[Histonet] RE: embedding like specimens sequentially

[RSRICHMOND <@t> aol.com]

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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