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  • Cellular Pathology

    Cellular Pathology

    The specialist staff in the Directorate of Cellular Pathology provide the clinical opinions on specimens of tissues (biopsies) and cells (cytology) that are taken to make a diagnosis, to guide treatment and to monitor the effects of treatment. Our reports contain the essential information that physicians, surgeons and oncologists use when talking to patients.

    We work with clinicians based in the community in Liverpool and in the main Liverpool hospitals and strive to ensure that patients receive a high quality service wherever they are being seen. This involves providing specialised pathological expertise to support many regional and national services, as well as the scientific expertise underpinning the diagnostic process.

    Our laboratories are fully accredited by Clinical Pathology Accreditation (CPA) which is now part of the United Kingdom Accreditation Service (UKAS), and are subject to regular inspections by UKAS, the Human Tissue Authority (HTA) and the northwest regional quality assurance reference centre (QARC).

    Each part of the service participates in national quality assurance schemes.

    Several staff are involved in national organisations, such as the Institute for Biomedical Sciences and the Royal College of Pathologists, contributing to the national pathology governance agenda and laboratory assessment services.

    Specialist Clinical Services

    The Directorate is based on specialist teams in the following areas:

    • Gastrointestinal Pathology, including diseases of the liver, gallbladder and pancreas
    • Soft Tissue Tumour Pathology, with close links to other specialist teams in North West England
    • Head and Neck Pathology, as an integral part of the regional service at Aintree University Hospital
    • Gynaecological Pathology, working closely with clinicians at the Liverpool Women’s Hospital
    • Cardiothoracic Pathology, working closely with clinicians at the Liverpool Heart and Chest Hospital
    • Dermatopathology, working with the specialist teams at the Royal Liverpool and Broadgreen Hospital and Aintree University Hospital
    • Breast Pathology, including provision for the rapid molecular pathology assessment (OSNA) of lymph nodes removed during surgery for breast cancers.
    • Haemato-oncology Diagnostic Service (HODS), working with specialist haematoliogsts across Merseyside and Cheshire
    • Ophthalmic Pathology is a nationally commissioned highly specialised service and forms part of the “National Specialist Ophthalmic Pathology Service” (NSOPS). It provides a diagnostic, molecular diagnostic and prognostic service to the nationally commissioned trust-based Ocular Oncology service and to St Pauls’ Eye Hospital, as well as to other clinicians and pathologists throughout the UK, Europe, and elsewhere.
    • Urological Pathology, as an integral part of the specialist clinical teams treating patients with cancers of the testis, kidneys and bladder

    For a comprehensive list of the tests we offer, or for more information, please refer to the relevant Laboratory Handbook.

    Histopathology

    Histopathology is the diagnostic service that looks at cells of the body within solid tissue specimens. By looking at the way that the cells are arranged, how they have developed and how they are functioning, it is possible to determine if a patient has a particular disease, inflammation, a cancer or a non-cancerous growth.

    Cells can be taken from tissues removed during surgical procedures in theatres, outpatient clinics, GP clinics or at post-mortem examination. Very thin slices of the tissue are dyed different colours allowing the cells to be examined under the microscope.

    The Histopathology services receives tissue samples from more than 55,000 patients in Liverpool each year, as well as clinical referrals from across Merseyside and Cheshire and part of the North West England.

    Findings from a patient’s cellular pathology studies are discussed at multi-disciplinary team meetings with other clinicians, and the team of experts work together to advise on an appropriate treatment plan for discussion with the patient or to review how a treatment is progressing. Cellular pathology is essential to delivering cancer services within the Trusts.

    Most of our work is associated with specific clinical services delivered in the Hospital Trusts with which we work, principally the Royal Liverpool and Broadgreen University Hospital, Aintree University Hospital, Liverpool Heart and Chest Hospital and the Liverpool Women’s Hospital.

    For a comprehensive list of the tests we offer, or for more information, please refer to the relevant Laboratory Handbook.

    Cytology

    Cytology is the diagnostic service that examines dispersed cells such as those obtained as part of the cervical screening programme (gynaecological cytology) or which may be found in body fluids or obtained by aspirating cells from lumps (non-gynaecological cytology).

    Gynaecological (Cervical) Cytology

    The NHS Cervical Screening Programme (NHSCSP) was set up in 1988 and screens approximately 4 million women each year with the aim of reducing the number of women who develop invasive cervical cancer (incidence) and the number of women who die from it (mortality). Screening involves taking samples of cells from the surface of the cervix (cervical smear test), identifying abnormalities in the cells to allow early treatment.

    Our cervical cytopathology service receives approximately 46,000 specimens per year and also processes approximately 46,000 specimens per year for Whiston and Warrington Hospitals. The department is heavily involved in the training of sample takers (from the community and hospitals) and liaises with the local screening and immunisation area team. The department has been performing Human papilloma virus (HPV) testing to include triage and test of cure since 2008 and is one of six sites nationally currently participating in the HPV primary screening pilot.

