Guidance

Breast screening: transferring specimens between laboratories

Published 21 June 2019

This guidance should be read in conjunction with the Royal College of Pathologists publication on inter-departmental dispatch of cellular material for referral and clinical trials and relates to transfer of blocks and/or slides, not ‘wet’ unprocessed samples.

Reasons for transfer of specimens

The transfer of breast specimens between departments may be for expert specialist opinion.

It may be mandated as routine by some trusts and in some networks (for example linked to patient pathways) for specific assays or as review as part of a clinical trial or research project.

The purpose may also be:

• to confirm the diagnosis before therapy is given and to ensure a complete archive at the treating centre
• to compare patient specimens for diagnosis or response to therapy
• to ensure uniformity of reporting of cases, for example in clinical trials or for the assessment and reporting of molecular predictive markers, such as HER2 status

Transfers should be undertaken as promptly as possible with appropriate information and material submitted.

Recommendations

There are a number of recommendations to facilitate clinical care.

Slides and blocks requested as part of ongoing patient management should be sent the same day where possible, or the next working day at the latest. The exception is historical material which may be located off-site.

Samples should be sent first class recorded delivery or via courier where they are trackable. This is especially true for paraffin blocks, which form an irreplaceable part of the patient record. If samples are not to be sent via recorded delivery or a courier, the option of sending blocks and slides separately can be considered to reduce risk of loss. If sending material within a network, it is likely that dedicated transport arrangements will be in place and these should be used.

The pathological material required may differ according to the reason for review. For example, if a case is submitted for further diagnostic opinion, it is often helpful to send the original haematoxylin and eosin stain (H and E), any immunostained slides and at least one representative block. If submitted for HER2 status assessment, just a representative block may be needed.

A copy of the original histology report and contact details of the sending laboratory should be included with the submitted material.

Notification of receipt should be sent on delivery via a secure method, for example to an nhs.net email account.

Submitted material should be given a unique identifier and logged in the computer system of the receiving laboratory as soon as possible after receipt.

A copy of the secondary pathology report should be included with the returned material.

Consideration should be given to other ways of returning the report from the referred centre as speedily as possible. This includes emailing a PDF to an nhs.net email account if it relates to patient management, for example in cases submitted for expert opinion or for HER2 status.

Original material should be returned to the source laboratory in a timely fashion after review unless retention of the specimen is required for ongoing patient care. This could be when a comparison is needed of the biopsy with the surgical excision specimen, or if the specimen forms part of a clinical trial resource (with appropriate patient consent).

Representative slides of second opinion cases may be retained for educational purposes with permission of the submitting pathologist. If additional sections have been produced in the referral centre, they should also be retained at that site.

Details of material should be returned, and the date recorded in the laboratory data system.

All slides and blocks should ideally be returned using first class recorded delivery or courier, or via local dedicated transport arrangements, if available.

Finally, the referral centre should ensure mechanisms are in place to enable rapid contact with the sender if there is diagnostic disagreement or discrepancy that will significantly alter the management of that individual patient. If there is a substantial disagreement in diagnosis on review, detailed communication between the pathologists should be considered as a matter of courtesy.