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Breast Tissue, Surgical Pathology

Important Note

Breast sample submitted to Pathology are time sensitive.

The D-H Laboratory is accredited by the College of American Pathologists (CAP).  The CAP requires that cold ischemic time be recorded for all breast pathology specimens.  Delays getting the tissue into formalin have adverse effects with the accuracy of predictive marker results. 

For fresh tissues:

  • Submit specimen to the D-H Lab as soon as possible by courier or tube system (Note:  Larger specimens MUST be walked to the lab immediately. Do not tube.) 
  • If sending the specimen to Radiology first for imaging, ice the sample when in transit and submit to the lab as soon as possible after imaging. 
  • The lab will record the cold ischemic time as the sample is triaged based on ‘time removed’ to ‘time placed in formalin’ by the lab.
  • Ischemic times are recorded in the Surgical Pathology Report.

For tissues submitted in 10% neutral buffered formalin:

  • Record ischemic times via eDH by completing prompts for time placed in formalin. Specimens must be fully submerged in formalin with optimal approximate specimen volume of 10:1 or higher.

For non-Lebanon sites:

Breast cancer excision specimens may require ‘at the bedside’ triage to meet regulatory requirements. 

  • Excisional biopsies/Partial mastectomies: After orienting and inking excisional biopsies, make 1-2 cuts to expose the lesion so that it comes in contact with formalin when placed in the specimen container.  Record time place in formalin.
  • Mastectomies:  at the level of the lesion, make 1-2 cuts to expose the lesion so that it comes in contact with formalin when placed in the specimen container. Record time place in formalin.

DH Standard inking protocol for breast excisions:   

red (medial), yellow (lateral), orange (superior), green (inferior), black (posterior) and blue (anterior)

Specimen Collection Information

  • Label container with patients full name, and date of birth or MRN (if available). Indicate specimen source.
  • Specimens submitted in 10% neutral buffered formalin need to be fully submerged with the optimal approximate specimen volume of 10:1 or higher
Specimen Container
Tissue
 

Specimen Transport Temperature

Transport fresh tissue immediately on ice ASAP.  Formalin fixed tissues – ambient.

Specimen Stability

Time sensitive – all fresh samples need to be sent to the lab ASAP.  Stable if in fixative.

Additional Specimen Instructions

See link under Resources: AP Surgical Pathology

Day(s) Performed

Monday through Friday; 8 a.m. – 5 p.m.; Off hours covered by Pathologist/Pathology Resident on-call

CPT(s)

88300; 88302; 88304; 88305; 88307; 88309

Performing Lab Section

Surgical Pathology

Ordering Specimens

For eDH users:

  • LAB1900, Surgical Pathology
  • Be sure to document the time removed from body

For non eDH users:

  • Record the ischemic time on the Surgical Pathology Requisition (time removed from body and time placed in formalin)
  • Each of the following items is required:
    •  All requisitions must be labeled with:
      • Patient name, date of birth and medical record number
      • Name of the ordering provider
        •  
      • Anatomic site and collection date
      • Brief patient history

Performing Lab(s)

Dartmouth Hitchcock Medical Center Laboratory (MHMH) 603-650-2200