Quality and safety aspects in histopathology laboratory

Root Cause Analysis: Unraveling Common Laboratory Challenges

Diverse errors occur in a pathology laboratory and manual mistakes are the most common. There are various advancements to replace manual procedures with digitized automation techniques. Guidelines and protocols are available to run a standard pathology laboratory. But, even with such attempts to reinforce and strengthen the protocols, the complete elimination of errors is yet not possible. Root cause analysis (RCA) is the best way forward to develop an error-free laboratory, In this review, the importance of RCA, common errors taking place in laboratories, methods to carry out RCA, and its effectiveness are discussed in detail. The review also highlights the potential of RCA to provide long-term quality improvement and efficient laboratory management.

Pathology Quality Control for Multiplex Immunofluorescence and Image Analysis Assessment in Longitudinal Studies

Immune profiling of formalin-fixed, paraffin-embedded tissues using multiplex immunofluorescence (mIF) staining and image analysis methodology allows for the study of several biomarkers on a single slide. The pathology quality control (PQC) for tumor tissue immune profiling using digital image analysis of core needle biopsies is an important step in any laboratory to avoid wasting time and materials. Although there are currently no established inclusion and exclusion criteria for samples used in this type of assay, a PQC is necessary to achieve accurate and reproducible data. We retrospectively reviewed PQC data from hematoxylin and eosin (H&E) slides and from mIF image analysis samples obtained during 2019. We reviewed a total of 931 reports from core needle biopsy samples; 123 (13.21%) were excluded during the mIF PQC. The most common causes of exclusion were the absence of malignant cells or fewer than 100 malignant cells in the entire section (n = 42, 34.15%), tissue size smaller than 4 × 1 mm (n = 16, 13.01%), fibrotic tissue without inflammatory cells (n = 12, 9.76%), and necrotic tissue (n = 11, 8.94%). Baseline excluded samples had more fibrosis (90 vs 10%) and less necrosis (5 vs 90%) compared with post-treatment excluded samples. The most common excluded organ site of the biopsy was the liver (n = 19, 15.45%), followed by soft tissue (n = 17, 13.82%) and the abdominal region (n = 15, 12.20%). We showed that the PQC is an important step for image analysis and that the absence of malignant cells is the most limiting sample characteristic for mIF image analysis. We also discuss other challenges that pathologists need to consider to report reliable and reproducible image analysis data.

Herbal-Based Formulation Containing Eurycoma longifolia and Labisia pumila Aqueous Extracts: Safe for Consumption?

A combined polyherbal formulation containing tongkat ali (Eurycoma longifolia) and kacip fatimah (Labisia pumila) aqueous extracts was evaluated for its safety aspect. A repeated dose 28-day toxicity study using Wistar rats was conducted where the polyherbal formulation was administered at doses 125, 500 and 2000 mg/kg body weight to male and female treatment groups daily via oral gavage, with rats receiving only water as the control group. In-life parameters measured include monitoring of food and water consumption and clinical and functional observations. On day 29, blood was collected for haematological and biochemical analysis. The rats were necropsied and the organs were collected for histopathological examination. This study showed that the combined formulation did not induce any significant toxicity effect at any dose level in terms of morbidity, mortality, behaviour, functional observation, body weight, food and water consumption, whole blood haematology and serum biochemistry. However, there were some microscopic changes in the histopathological examinations of some organs given 2000 mg/kg body weight, which may suggest an early response to the polyherbal formulation. From this study, the no observed adverse effect level is estimated to be more than 500 mg/kg body weight but not exceeding 2000 mg/kg body weight. The observed effects at the highest dose indicate the need for further study of longer dosing duration.

Impact of Clinical Information on the Turnaround Time in Surgical Histopathology: A Retrospective Study

Introduction

Clinical information (CI) is a key requisite to diagnose and report a specimen in histopathology. A timely dispatched report can help a clinician to confirm a diagnosis and initiate a prompt treatment plan while an unnecessary delay in reporting time can compromise patient's healthcare. The aim of this study was to ascertain the impact of the adequacy of CI provided by clinicians on the turnaround time (TAT) and to investigate factors pertinent to specimens, their handling, and diagnosis.

Methods

This retrospective study reviewed a total of 803 surgical specimens reported in a duration of four months (from December 2015 till March 2016) by the Department of Histopathology, FMH College of Medicine & Dentistry, Lahore, Pakistan. Frozen section and cytology specimens were excluded. CI was classified into three categories: short and focused, long and detailed, and deficient CI. Deficient CI was designated where the pathologist had to seek more information from the requesting clinicians. Total time taken by the histopathologist to complete a report was calculated after excluding weekends and holidays. Other factors like type of specimen, special staining, diagnosis of malignancy and source of referral were also studied. The data were entered and analyzed on SPSS 22.0 (IBM, Armonk, NY). Shapiro-Wilk test was used to measure the distribution.

