We're all walking on cloud nine here at Southside Hospital we just passed
our first CAP insoection with a perfect score- no deficiencies that we
couldn't clean up before the inspectors left for the day. In Pathology, we
were perfect with nothing but a recommendation for more space. I think we
got the best score in our whole system, every hospital of which was
inspected this week by CAP for the lab and JCHCO for the hospitals. Since
I've been doing nothing but writing policies for the last two months, here's
my sentinel node procedure again.

Jeff Silverman HT HTL QIHC (ASCP) Suthside Hospital Bay Shore NY

Microtomy wise:
Sentinel nodes for breast cancer or other carcinoma- for each block: three H
and E levels on regular slides AND  two sections on PLUS slides, one for
positive stain and one for negative control AE1/AE3 Cytokeratin
immunostains.

Sentinel nodes for melanoma- for each block: 3 H and E levels on regular
slides AND  three unstained slides for immunohistochemistry picked up on
PLUS slides: one each  for S-100 and HMB-45 stains, and one for the negative
control. Cut one more if you want to use MART-1, a newer  very useful marker
for melanoma as well, we don't do it.

Safety wise-


Lab Section:  Histopathology
Subject: Radiation Safety
Procedure: Sentinel Node and other Radioguided surgical specimens

PRINCIPLE: The sentinel node biopsy procedure is currently being evaluated
for its utility in sparing patients more mutilating lymphadenectomy surgery
utilizing radioactive labeling to guide sampling of the primary lymph node
drainage areas of primary breast carcinomas and malignant melanomas. This is
done by injecting a chromogenic radionuclide into the primary tumor site and
measuring the lymphatic drainage area with imaging procedures designed to
locate the first lymph node draining the area. These specimens may pose a
risk to Operating Room and Laboratory personnel due to their radioactivity.
Though the level is low, unnecessary exposure is to be avoided.

SPECIMEN: Surgically excised mammary tissue or somatic skin and soft tissue.
Surgically excised lymph nodes.

	Patient Preparation: Patient is injected in Nuclear Medicine or in the
operating room 2 hours before surgery.


PROCEDURE:
1.	Upon excision, specimens are placed in labeled containers and fixed by
immersion in Histochoice Fixative.  OR personnel will label specimens as
radioactive.
2.	Nuclear medicine technologist must be called immediately by OR personnel.
The Nuclear Medicine technologist shall survey the specimens with a Geiger
counter. Any item reading greater than 0.2 mR/hour shall be taken by Nuclear
Medicine technologist to that department’s secure area and allowed to decay
for 60 hours (10 half lives) and until they read less than 0.2mR/hour.
a.	Operating room work areas and refuse reading more than 0.2 mr/hour are
decontaminated or removed to Nuclear Medicine for decay if readings exceed
0.2mR/hour.
3.	The specimen will be logged in Nuclear Medicine. The specimen is brought
to pathology by Nuclear Medicine after decay has been accomplished. The
specimen is then signed for by Pathology.
4.	Intraoperative examination of radioactive specimens is discouraged. If
this is necessary, use remote handling techniques and call  Nuclear Medicine
to test the specimen and advise Pathology as to the level of radiation.
5.	Examine in a plastic tray to contain all spillage. After completion of
the examination, all work surfaces and absorbent materials are to be tested
by Nuclear Medicine in the Pathology Department.  If readings are greater
than 0.2mR/hour,  all refuse is red bagged and taken to Nuclear Medicine to
decay for 10 half lives (60 hours).  The grossing work area is tested and if
necessary decontaminated according to Nuclear Medicine protocols. The
specimen is taken to Nuclear Medicine for decay, logged in, and returned to
Pathology as above.




REFERENCES:  Radiation Safety Officer


  ANNUAL REVIEW:     DATE: ___/___/02  ___/___/03___/___04 ___/___05
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