The speed of processing in surgical pathology laboratories is faster than it was a couple of decades ago, but the average weight of specimens is lighter. However, although surgical pathology laboratories are overwhelmed with biopsies, larger laboratories, especially those in academic institutions, have considerable numbers of “heavy” specimens. Advances in surgery have led to production of voluminous specimens. Examples include the specimens taken during Whipple procedure, transplants, radical resections, and amputations due to tumors. New circumstances involving factors such as TAT pressure, productivity concerns, and stricter laboratory safety requirements dictate the gradual specialization of grossing stations.
Calcified specimens are first in the line for specialized grossing processing. Bone grossing employs saws, hammers and other attributes that require a literally heavy-duty table. Additional hazards, such as formalin- loaded sharp particles of bone dust, add to the necessity of separating this type of grossing from others in order to provide high quality work under safe conditions. For details, see Bone Grossing Table article. TBJ Inc. has developed and introduced the Bone Grossing Table.www.tbjinc.com/Product.aspx?id=110401.
It is doubtful that there is a waiting list to acquire this piece of equipment. Perhaps, the limited demand can be explained by customer’s filling that they do not need a specially designated bone grossing table when they are grossing only a couple of femoral heads or tibia plateaus per day or even week. With the exception of large laboratories that deal with head and neck surgery or bone oncology surgery, most surgical pathology laboratories can cope without a specially designated bone grossing table. At least, that is what most decision making managers think.
This is a tribute to old ways of work in the surgical pathology laboratory. Separation of biopsies and the rest of the materials, an appropriate working place contributes to laboratory productivity and higher quality of grossing besides bone sampling. There are other substantial details. Let’s take some examples from the surgical pathology laboratory practice.
When a gangrenous odorous small bowel is opened, the laboratory is paralyzed by the intolerable smell. The “heavy –duty” grossing station (i.e., the Bone Grossing Table) with its enhanced ventilation can somewhat alleviate the laboratory stuff suffering. The same can be mentioned when other gangrenous specimens are sampled.
An amputated extremity needs both space and special cumbersome immobilization contrivances. Sampling an extremity specimen can be a time- and efforts- consuming procedure which combines both bone sections and vessels dissection. A “heavy-duty” grossing station is the right place to work with such a specimen.
Large specimens obviously require an appropriately larger table space that a standard grossing station can barely provide. Often, the grossing person has to stop the sampling in order to ask questions of the pathologist who is not always immediately available. If the specimen is placed back in the container, many tissue relationships become less clear. Thus, the specimen needs to be left on the table for some time while the grossing person waits for the pathologist. Sometimes clinicians also need to be involved in grossing. They are rarely available immediately. Big, complicated specimens should be sampled on the “heavy-duty” grossing station.
Often, upon request from the pathologist, a big specimen needs to be pulled out after sampling. The specimen is already saturated with formalin. For example, a search for additional mesenteric lymph nodes in colon cancer can take some time when the grossing person inhales formaldehyde in a dose much greater than by OSHA- regulated short- and long- term limits. And often the saturated with formalin specimen is pulled out for observation of a pathologist who for whatever reason cannot arrive immediately, and thus the specimen is left to wait for some time while emanating formaldehyde. A “heavy- duty” grossing station is designated to be the most adequate equipment for these kinds of grossing situations.
Specimens are now very often sampled in the fresh state. Although the previous 1:20 ratio orthodoxy has now, for good reason as unnecessary, been abandoned, the amount of formalin used is substantial. Rivers of formalin flow during fixation. The installation of a formalin- powered dispenser might be reasonable for a “heavy-duty” grossing station (TBJ’s Powered Formalin Dispensing System, MOPEC’s FP250), while its presence in a standard grossing station is questionable because most specimens, biopsies, are in formalin- prefilled containers.
These are features of everyday practice that cannot be dismissed. However, such real- life examples are not often on the minds of decision- making people when they encounter the Bone Grossing Table which should be called the “heavy-duty” grossing station.
There is another reason that a “heavy-duty” grossing station makes an attractive and necessary addition to a surgical pathology practice: the disposal of specimens. Specimen disposal is a serious safety problem. See the post Wet Specimen Disposal in the Surgical Pathology Laboratory.It is an area that is neglected by management and safety officers. When a specimen is separated from formalin, both the saturated- with- formalin specimen and the formalin itself emanate formaldehyde in concentrations much exceeding any monitoring limits. OSHA standard monitoring cannot catch these episodes, in which the formaldehyde is in its most damaging. Everyone who has participated in specimen disposal can remember filling irritation and the sour taste that lingers in the mouth. Of course, PPE- wearing is helpful and obligatory, but the procedure needs an appropriate space and different than a regular grossing station ventilation. The table needs higher vertical panels.
Autopsy specimen disposal would be also a “customer” of “heavy-duty” grossing station because autopsies use large volumes of formalin, and periodic specimen disposal is a real safety problem. Brain washing (literally) after postmortem fixation would be safer to perform on the station’s table. The entire anatomical pathology department would benefit from the presence of this station, which can also be used for postmortem gross sampling.
Disposal of formalin after its separation from the specimen is another problem. Most laboratories neutralize formalin before it is discarded. The hazardous effect for laboratory environment of this procedure is underestimated. The “heavy duty” grossing station can be connected to a special neutralization device for this purpose. A combination of the “heavy-duty” grossing stations with specimens and formalin disposal would be a solution of many problems in the surgical pathology laboratory.
This post has tried to make the case that the “heavy-duty” grossing station with the Bone Grossing Table, as the base design, is not a luxury for a surgical pathology laboratory, but rather a necessity for productive and safe work. Perhaps, the quotation marks will be irrelevant for this equipment in the near future, as it will become a commonly accepted fixture of civilized work in the modern surgical pathology laboratory.