Systematic Investigation of Pathological Specimens

Module details

Title

Systematic Investigation of Pathological Specimens

Type

Specialist

Module code

SLS338

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the systematic investigation of pathological specimens as part of the clinical investigation of patients. They will understand and apply a range of  techniques to several clinical disorders and gain experience of interpreting results from patient investigations.

This module will provide trainees with the knowledge and understanding of the pathological basis of disease and the use of histopathology to detect and diagnose disease.

This module is also part of cytopathology specialist training. The module may be delivered as a combined module or as separate modules with appropriate clinical context.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Use a range of methods for the identification and collection of tissue and cellular preparations for the microscopic investigation of named common conditions, to include: needle biopsy surgical biopsy.	Action View
# 2	Learning outcome 2	Competency Interpret clinical requests and associated specimens to prioritise investigations, including the identification of urgent cases.	Action View
# 3	Learning outcome 4	Competency Interpret clinical requests and associated specimens from named clinical conditions and plan the investigations to be performed in line with agreed protocol.	Action View
# 4	Learning outcome 3	Competency Prepare and perform macroscopic examination and dissection of specimens as part of systematic investigation of named clinical conditions, to include: macroscopic examination of organs and tissues orientation and marking dissection and sampling of Category A to C specimens according to local protocol macrophotography during dissection note taking during dissection specialised containment to prevent sample loss or cross- contamination containment of high-risk samples recognition of own limits of practice.	Action View
# 5	Learning outcome 6	Competency Prepare and section tissue blocks and perform routine and specialised procedures in line with systematic investigation of named clinical conditions, to include: routine and special stains decalcification of tissues immunocytochemistry in situ hybridisation molecular pathology.	Action View
# 6	Learning outcome 5,6	Competency Interpret routine and specialised investigations performed and recommend appropriate action, to include: identification microscopically of normal and abnormal tissue request specialised demonstration techniques reporting.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform interpretation of clinical details and prioritise samples according to clinical urgency.	DOPS
Perform interpretation of clinical details and plan the investigations to be performed and annotate the request accordingly.	DOPS
Perform specimen dissection of a range of sample types requiring tissue transfer and select appropriate samples from those specimens to enable a diagnosis	DOPS
Perform assessment and marking of relevant specimen excision margins to enable correct orientation of the samples.	DOPS
Perform decalcification on a selection of tissue types, selecting the most appropriate methodology for the specific clinical presentation.	DOPS
Perform dictated description of 12 specimens being dissected.	DOPS
Perform microtomy on 10 different tissue types and stain with H and E stain.	DOPS
Perform microscopical interpretation of stained slides and produce a quality assessment evaluation report	DOPS
Perform microscopical interpretation of stained slides from 6 different tissue types	DOPS
In the clinic, collect biopsy samples from the clinician and return them to the laboratory using the correct storage and transportation methodology relevant to the investigations required and the local operational protocols.	OCE
In the clinic, collect aspirate samples from the clinician and return them to the laboratory using the correct storage and transportation methodology relevant to the investigations required and the local operational protocols.	OCE
From evidence gathered, discuss differential diagnosis at a relevant MDT meeting.	OCE
From evidence gathered and discussions with relevant clinical colleagues, produce a clinical pathway document detailing the impact of the diagnostic process on the overall patient pathway.	OCE
From evidence gathered and discussions with relevant clinical colleagues, produce a reflective account of the learning acquired	OCE
Explain to a Consultant Histopathologist normal and abnormal morphology, relating their morphologic appearance to the clinical condition.	OCE
Explain to a Consultant Histopathologist the algorithmic processes used to determine a differential diagnosis.	OCE
In discussion with a Consultant Histopathologist, use information gathered from the algorithmic process to produce a preliminary diagnosis.	OCE

Learning outcomes

1. Participate in the collection of a range of histopathology and cytopathology clinical specimens.
2. Perform investigations for the diagnosis, treatment and monitoring of named clinical conditions.
3. Evaluate and communicate the limitations of a range of investigative techniques in named clinical conditions.
4. Determine and give clinical advice on the sensitivity and specificity of investigative techniques in named clinical conditions.
5. Under supervision prepare and interpret reports that involve a range of histological and cytological techniques as part of the systematic investigation of named clinical conditions.
6. Work in partnership with other clinical specialisms as part of the diagnosis and review of individual cases.

Learning outcomes

1. Describe a wide range of invasive and non-invasive surgical procedures, and their relationship to the collection of histopathology and cytopathology specimens.
2. Discuss and justify the choice of appropriate investigations for named clinical conditions.
3. Describe and develop investigations that contribute to the treatment and monitoring of disease.
4. Describe and evaluate the limitations of a variety of investigative techniques in the diagnostic process.
5. Discuss the sensitivity and specificity of a variety of investigative techniques in named clinical conditions.
6. Discuss and interpret the outcomes of a variety of investigative techniques in named clinical conditions.
7. Discuss the importance of laboratory and clinical evaluation of new equipment and methods for histopathology and cytopathology.

Indicative content

• Application of a wide range of invasive and non-invasive surgical procedures, and their relationship to histopathology and cytopathology specimens, e.g. smears, aspirates, biopsies, excisions, resections
• Awareness of the relationship between imaging and the histological or cytological sample, e.g. ultrasound to identify the specific sample site
• Use of standard operating procedures (SOPs) applied to the systematic investigation of a disease process in a specific tissue type
• Application of a range of sampling and staining techniques and using them in a systematic way, according to protocols designed for that tissue type, and ensuring quality control procedures are in place
• An appreciation of how an accurate and timely histopathological and cytopathological diagnosis and reporting is essential in shaping the treatment and management of the patient. To include supplementary reporting when results of immunocytochemistry or molecular techniques become available
• Current legislation relating to the retention of tissues and organs
• Evaluation of new methods and techniques for processing tissue and for the investigation of tissue and cell preparations

Activities

• Prepare an evidence-based report listing the strengths and limitations of a range of investigative techniques used in named clinical conditions.
• Describe and apply evidence-based data on the sensitivity of investigative techniques in named clinical conditions. To include suggesting clinical advice in specific clinical cases.
• Working directly with a pathologist, discuss the systematic investigation that you have performed in named clinical conditions on specimens from a range of clinical referrals. In each case, agree how these may be incorporated into a report prepared in the correct clinical context.
•  Participate in multidisciplinary review meetings at which histopathology results are presented as part of the clinical record. Prepare a portfolio of cases to illustrate how key histological and cytological findings may be integrated with imaging and other diagnostic findings to facilitate diagnosis and patient management in named clinical conditions. 
• Attend clinics and ward rounds where patients with named clinical conditions are investigated. Gain understanding of the importance of pathology to the patient journey and write a reflective account of what you have learned. 
• Prepare a portfolio of cases from named clinical conditions where you have played a significant role in the systematic investigation and include the use and interpretation of sensitivity and specificity data.