    Non-gynaecological Cytology

    The non-gynaecological cytology service receives approximately 10,000 cases per year and many different types including bronchoalveolar lavage, bronchial washings, bronchial brushings, bronchial trap, sputum, ascitic fluid, peritoneal fluid, cyst fluid, pericardial fluid, pleural fluid, urine, synovial fluid, nipple discharge and fine needle aspirations (FNA) from sites such as breast and thyroid.

    We attend seven rapid diagnosis clinics at the breast unit, three head and neck, two endoscopy/pancreatic and one thyroid clinic per week, as well as attending ward FNA’s on request. In this setting, cytopathologists provide rapid diagnosis and a fast track for patients to move to a specific diagnostic pathway, especially where a tumour is diagnosed.

    For a comprehensive list of the tests we offer, or for more information, please refer to the relevant Laboratory Handbook.

    Molecular Pathology

    Immunocytochemistry (ICC)

    ICC is a technique for identifying cellular or tissue constituents by means of specific antibody-antigen interactions. Labelled antibodies are used as highly specific reagents for the localization of antigens in cells and tissues. This is a major diagnostic tool in Cellular Pathology proving to be a useful adjunct to routine histological analysis for the investigation and diagnosis of disease. ICC is widely used for diagnostic and prognostic characterization of different tumour types and also plays a role in the field of companion diagnostics.

    Our immunocytochemistry service offers an extensive repertoire of primary antibodies and provides support to routine histopathology and cytopathology diagnosis at the Liverpool Clinical Laboratories and also undertakes Her2 testing in breast cancer samples, Human Papilloma Virus (HPV) testing in oropharyngeal specimens, detection of Epstein Barr Virus (EBV) mRNA, and EGFR profiling in lung cancer specimens and offers these as a regional service.

    Molecular Pathology

    The Molecular Pathology service offers a comprehensive test repertoire to support its clinical service activity. The service offers PCR for TCR/IgH gene rearrangement studies in haematological neoplasms and coeliac disease; RT-PCR for gene mutation detection, e.g. EGFR in non-small cell lung cancer and BRAF in ocular melanoma; and Multiplex Ligation Dependant Ligation dependant probe Amplification (MLPA) and micro-satellite instability (MSI) studies for prognostication in ocular oncology. In conjunction with the Immunocytochemistry service, a range of chromogenic in situ hybridization (CISH) and fluorescence in situ hybridization (FISH) protocols are also offered as diagnostic and therapeutic predictive aids for the investigation of breast cancer, non-small cell lung cancer, lymphoma and oropharyngeal carcinoma specimens.

    Specimen requirements for this delivery of this service include fresh frozen or formalin fixed paraffin embedded tissue sections and whole blood samples.

    For a comprehensive list of the tests we offer, or for more information, please refer to the relevant Laboratory Handbook.

    Mortuary and Bereavement Services

    The Mortuary Service is responsible for the care of the deceased who die in hospital, or are brought to hospital after death, and to their families and friends. Mortuary staff have an important role, providing an efficient service whilst responding sensitively to the needs of the bereaved. The Mortuary Service deals with deaths from wards at the Royal Liverpool University Hospital, Aintree University Hospital and covers the Mortuary at Broadgreen Hospital and death from Liverpool Women’s Hospital, Broadoak Unit (situated at Broadgreen Hospital) and Liverpool Heart and Chest Hospital. The mortuaries receive deceased from external sources due to post-mortems ordered by the Coroners and/or Forensic investigations as part of the regional service covering Merseyside, Cheshire, North Wales, Cumbria, Southport, Blackpool, Sefton/Knowsley, Whiston and Wirral.

    The bereavement service provides comprehensive information, guidance and support for bereaved relatives and friends following the death of a patient at the hospitals. Our service includes the prompt completion of all the necessary paperwork after a death as well as explaining to the bereaved how to register a death, how to find a Funeral Director or arrange a funeral without a Funeral Director. We work very closely with the Liverpool Coroner’s Service, the Liverpool Registration Service and local Funeral Directors to ensure the bereaved have access to all the information and services they require.

    Skin camouflage techniques – The recognition of facial features remains central to formal identification procedures and being able to view the deceased is an integral part of the early grieving process. The use of camouflage techniques minimises the adverse emotional impact that unpleasant facial trauma and discoloration can have on those who are required to identify or wish to view the deceased. Our experience indicates that a mortuary skin camouflage service offers a significant benefit to the bereaved, especially when the degree of trauma or discoloration would have made viewing a very distressing experience. The feedback received from the relatives themselves has been very encouraging and given with heartfelt thanks.

    For a comprehensive list of the tests we offer, or for more information, please refer to the relevant Laboratory Handbook.