[Histonet] RE: embedding like specimens sequentially


Sheila Tapper recently submitted a query - to which several people replied - about whether a surgical pathology service should avoid accessioning grossly similar specimens (such as prostate needle biopsies) sequentially rather than spacing them with histologically dissimilar specimens.

I certainly concur with Curtis Tague: >>I'd have your pathologist put the hammer down. He or she would no doubt be happy to see your desire to improve quality control and reduce the chance any mix up that could lead to legal problems. Explain to them the risks and I'm sure they'll back you.<<

As a surgical pathologist with experience in about 60 surgical pathology services over the last 40 years, I'd say that avoiding sequential accessioning of similar specimens is standard practice - I learned it in residency and have seen many services apply it since then. I see no reason to have to cite "chapter and verse" - but as a matter of fact the College of American Pathologists is considering a resolution on this and related topics right now.

My friend and former locum tenens client Joseph C. Bergeron Jr. MD FCAP is now chairing the CAP's House Ad Hoc Committee on Medicolegal Testimony.He's submitted CAP House of Delegates Resolution F2003-55: "Guidelines regarding the technical handling and reporting aspects of histology" - which is somewhere in process right now, and is still in draft form.

Perhaps one of the standard histotechnology references cites this practice - Freida Carson, do you know of such a citation?

If you're writing a procedure, you need to make clear that this is a rule that can be broken - if three prostate biopsy specimens come in in the late afternoon and you have no other specimens to space them with, then you accession them sequentially.

I have to be vague about the details, but right now I'm serving as an expert witness in a case where a disastrous outcome occurred as a result of a mixup of adjacent similar specimens. Sequence of accessioning is one of the issues that's been raised in depositions.

Since this note is going into the HistoNet archives, you can cite it as a reference!

Bob Richmond
Samurai Pathologist
Knoxville TN
(Robert S. Richmond, MD, FCAP)

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