Memorandum
Date: October 10, 2012
To: Edmonton, Central, North and South Zones: Laboratory Directors, Managers, Pathologists and Anatomic Pathology Staff at: Grey Nuns Community Hospital, Misericordia Community Hospital, Royal Alexandra Hospital, University of Alberta Hospital, DynaLifeDx Red Deer Regional Hospital Bonnyville Healthcare Centre, Queen Elizabeth II Hospital, Northern Lights Regional Health Centre - DynaLifeDx Chinook Regional Hospital, Medicine Hat Regional Hospital and Medicine Hat Diagnostic Laboratory
From: AHS Laboratory Services – Edmonton Zone
RE: Edmonton Zone IHC Laboratory Breast Biomarker Requests
Please be advised that the Edmonton Zone Immunohistochemistry Laboratory (EZIHC Lab) requires a “Breast Biomarker Requests” form to be completed for all Biomarker requests including requests from within the Edmonton zone. Along with each completed form, a copy of the report with a diagnosis must also be submitted to the EZIHC Lab.
Information that must be provided: • Patient Identification • Original Accession number • Collection Date • Reporting Pathologist • Specimen Type • Material Sent • Diagnosis information • Report type
Additionally, fixation data must also be provided. The requesting laboratory must provide information about the fixative used, the devitalization time and the duration of fixative exposure.
A copy of the most up to date Breast Biomarker Requests form is provided.
Questions or concerns may be directed to:
Dr. Gilbert Bigras, Medical Lead, Edmonton Zone IHC Laboratory [email protected] or 780-432-8445
Robin Stocks, Technologist II Supervisor, Edmonton Zone IHC Laboratory [email protected] or 780-577-8122
Edmonton • Cross Cancer Institute • Laboratory Medicine & Pathology
Rm. 2338, 11560 University Avenue, Edmonton, Alberta, Canada T6G 1Z2
www.albertahealthservices.ca
Edmonton Zone Immunohistochemistry Laboratory Department of Laboratory Medicine and Pathology
Cross Cance r Institute 11560 University Avenue, Edmonton, AB T6G 1Z2
Ph. 780.432.8587 Fax. 780.432.8455
BREAST BIOMARKER REQUESTS
PATIENT NAME: ______
PHN: ______DOB (DD/MM/YYYY): ______
ORIGINAL ACCESSION NO: ______BLOCK NO: ______
COLLECTION DATE: ______PATHOLOGIST: ______
SPECIMEN TYPE (e.g., segmental, needle core, etc): ______
MATERIAL SENT (e.g., block, slide, etc): ______
DIAGNOSIS: Invasive Carcinoma DCIS Only
PRELIMINARY Report FINAL Report
FIXATION DATA
FIXATIVE: 10% NEUTRAL BUFFERED FORMALIN CONFIRMED OTHER (please specify): ______
DEVITALIZATION TIME: ______hours ______min
Time delay before formalin exposure (normally less than 1 hour i.e. 0 hour 42 minutes). This would essentially capture any delays between surgical resection / specimen collection and adequate formalin exposure (sliced when necessary). This should reflect any delays encountered for transport, specimen imaging or slicing of large specimens (into 1 cm or less tissue slices) prior to tumor exposure to formalin.
TIME IN FIXATIVE: ______hours ______min
Time duration of formalin exposure (# hours ie. TOTAL to nearest hour – also including hours of processor formalin steps as well 0,1,2,3,4,5,6…999 etc.)
(Rev October 2012)