[Histonet] Renal biopsies and muscle biopsies

[Richard Cartun]

I have been involved in the immediate adequacy assessment and triage of renal biopsies for a very long time here at Hartford Hospital.  We now have a team of two pathologists and myself that are called to interventional radiology and our children's hospital for renal biopsy procedures.  I also take a resident or fellow with me when they are rotating with me.  We provide "on-site" adequacy assessment and we tell the interventional radiologist or nephrologist when to stop based on the examination of the gross tissue provided under the microscope at 4x and 10x (I keep a microscope in both locations).  We report and bill an intra-operative consultation for this service.  I would say that over 90% of our procedures consistent of 2, 18-gauge needle cores.  I think in the last 10 years we've had to call a patient back for a repeat biopsy once.

I think that it is imperative that a pathologist or someone with extensive training in kidney anatomy be involved in the triaging of the specimen so that the correct tissue can be submitted for light microscopy, immunofluorescence, and electron microscopy depending on the clinical diagnosis, and the amount of tissue provided.

Richard


Richard W. Cartun, MS, PhD
Director, Histology & Immunopathology
Director, Biospecimen Collection Programs
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 545-1596
(860) 545-2204 Fax


>>> "Vickroy, Jim" <Vickroy.Jim <@t> mhsil.com> 10/22/2012 8:58 AM >>>
I have been at the same hospital for over 34 years.   I have seen pathologists come and go, and have seen changes in services like everyone has, some good and some bad.  Since workflow changes demands that we do more with less, we are evaluating some of the extra things we do to see if  some of these duties need to be done by other staff and not histotechs.

In our hospital whenever a renal biopsy procedure is done in ultrasound they call the histology department and one of the staff go to the ultrasound and receive the tissue from the radiologist.  The tech then brings the tissue to the gross room and the grossing staff separates and processes the specimen.   In the old days ultrasound would page the renal pathologist and the renal pathologist would go get the specimens and then bring them to the gross lab, but it seems like many things this has now been relegated to the technical staff.   We also pick up renal biopsies and muscle biopsies specimens from another hospital in the same town that sends us renal biopsies since we have the local renal pathologist.

We do not routinely pick up any other specimens because we have a courier system, but the renal and sometimes muscle biopsy service still remains in the hands of the histology department.  I would like to know how other hospitals handle transportation of specialized specimens such as renal biopsies and muscle biopsies.  In the old days there was a purpose for a pathologist to be present since often the radiologist asked the pathologist to evaluate if he or she had enough adequate tissue, but today with better ultrasound methods rarely do the radiologists ask the techs to evaluate whether enough adequate tissue has been taken.

I need some background information from others before I approach the powers to be to come up with an alternate plan so that the histotechs can spend more time in the lab and less time being a courier service for these biopsies.  Of course an alternate way will have to include a method that is reliable and not threaten the patient results.

Your thoughts?


James Vickroy BS, HT(ASCP)

Surgical  and Autopsy Pathology Technical Supervisor
Memorial Medical Center
217-788-4046


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