Standard Operating Procedure for Grossing of All Excised Tissues
1.0 Purpose
To establish a uniform procedure for the grossing of all excised tissues.
2.0 Scope
This procedure applies to all biopsy specimens received and
is intended for all technical staff in the section.
3.0 Introduction
Gross examination, or "grossing," is the inspection of pathology specimens with the naked eye to obtain diagnostic information while preparing them for further microscopic examination.
4.0 Principle
There are generally two end products of the gross
examination of a surgical specimen:
1. Gross Description: A written record of the examiner's
findings included in the final pathology report.
2. Tissue Blocks: Small portions of tissue sealed in plastic cassettes, processed into slides for microscopic examination.
The success of the final histological diagnosis heavily depends on the skill of the professional performing the gross examination. The gross examiner may sample portions of the specimen for ancillary tests, such as flow cytometry and cytogenetics.
5.0 Analytical Measuring Range and Limit of Detection
Not Applicable
6.0 Responsibility
Technical staff and section in charge.
7.0 Abbreviations
TRF: Test Requisition Form
8.0 Requirements
Reagents
- Buffered Formalin
- India Ink
- 5% Acetic Acid
Instrumentation and Software
- Grossing station
- Cutting board
- Blade handle
- Surgical blade
- Forceps
- Scissors
- Scale
- Measuring tape
- Cassettes with lids
- Weighing scale
- Camera
- Absorbent cotton
- Stationery
Other Materials
- Preparation of reagents if any
Specimen Collection and Handling
Specimens should be immersed in 10 times their volume of proper fixative (10% buffered formalin) inside correctly labelled containers. Both the specimen container and TRF should include patient and specimen details along with the accession ID and section number.
9.0 Precautions
- All specimens should be handled with gloves, masks, and
goggles.
- All instruments should be handled with care to prevent injury.
10.0 Limitations & Interferences
Not Applicable
11.0 Documentation
All documents are maintained along with the TRF of the case.
12.0 Instructions
12.1 Pre-Analytical Steps
12.1.1 Preparation of Buffered Formalin
- Mix 100 ml of 40% formaldehyde solution with distilled
water to make up 900 ml.
- Store at room temperature.
12.1.2 Preparation of 5% Acetic Acid
- Mix 5 ml of glacial acetic acid with 95 ml of distilled
water.
12.1.3 Preparation of Decalcifying Fluid
- Mix 10 ml of formic acid with 90 ml of distilled water.
12.1.4 Specimen Entry
- All specimens are entered into the Histopathology Entry
register and assigned a department ID (Biopsy number), e.g., B/0000/Year.
- This number is noted on the TRF and specimen containers to ensure the integrity of patient specimen identity. The same numbers are used during all steps of processing, embedding, cutting, staining, examination of slides, and finalization of reports.
12.2 Analytical Steps
12.2.1 Verification
- The pathologist checks the particulars on the specimen container against the requisition form and verifies the section number.
12.2.2 Large Specimens
- Place large specimens in their anatomical position.
Measure and weigh the specimen.
- Record a naked-eye description in the gross register. Ink the margins for oncology specimens. Take gross photographs if required.
12.2.3 Small Specimens
- Record a naked-eye description, including measurements and weight/volume where applicable.
12.2.4 Slicing and Description
- Slice large specimens and record a gross description of the lesion. If needed, keep the specimen for further fixation.
12.2.5 Tissue Sampling
- Take tissue bits from various areas and place them in
labeled cassettes with details of the specimen number, block identity (e.g.,
B/90/A/12), and year. Record these details in the TRF.
- For single specimens, sequence cassettes alphabetically (A, B, C). For multiple samples, sequence cassettes alphanumerically (A1, A2 for the first specimen; B1, B2 for the second).
12.2.6 Small Biopsies
- If the entire tissue is submitted, note "NIL" (no tissue left) on the TRF. If tissue remains, note "SK" (some kept) on the TRF.
12.2.7 Formalin Transfer
- Place labeled cassettes with representative tissues in formalin and transfer them to the first bucket of the tissue processor.
12.2.8 Decalcifying Fluid
- Place representative bits of specimens with bony materials in decalcifying fluid. Once the tissue softens, place it in labeled cassettes for further processing.
12.2.9 Grossing Station Disinfection
- Every morning, disinfect the grossing station by wiping with 70% ethanol/1% hypochlorite, followed by UV treatment for 20 minutes.
12.3 Quality Control and Assurance
- Not Applicable
12.4 Storage of Samples
- Preserve wet tissue for 2 weeks after the final report is signed, then discard as per biological waste disposal guidelines.
13.0 Reference Range
Not Applicable
14.0 Critical Value
Not Applicable
15.0 Reporting of Results and Interpretation
Not Applicable
16.0 Contingency Plan
In case of a temporary breakdown of the grossing station, perform grossing in an open area with an exhaust fan.
17.0 References
- Surgical Pathology, Juan Rosai: 9th edition
- Grossing Manual
END OF THE DOCUMENT
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