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Case Complexity Banding 2020

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Case Complexity Banding 2020 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 Cartilage Femoral head Digit amputation Bone tumour resection (local) Tendon biopsy Synovial biopsy Tendon Vertebrae Vertebral disc Breast reduction Breast implant capsule Axillary clearance Excision biopsy with shave Bilateral mastectomy Breast excision & axillary clearance Excision biopsy Cavity shave WLE with shave excision Mastectomy - malignant & axillary clearance Mastectomy scar Needlecore biopsy (2 specimens) Needle/wire guided excision Microdochectomy 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 CUST-DOC-1 Version 7.0 Complexity 1 Complexity 2 Complexity 3 Complexity 4 Complexity 5 Complexity 6 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 CUST-DOC-1 Version 7.0 Complexity 1 Complexity 2 Complexity 3 Complexity 4 Complexity 5 Complexity 6 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 CUST-DOC-1 Version 7.0 Complexity 1 Complexity 2 Complexity 3 Complexity 4 Complexity 5 Complexity 6 Thrombus/embolus Cervical lymph node 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 cancer 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 CUST-DOC-1 Version 7.0 Complexity 1 Complexity 2 Complexity 3 Complexity 4 Complexity 5 Complexity 6 Dermatofibroma Soft tissue lipoma – 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 CUST-DOC-1 Version 7.0.
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