[Histonet] Levels and Recuts

Fri Aug 26 08:07:18 CDT 2005

I've no idea what ICC is, but yes:-)
All this is possible in time, and given a receptive attitude of those in control.
Ah. There's the stumbling block.

We've strayed a bit from the subject of levels and recuts:-)

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path
 Consultant Pathologist
 Rotherham General Hospital
 South Yorkshire
 England
        terry.marshall <@t> rothgen.nhs.uk

-----Original Message-----
From: Rogerson Kemlo (ELHT) Pathology
[mailto:Kemlo.Rogerson <@t> elht.nhs.uk]
Sent: 26 August 2005 13:53
To: Marshall Terry Dr, Consultant Histopathologist;
Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Levels and Recuts

I accept what you say, but it wouldn't work like that would it? Remember
the very small team of 'skin' Techs (1) you once had? I remember that
team had enough time to cut up (gross), embed, stain, Q/C and then go
through the slides before you had them and take a stab of interpreting
them. You were generous enough to teach the team (of 1) the bsic
rudiments of Dermatopathology; that art could well be deemed to be
outside the realms of a BMS, but I certainly had enough time to report
them if I had the skill. The practicalities of licensing, I would
respectfully suggest, is not an issue; as long as training is adequate
and revisited and the proper piece of paper gained, then it's not an
issue.

We could start with BMS reporting the ICC couldn't we? Granted it needs
good communication our Medical colleagues but us Techs are getting the
hang being loquacious.     

-----Original Message-----
From: Marshall Terry Dr, Consultant Histopathologist
[mailto:Terry.Marshall <@t> rothgen.nhs.uk] 
Sent: 26 August 2005 13:37
To: Rogerson Kemlo (ELHT) Pathology; Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Levels and Recuts

Kemlo, 
I was not saying, seriously or otherwise. I did not use the word
"unable".
However, I will now say it. Not unable due to deficiency of ability of
course, but to practicalities of licensing etc.
What I was thinking of when I said "It just isn't possible.", is the
"most efficient use of time" element.
For a start, to be in to block out and cut, I would have to get up early
in the morning, and you may remember how difficult I found that:-)

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path
 Consultant Pathologist
 Rotherham General Hospital
 South Yorkshire
 England
        terry.marshall <@t> rothgen.nhs.uk

-----Original Message-----
From: Rogerson Kemlo (ELHT) Pathology
[mailto:Kemlo.Rogerson <@t> elht.nhs.uk]
Sent: 26 August 2005 13:28
To: Marshall Terry Dr, Consultant Histopathologist;
Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Levels and Recuts

Can't it? Really why not? Are you seriously saying that a properly
qualified and trained BMS is unable to report on such things as
appendix, gall bladder, vas deferens, etc. Surely not as that defies the
very 80:20 rule you so generously taught me. 

The most important aspect of reporting that a BMS has to learn is the
boundary of his/ her training. If something is without that boundary
then referral to a Medic is needed; the old chestnut of 'most of these
are easy to report, but you need medical training to identify a subtle
change' does not hold water; surely experience and training is the real
secret.

If something is present that ought not be, then Cytology has shown us
that the BMS is just a likely to see it, but I concede may not have the
skill to report it. Are you really going to wade through shed loads of
gut biopsies to weed out the negatives from the abnormals in colorectal
cancer screening? Is that a good use of your valuable and expensive
time? The other benefit will be, as in cytology, if the slide is 'bloody
rubbish' then that will motivate the BMS to do the job better as he or
she will have to report some of them; nothing like having your name on a
report to crystallise the mind.

You were always very good at 'thinking out of the box', but I expect you
were counting on a reply like this. 

-----Original Message-----
From: Marshall Terry Dr, Consultant Histopathologist
[mailto:Terry.Marshall <@t> rothgen.nhs.uk] 
Sent: 26 August 2005 13:14
To: Rogerson Kemlo (ELHT) Pathology; Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Levels and Recuts

Well, I do often write that stuff, but it's good natured teasing too.
Seriously, one intractable problem in histology is that the tech.
produces and the pathologist interprets. Ideally it should be done by
the same people (or even) person. It just isn't possible.

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path
 Consultant Pathologist
 Rotherham General Hospital
 South Yorkshire
 England
        terry.marshall <@t> rothgen.nhs.uk

-----Original Message-----
From: Rogerson Kemlo (ELHT) Pathology
[mailto:Kemlo.Rogerson <@t> elht.nhs.uk]
Sent: 26 August 2005 12:40
To: Marshall Terry Dr, Consultant Histopathologist;
Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Levels and Recuts

"bloody rubbish"? Is that accepted terminology for one Professional to
talk to another? Only teasing but it does highlight one worrying aspect
in some Histology Labs. If Biomedical Scientists are really going to be
respected by their Medical colleagues then they have to accept
responsibility for the work they produce.

If a Transfusion BMS gets it wrong the Patient gets maybe the wrong
blood type; if a Histology BMS gets it wrong, he/she gets told it's
'bloody rubbish'. If the Medic gets it wrong then it has an effect on
Patient management and/ or their can be litigation. I'm all for
extending the role of the BMS in Histology, but from my experience, and
Terry's response we must do what we do now, better, it seems.

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Marshall
Terry Dr,Consultant Histopathologist
Sent: 26 August 2005 12:30
To: Stephen Peters M.D.; Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Levels and Recuts

Another subject talked about several times before.

I agree it is sensible to call another section (usually 'cos there is
something technically wrong with the first), a recut.
I usually scribble on the form, something like, "bloody rubbish" or
"?Q.C.", or something similarly inflammatory:-)

Levels are just a few extra sections at an arbitrary interval.

Serial sections are self explanatory, and semi-serial is a combination
of serial and levels - cut in a bit then do a burst of serials, then
repeat.
Sometimes I ask for levels through the block.
What is asked for depends and what you are looking for and how you
expect to find it.
Invariably, for anything other than levels, I talk about the problem to
the tech., so that they can cut with an eye to the problem.

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path
 Consultant Pathologist
 Rotherham General Hospital
 South Yorkshire
 England
        terry.marshall <@t> rothgen.nhs.uk

-----Original Message-----
From: Stephen Peters M.D. [mailto:petepath <@t> yahoo.com]
Sent: 25 August 2005 21:45
To: Histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Levels and Recuts

In my training "levels" were " step sections" going a given number of
turns of the wheel between each section. A recut was another slide made
trimming as little as possible.
I have heard people refer to recuts as I described "levels". I think
this leads to confusion. I 
do not know what the official definitions are but if there is a vote, I
like it the way I described. 
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