What does it include?

Answer 33

1. ) Patient and clinical information
2. ) Gross description
3. ) diagnosis section
4. ) microscopic description

Question 34

Other sections of the report:

Answer 34

1.) Synoptic report

Question 35

What is a Synoptic report?

Answer 35

lists all the most important findings in the case, summarized as one table. Pathology staging information is also provided in the synoptic report.

Question 36

Other sections of the report:

Answer 36

1. ) Synoptic report

2. ) comment section

Question 37

Key Takeaways

Answer 37

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.

Question 38

What’s the Medicare 14-day rule?

Answer 38

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.

Question 39

Do we always ask how they want to go about this?

Answer 39

Yes