How to get better pathology results - Veterinary Medicine
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How to get better pathology results
Find answers to your questions about submitting samples for cytologic and histologic examinations and communicating with pathologists—plus, tips for avoiding common mistakes.


VETERINARY MEDICINE


SHOULD THE SOURCE FOR THE SAMPLE BE IDENTIFIED?

A misconception exists that pathologists can interpret sample findings without knowing the specific source (e.g. tissue, body cavity). Practitioners may assume that if a cellular sample is obtained or an adequate amount of tissue is submitted, the pathologist should be able to identify the tissue source and provide an accurate interpretation. While in some cases that assumption is correct, failure to indicate the sample source or providing incomplete information about the source may result in several problems.

First, the pathologist may be hesitant to interpret the sample findings without knowing the precise origin, which may lead to unnecessary delays while the laboratory or pathologist attempts to contact the practitioner to obtain this additional information.

Second, an incorrect or speculative diagnosis may result. For example, considerable overlap exists in the cytologic appearance of certain tumors that arise in various tissues and organs. Thus, the pathologist may be forced to speculate or simply provide a list of possibilities that may correlate with the microscopic findings.

A related problem occurs when samples are submitted with only a notation that a mass is present and without an appropriate description of the lesion. An adequate gross description of the lesion, such as a "rapidly growing, 3-cm firm mass in the skin over the right thigh attached to underlying tissue" instead of "skin mass," helps the pathologist accurately interpret cytologic and histologic findings.

Another important part of submission is to properly label all slides and containers with the patient name and sample source or tissue of origin. For
cytologic specimens, slides with a frosted edge are ideal, as this area can easily be labeled with a pencil. Labeling slides with a marker or attaching tape labels is discouraged. Tape labels may need to be removed for slide processing, and marker ink often dissolves during fixation and staining. Improperly labeled slides or containers can result in sample misidentification or unnecessary delays. All pertinent patient information and clinical and diagnostic findings should be included on the submission form.

Unfortunately, lawsuits in veterinary medicine occur, and a pathology report may play an integral role in the case management or outcome. If a sample was submitted improperly or requested information was not provided (history, sample source, or both), a potential liability exists. Proper sample submission is a simple task that increases the likelihood of receiving satisfactory results and protects the practitioner.

For example, a sample containing numerous small lymphocytes may be interpreted differently in the absence of an appropriate history and source. If the sample was obtained from a marginally increased popliteal lymph node, the findings might reflect a normal or slightly hyperplastic population. However, if the sample was obtained from a 6-cm lymph node, small cell lymphoma might be considered more likely. Another common example is a sample containing small numbers of spindle cells. If the sample was obtained from a small lesion of chronic duration, the cells might reflect traumatic injury with fibrosis or granulation tissue or both. If the sample was obtained from a baseball-sized mass, the pathologist is more likely to consider a mesenchymal tumor.


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Source: VETERINARY MEDICINE,
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