Results

Most of the specimens (46.2%, n = 371) were reported within three days. Of these, most of the specimens (46.9%, n = 174) had a short and focused CI (p < 0.001). Majority of the specimens which were reported within four to five days (42.1%, n = 114) and after five days (62.1%, n = 100) were found to have a long and detailed CI in their requisition forms. Median TAT extended to six (4.00-7.00) days with the use of special stains (p < 0.001). One hundred and sixty-three (20.29%) of the total cases were diagnosed as malignant in which the median TAT significantly prolonged to five days (p < 0.001). Most of the specimens (80%, n = 60) received from the outside laboratories had a long and detailed CI in requisition forms. Endometrial tissue specimen was the predominant type received by the department (24.3%, n = 90).

Conclusion

Adequate CI is necessary for timely and error-free reporting of a specimen in surgical histopathology. A short, focused and concise CI is associated with a shorter TAT. Long and detailed CI is often seen with a complex surgical specimen that requires a longer time to report. Factors like specimen type, special staining, number of special stains and diagnosis of a malignancy also affect TAT.

Assessment of Quality and Risks Exposure in Histopathology Department

The role of histopathology department in establishing a correct and final diagnosis is essential, this leading to an effective treatment for the patient so its healing to be complete. In order to achieve this goal, it is necessary that all complex steps belonging to this department to be properly carried out because any mistakes in a pathology report may adversely affect the patient outcome. Therefore, it is mandatory the quality assessment of all procedures from the laboratory to be constantly done so that the report to be reliable and accuracy. All three main categories of activities specific to a pathological laboratory (pre-analytic, analytic and post-analytic phases) must undergo quality control. During the progress of these phases, it also must be identified the risks and safety problems regarding the personal staff. These may be different for each activity or procedure which is performed by the laboratory workers. All the physical, chemical or biological hazards must be identified to assess, appreciate the possible risks and to implement preventive measures. The aim of this study is to highlight the importance of quality management for all phases included in a surgical pathological laboratory based on the pathological errors observed, identify emerging risks exposure and necessary measures to prevent them.

Quality of Breast Cancer Surgical Pathology Reports

Background: Surgical pathology reporting of breast cancer is needed for appropriate staging and treatment decisions. We here checked the quality of surgical pathology reports of breast cancer from different laboratories of Karachi, Pakistan. Methods: One hundred surgical pathology reports from ten different laboratories of Karachi were assessed for documentation of elements against a checklist adopted from the CAP guideline over a period of six months from January, 2017 to June, 2017 in the Oncology Department, Jinnah Postgraduate Medical Centre, Karachi. Results: Out of 100 reports, clinical information was documented in 68%, type of procedure and lymph node sampling in 84% and 34% respectively. Specimen laterality was mentioned in 90%, tumor site in 44%, tumor size in 92%, focality in 40%, histological type in 96%, grade in 87%, LCIS in 19%, DCIS in 83%, size of DCIS in 19%, architectural pattern in 26% , nuclear grade in 17%, necrosis in 14%, excision margin status in 91%, invasive component in 83%, DCIS in 16%, lymph node status in 91% with positive nodes in 56%, size of macro met in 54%, extranodal involvement in 48%, lymph vascular invasion in 86%, treatment effects in 31%, and pathology reporting with TNM in 57%. Conclusion: This study shows that the quality of surgical pathology reports for breast cancer in Karachi is not satisfactory. Therefore, there is great need to create awareness among histopathologists regarding the importance of accurate breast cancer surgical pathology reporting and to introduce a standardized checklist according to international guidelines for better treatment planning.

Diagnostic Laboratories in India: Investigating Quality Characteristics, Productivity and Time of Reporting

This is the result of a Survey of diagnostics laboratories in the Asia Pacific (APAC) region with perspectives on India, investigating the three key aspects that are central to the success of a laboratory: quality, cost and speed. This Survey provides a comparison in selected performance indicators in a large number of diagnostic laboratories in a broad range of countries in the APAC region. The Survey provides data on some key performance characteristics such as quality improvement activities, staff productivity and Turnaround Time (TAT). This Survey also demonstrates in India the common issues facing all the laboratories surveyed but also common solutions using a Quality Systems approach which involves Accreditation, customer responsiveness, greater use of IT, automation and Lean principles. Indian laboratories reported less automation and fewer laboratories have Laboratory Information Systems. The productivity by various measures in Indian laboratories was less than in other APAC laboratories. TAT was more commonly monitored in the Indian specimens though there were fewer laboratories compared with the APAC specimens where there were separate TATs for Short Turnaround Time and Routine specimens.

Natural Alternatives for Chemicals Used in Histopathology Lab- A Literature Review

Histopathology lab is the place where the specimen gets processed and stained to view under microscope for interpretation. Exposure to the chemicals used in these processes cause various health hazards to the laboratory technicians, pathologists, and scientists working in the laboratory. Hence, there is a dire need to introduce healthy and bio-friendly alternatives in the field. This literature review explores the natural products and their efficiency to be used as alternatives for chemicals in the histopathology lab.