Subject: Human Tissue Management
Effective Date: January 1994
Review Dates: October 2002, August 2016
American Dental Association (ADA) standard 6.1.3 requires that “all tissues removed are subjected to gross and/or microscopic examinations with findings noted in the patient’s record.”
In keeping with the ADA standard 6.1.3, all tissue removed anywhere within the University of Washington School of Dentistry must be sent to the Oral Pathology Biopsy Service (OPBS) for examination. Exemptions from this policy are listed below (see Implementation, Section II A.). It is up to the discretion of the attending pathologist to determine if the tissue will be examined “gross only” or “gross combined with histopathologic examination.” By far, the majority of the cases fall in the latter category. On rare occasions, specimens are submitted to other laboratories for specialized studies. However, all non-exempt tissues removed within the University of Washington, School of Dentistry (UW SOD) must be accessioned and submitted for histopathologic examination. A record of exempted tissue (gross only) will be dictated by the attending pathologist and kept on file in the office of the OPBS.
I. Specimen Handling
All tissues removed from patients within different clinics including the Emergency Clinics and Hospital Dentistry, regardless of the site of removal of the tissue, should have an Oral Pathology laboratory request form accompanying the specimen (see Appendix A). This may be completed by a dental student, resident, attending faculty, or dental assistant assisting in the procedure.
The dentist removing the specimen will provide the following pertinent information, which includes:
- Patient: His/her address, phone number
- Patient’s: Age, sex, and race
- Specimen: Location, clinical presentation, risk factors
- Procedure performed
- Provisional/preoperative diagnosis
- Dentist/physician’s name, address and phone number
It is imperative that the patient’s full name, the site of the specimen, the attending’s full name and the date of removal of the specimen be accurate and clearly recorded on this form. The specimen should be placed into a container with 10% buffered formalin (standard fixative) labeled with patient’s name. Other fixatives are required for special studies such as immunofluorescence studies in which case the specimen should be placed in a special transport medium known as Michel’s solution. The specimen along with the Oral Pathology laboratory request form is taken to the OPBS office located in Room B202 for prompt processing. When unusual studies are necessary, special handling and fixation of the specimen may be arranged through the OPBS office staff or with the attending Oral Pathologist by calling 543-4440.
The final signed written report of the diagnosis is usually available within 24 hours of the time of receipt of the specimen (weekends excluded). If special studies or unusual handling of the specimen are required, a provisional diagnosis can usually be obtained verbally within 24 hours of the receipt with the exception of tissue that requires decalcification.
Patients will be informed that there will be a separate charge for these pathology services. Such services would be included in the treatment plan when appropriate.
II. Specimen Categorization
A. List of Tissues Exempted from Accessioning in the OPBS:
Note: The removal of such tissues and their disposition must be documented in the patient’s chart.
- Periodontal tissue specimens from patients clinically diagnosed with periodontal disease. All tissues removed during periodontal procedures showing signs of pathology other than periodontal inflammation are to be submitted for gross and/or microscopic examination.
- Dental devices such as implants, etc.
- Foreign body, unless the dentist requests an identification
- Tissues and organs for transplantation, including bone submitted to the bone bank
- Portions of bone and other tissues removed for access to an operative field
- Dental pulp tissue
B .Tissues for Gross Examination Only
- Oral soft tissue or bone from plastic and/or reconstructive procedures, other than those performed for malignant neoplasms
- Teeth, at the dentist’s or patient’s request
- Foreign body, at the dentist’s or patient’s request
- Portions of bone removed for traumatic fracture
III. Review of Outside Slides for Patients Referred for Treatment to UWSOD:
The OPBS strongly recommends that outside slides for patients referred to the UWSOD for definitive therapy is reviewed by an oral pathologist within the UWSOD. The purpose of this policy is to provide the attending clinicians at the UWSOD with a consistently high standard of care by minimizing the possibility of misdiagnosis or misinterpretation. This recommendation helps maintain a classification and grading system known to UWSOD faculty so that a familiar and reliable basis for management is maintained. The policy for review of outside pathology slides on patients referred here for definitive treatment is as follows:
A. The outside pathology slides on which the patient’s diagnosis was based should be formally reviewed by a UWSOD oral pathologist and a formal written report be generated and included in the patient’s chart before treatment is administered at the UWSOD.
B. If the pathology slides were reviewed by a pathologist within the University of Washington, School of Medicine (UWSOM) & Medical Center system, the necessity for a second review by an oral pathologist at the UWSOD can by waived but it is recommended that the slides be informally reviewed by a UWSOD oral pathologist. If the oral pathologist disagrees with the diagnosis rendered by the UW SOM pathologist, a formal report should be generated and included in the patient’s chart. If in agreement, the patient’s chart should contain a preoperative note from the UWSOD attending explaining the mechanism that is being invoked.
C. In addition, outside pathology slides can be reviewed by the OPBS pathologist on any patient referred to the UWSOD for consultation or treatment at the request of the attending dentist.
IV. Report Management
Pathology reports must be filed in the patient’s dental record and in the Division of Oral Pathology. The following should be expected from each pathology report:
A. Each tissue specimen should generate a dated and signed report. The report becomes part of the patient’s record.
B. If a specific test is performed in a referred laboratory, the name of the laboratory performing the test is included in the report. If this laboratory generates its own report separate from that of the OPBS, an original copy will be attached to the Oral Pathology report. Both reports will be part of the patient’s record. A copy of the reference laboratory report will be kept in the OPBS Office.
C. The oral pathologist signing the report is responsible for the diagnosis and microscopic description of the specimen.
D. Diagnoses made from specimens are expressed in acceptable terminology of a recognized disease nomenclature and are coded for retrieval.
E. In all cases, a certain degree of microscopic description is recorded.
V. Disposal of Human Tissue
The tissue received by the OPBS is usually fixed in a10% buffered formalin. Most of the specimens are paraffin embedded and stored as blocks for as long as possible. Certain tissues such as teeth are fixed (if submitted unfixed), saved for approximately three months and then drained of fixative, double bagged and carried to the autopsy room at the Division of Surgical Pathology, School of Medicine to be incinerated.
Dean of UW SOD:
Joel Berg, Dean of the UW School of Dentistry