Case Complexity Banding 2020

Issue date: February 2020 Complexity 1 Complexity 2 Complexity 3 Complexity 4 Complexity 5 Complexity 6

Two complexity Three complexity 1 specimens Four or more complexity Cases sent for a specialist Samples of 20 slides Applicable to 1 specimens 1 specimens second opinion or greater all Specialities Two complexity 2 specimens Three complexity 2 specimens

Wet specimen X-Ray

Ligament biopsy Bursa Joint biopsy Bone - benign (small) Bone - benign (large) Bone biopsy Bone, Joint and Osteo Ligament cyst Femoral head Digit amputation Bone tumour resection (local)

Tendon biopsy Synovial biopsy Tendon Vertebrae

Vertebral disc

Breast reduction capsule Axillary clearance Excision biopsy with shave Bilateral Breast excision & axillary clearance Excision biopsy Cavity shave WLE with shave excision Mastectomy - malignant & axillary clearance Mastectomy Needlecore biopsy (2 specimens) Needle/wire guided excision Wide Local Excision Needlecore biopsy (WLE) +/- axillary clearance

Nipple biopsy

Artery Mitral valve Aortic valve Heart transplant Cardio Aortic valve biopsy

Heart valve

Parathyroid - one specimen Adrenal – benign Adrenal - malignant Endocrine Thyroid biopsy Parathyroid -– Parathyroid – malignant 2 or more specimens Pituitary – malignant Pituitary – benign Thyroid -– malignant Thyroid - benign

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Anal fistula Colonic donut Biopsy/polyp (1-3 specimens)* Biopsy/polyp (4-6 specimens)* Biopsy/polyp (7+ specimens)* Colorectal resections GI - malignant Anal wart(s) Stoma Oesophageal biopsy Colorectal resection – benign Bile duct resection (Barretts) Pancreatic resection Appendix Oesophageal/Gastric Gall bladder resection - malignant Omental biopsy resection – benign -malignant Gall bladder Peritoneal biopsy Retroperitoneal biopsy Oesophageal/Gastric resection Haemorrhoid - malignant Random colonic biopsies Pancreatic core biopsy Hernia sac (including multiple Resection for inflammatory specimens in one pot) ** bowel disease Perianal abscess Pancreatic cyst

Pilonidal sinus Pancreatic resection - benign

Epididymis biopsy Pelvi-ureteric junction (PUJ) Bladder biopsy Foreskin - inflammatory Nephrectomy - malignant Radical cystectomy GU biopsy Hydrocele sac Bladder tumour - TURBT Nephrectomy - benign Orchidectomy - malignant Radical prostatectomy Ureteric biopsy Vas deferens Prostate chippings- TURP Orchidectomy - benign Renal biopsy (post-transplant) Renal biopsy – diagnostic Urethral biopsy (less than 6 blocks) Penectomy Supra pubic resection Foreskin - circumcision Penile Biopsy Prostate biopsies Ureter resection (1-2 blocks) *** Urethra resection Prostate chippings- TURP (6+ blocks)

Renal biopsy – tumour

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Bartholin’s cyst Endometrial biopsy Cervical Biopsy Cone/Lletz biopsy (<20 slides) Cervix - malignant Gynae Cervical polyp Endometrial pipelle/curettings Ectopic pregnancy Hysterectomy & salpingo-oo- Hysterectomy +/- tubes phorectomy - benign and ovaries –malignant Endocervical cyst Endometrial polyp Endocervical biopsy Ovarian cyst Ovary - malignant Fallopian tubes (one or two) Vaginal Biopsy Endometrial ablation Placenta Vaginal resection – malignant Endometrial curettings/ Products of conception Vulval Biopsy biopsy- hyperplasia or neoplasia Vulval resection – malignant Vaginal/vulval polyp Fibroid Twin and Triplet Placenta Vulval wart Hysterectomy – benign

