GI Pathology: The Mysteries of Specimen Collection and

Submission RevealedMichelle Coker, HT(ASCP)cm

Laboratory ManagerAustin Gastroenterology

ObjectivesIdentify what types of specimens can be

collected during an EGD/colonoscopyKnow common tests that might be ordered on

samples from the EGD/colonoscopyKnow what constitutes an adequate specimen

for different testingBe able to identify what type of transport

medium the specimen should be placed in based on testing

Know which specimens need to be sent to the lab immediately and which can wait

Have you ever been asked to obtain samples for testing you are unfamiliar with???

There are many types of lab testing that can be done on tissue samples obtained during the EGD/colonoscopy procedure. Sometimes, nurses and technicians are asked to obtain samples for tests they are not familiar with. Today, we will increase your awareness of these specimens and how to collect them correctly.

Types of Samples Obtained during an EGD/Colonoscopy• Tissue Biopsies• Brushings• Fecal/stool• Foreign object/foreign body removal

Most Common Type of Specimen is Tissue Biopsies

EsophagusGastric/StomachDuodenum/small bowelCecumColonRectumThese specimens can be submitted for routine pathology or a variety of other tests.

Other Specimens that can be collected during a procedureBrushings-most common locations:

EsophagusBile ductrectum

Fecal/stool samplesForeign Body Removal

These specimens will be submitted to the lab, but not for routine Histology

Common Testing• Routine Pathology• Flow Cytometry• Bacterial Cultures• Viral Cultures• Brushings for cytology• Brushings for bacterial/viral cultures• Fecal/Stool samples• Foreign Body Removal

Routine Pathology CollectionTransport medium is

10 % Neutral Buffered Formalin

Place the specimen in formalin as soon as possible to prevent autolysis (cellular breakdown)

Specimen may be kept in formalin indefinitely with no adverse effects on testing

Labeling for any specimenThe vast majority of errors with the

specimens involve labeling problemsAt a minimum, the label must have the

following information:Patient nameMedical record numberDate of birthPhysicianDate and time of collectionSite of collection

The specimen site is often the labeling errorExamples of good

site labeling:Gastroesophageal

junction biopsyStomach body

biopsyAscending colon

polypColon @ 30 cm

biopsyGastric body

anastamosis site biopsy

Examples of bad site labeling:Anastamosis biopsyBody biopsy@ 29 cm biopsyBiopsy r/o h.PyloriPolypr/o “fill in the blank”

Adequate Samples vs. Inadequate Samples

It is imperative to collect an adequate sampling to obtain a reliable test result!!

Examples of Adequate vs. InadequatePhoto of adequate specimens

Photo of inadequate specimens

Diagram of GI tract RegionsEsophagus

Barrett’s Esophagus. (2015). Retrieved from http://www.barrettsinfo.com/content/3b_what_is_histology.cfm

Diagram of GI Tract RegionsStomach

stomach. (2015). In Encyclopædia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/567085/stomach

Diagram of GI Tract RegionsSmall Instestine (Duodenum) and

Large intestine

Chapter 23. (2015). Retrieved from https://facweb.northseattle.edu/jlearn/BIOL_241_242/Ch_23b_Digestive.htm

Specimens other than Routine PathologyAs mentioned before there are many other types

of specimens you may be asked to collect.Some things to remember:

If you don’t know what testing is required, a sterile piece of gauze moistened with sterile saline in a sterile urine container will preserve the specimen long enough for you to find out.

You should always have a contact at the laboratory that does your pathology/microbiology testing that you can call with questions. It is best if you can call before the procedure, but after will work as long as the specimen is dealt with expeditiously.

Flow CytometryFlow cytometry is testing done when the physician feels there may be a risk of lymphoma. The test results are far more effective to diagnose lymphoma than just pathology alone. The two reports are generally correlated by the pathologist. Flow cytometry can be done on tissue, blood, or body fluids from the area of the suspected lesion.

Bacterial CulturesBacterial cultures are often done during the colonoscopy to detect any abnormal bacteria in the GI tract. Method of collection is vital to obtaining accurate results. Collection must be sterile.

Viral CulturesVery similar to bacterial cultures, viral cultures are done often during a colonoscopy. Again, collection methods are of vital importance.

BRUSHINGS

Brushings can be done for cytology, as well as bacterial and viral cultures. Brushings are often done in areas where biopsies are contraindicated.

FECAL/STOOL SAMPLESFecal/stool samples can be collected for various reasons. Sometimes the physician wants an occult blood test, sometimes he wants an ova and parasite test done. First, find out exactly what type of testing the physician wants. This will determine how you hand the sample. It’s always wise to use sterile containers in case the physician decides to add on any testing after collection is done.

FOREIGN BODY EMOVALForeign body removal happens occasional during colonoscopies. When a foreign body is removed, it is sent to the lab to document and issue a report regarding what was removed from the colon. It can be materials ingested by the patient or can be the removal of a stent. The item can be retrieved from the lab after the case is signed out and a release form is signed.

Q&AQuestion and answer time…