Ovarian biopsy

Ovary (+/- fallopian tube) - benign Cholesteatoma Adenoids Laryngeal biopsy Salivary gland Jaw – malignant Tonsil (lymphoma) Head & Neck (non odontogenic) Conjunctival Biopsy - Salivary gland biopsy Thymus Benign Cornea Larynx -malignant Lip wedge resection Ear, middle/inner Nasopharynx - malignant (single specimen) Thyroglossal cyst Neck dissection Epiglottis Tonsillectomy Tongue resection – malignant Lip biopsy (one or two specimens) Tonsil - malignant Mucosal biopsy of nose Cornea (non lymphoma)

Oropharynx biopsy Tumour with unilateral neck dissection Nasal cyst/papilloma

Nasal polyps

Nasophrynx biopsy

Palate biopsy

Postnasal space biopsy

Tongue biopsy

Paranasal sinus biopsy

Vocal cord biopsy

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Thrombus/embolus Cervical biopsy – Lymph node biopsy – Lymphoma Haemo & non tumour / non lymphoma tumour / lymphoma Lymph Spleen - lymphoma/tumour/ Spleen - benign Lymph node regional leukaemia dissection

Liver biopsy Liver Liver resection

Nerve biopsy Brain biopsy Meningioma Neurosurgical biopsies Neuro (multiple biopsies) Temporal artery biopsy Skeletal muscle

Dental biopsy Muscle biopsy Buccal mucosa - malignant Oral Dental cyst Odontogenic tumour Tooth

Oral mucosal biopsy Developmental cysts

Tracheal biopsy Respiratory biopsies Carotid body neoplasm Lung wedge/resection - ma- Lung transplant Respiratory lignant Lung wedge/resection (non malignant)

Mediastinum

Pleural resection

Dermatofibroma Actinic keratosis/compound Atypical naevus Benign adnexal tumour Alopecia biopsies Unorientated BCC/SCC Skin naevus (6+ specimens) Intradermal naevus Dysplastic naevus Keratoacanthoma Melanoma resection Morton’s neuroma (1-2-specimens) Cutaneous lymphoma Nail Skin biopsy (malignant) Nail bed/matrix biopsy Pseudolymphoma Orientated BCC/SCC Non-inflammatory lesions Skin biopsy (melanoma) (1-3 specimens) Melanoma resection (3-4 specimens) Seborrheic keratosis Inflammatory skin biopsy Rare unorientated skin specimens including sarcoma Orientated BCC/SCC Simple Cyst Unorientated BCC/SCC (4+ specimens) (1 or 2 specimens) Small orientated surgical Skin Tag skin cancer specimen Rare orientated surgical Viral wart/Papilomas (1 or 2 specimens) skin cancer specimens including sarcoma All other incisional/excisional Unorientated BCC/SCC samples of simple (3 - 5 specimens) non-malignant origin

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Dermatofibroma Soft tissue – large Soft tissue - malignant Complex Soft tissue tumour Soft Tissue (3+ slides) requiring IHC Ganglion cyst Soft tissue lipoma – more than Haemangioma one site

Histiocytoma

Soft tissue biopsy

Soft tissue lipoma – small (1-2 slides)

Bronchial lavage Bile duct brushings Any non-gynae cytology case Any non-gynae cytology case Non gynae with 5 or more slides with 10 or more slides cytology Cerebro-spinal-fluid (CSF) Bronchial brushings

Peritoneal fluid FNA’s 1 – 4 slides

Pleural Aspirate Gastric brushings

Sputum Oesophageal brushings

Urine

Please note: The complexities above should be considered a guide. There may be cases which require up or down banding upon reporting to reflect the true complexity

* Oesophagus (non-barrett’s), duodenum, small bowel, colon, rectum, anus, GOJ, Gastric

** Colonic series biopsies received in one pot requiring separate reporting are regarded as separate specimens

*** Prostate biopsies cases of 3 or more blocks do not fall into the above complexity banding and will be subject to charges per additional block. £28 for Pre-prepared, £32 for Block, £35 for Wet

The following cases/analyses require specialist procedures. These should be discussed with Source Pathology prior to referral.

Prostate Templates / Mapping Renal biopsy (inc. E.M. and IHC) requiring special fixation and handling Foetus Eye enucleation Brain (whole) BMT

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