Pathology Frequently Asked Questions (FAQ)

Why do some pathology results take longer than expected?

Laboratories work to defined turnaround time targets (refer to user information) and continuously review workflows to improve the timeliness of reporting and communication.

Typical turnaround targets include:

  • Blood Sciences: 1 hour for acute areas such as ED and ITU

  • Blood Sciences: 4 hours for inpatient wards

  • Blood Sciences: 24 hours for outpatient and GP samples

Some tests may take longer because they require specialist investigation, referral to another laboratory, complex antibody investigations, microbiological resistance testing, or further clinical review.

How will I know if a sample has been rejected?

When a sample is unsuitable for testing, the reason for rejection is recorded promptly and should be visible within EPR/CyberLab systems. For urgent transfusion-related samples, wards are contacted directly by telephone to ensure timely action can be taken.

Why do results sometimes arrive separately?

Different tests require different methods, processing times and levels of clinical review. Some results can therefore become available sooner than others.

Our reporting processes are designed to prioritise patient safety and ensure urgent or clinically significant findings are communicated as soon as they are available. We continue to look at opportunities to improve how results are presented and communicated.

Where can I find guidance on interpreting pathology results?

The Pathology User Handbook provides advice and guidance to support clinical decision-making. Additional general information about laboratory tests is available through Lab Tests Online UK | Homepage.

How will I be informed about analyser failures or service disruptions?

Pathology recognises the importance of clear communication during service interruptions. Existing escalation arrangements continue to be reviewed to improve the consistency and timeliness of updates provided to service users.

Can nurse-led services request pathology tests?

Pathology test requesting permissions are controlled through Electronic Patient Record (EPR) role-based access arrangements. Feedback regarding recognition of nurse-led services has been shared with relevant Trust teams for consideration in future developments.

How can I obtain specialist pathology advice?

Dedicated telephone and email advice services are available across pathology specialties. Contact information can be found within the Pathology User Handbook, which remains the primary source of clinical advice contact details.

Why do some specialist tests take longer to report?

Some specialised tests are referred to external laboratories or require additional processing. Pathology continues to explore opportunities to expand local testing capacity where this is clinically appropriate and operationally feasible.

Has phlebotomy capacity improved?

Yes. The phlebotomy service increased capacity by reducing appointment times, significantly increasing the number of patients who can be accommodated each day.

Our Ongoing Commitment

We will continue to:

  • Improve communication during service disruptions

  • Promote availability of specialist advice services

  • Support and enhance electronic requesting systems

  • Review turnaround times and laboratory workflows

  • Work collaboratively with service users to improve reporting and communication arrangements

Cellular pathology referral centres

Sending cases to an external pathologist for reporting or second opinion / referred cases Table 1: Referral Sites and Pathologists

Table 1: Referral Sites and Pathologists
Specialty Referral Name and address
Breast Pathology Professor Sarah Pinder, Chair in Breast Histopathology, St Thomas’ Hospital, Westminster Palace Road, Westminster SE1 7EH
Gynaecological Pathology Dr Naveena Singh, Department of Histopathology, Royal London Hospital, 80 Newark Street, London E1 2ES
Professor Glenn McCluggage, Department of Pathology, Royal Group of Hospitals NHS Trust, Grosvenor Road, Belfast BT12 6BF
Haematological Pathology Dr Maria Calaminici, Department of Histopathology, Royal London Hospital, 80 Newark Street, London E1 2ES
Bone/Soft Tissue Pathology Professor Adrienne Flanagan, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP
Dr Fernanda Amary, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP
Respiratory Pathology Professor Andrew Nicholson, Department of Histopathology, Royal Brompton Hospital, Sydney Street Wing, London SW3 6NP
Professor Mike Sheaff, Department of Histopathology, Royal London Hospital, 80 Newark Street, London. E1 2ES
Urological Pathology Dr D Berney, Department of Histopathology, Royal London Hospital, 80 Newark Street, London . E1 2ES
Head and Neck Pathology Dr Hannah Cottom , Department of Histopathology, Royal London Hospital, 80 Newark Street, London . E1 2ES
Skin Pathology Dr E Calonje, St John’s Institute of Dermatology, South Wing, Block 7, St Thomas’ Hospital, London SE1 7EH
Dr S Jeetle, Department of Histopathology, Royal London Hospital, 80 Newark Street, London
GI Pathology including BCSP Professor Marco Novelli. Consultant Histopathologist Department of Histopathology, 4th floor Rockerfeller Building, UCLH University Street, London WC1E 6JJ
Professor Neil Shepherd. Cellular Pathology, Cheltenham General Hospital, Sandford road, Cheltenham, Gloucestershire, GL53 7AN
Endocrine Pathology Dr Derek Roskell, Department of Cellular Pathology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU
Paediatric Pathology Dr. Irene Scheimberg Department of Histopathology, Royal London Hospital, 80 Newark Street, London E1 2ES
Neuropathology Professor S Brandner/ /Dr Thom, Professor J Holton, Institute of Neurology, Queen’s Square, London WC1N 3BG

Cellular Pathology offers a comprehensive service to its users and patients however a number of investigations are referred to external centers if not performed on site. These investigations are listed in table 2.

Test Name
Test Type
Referral Site Name and Address
Justification for referral
EGFR
 NGS
Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The Centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust 15 Cotswold Road, Sutton Surrey SM2 5NG
 Testing from the National Genomic Test Directory
KRAS
 NGS Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The Centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust 15 Cotswold Road, Sutton Surrey SM2 5NG
Testing from the National Genomic Test Director
NRAS
 NGS
Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The Centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust 15 Cotswold Road, Sutton Surrey SM2 5NG
 Testing from the National Genomic Test Directory
BRAF
 NGS
Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The Centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust 15 Cotswold Road, Sutton Surrey SM2 5NG
Testing from the National Genomic Test Directory
GIST
NGS
 Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust Testing from the National Genomic Test Directory
PD-L1 - Triple negative Breast Ca.
IHC
UHB, Molecular Diagnostics, Mindelsohn Way, Birmingham B15 2TH
Test not performed in-house
PD-L1 Urothelial Ca
IHC
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
HER2- Gastric Ca
IHC
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
DNA/RNA Sequencing for tests on the Genomic Test Directory
All
Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The Centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust 15 Cotswold Road, Sutton Surrey SM2 5NG
Testing from the National Genomic Test Directory
Oncotype DX- Breast ca
PCR
Genomic Health
Test not performed in-house
Other antibody requests not on the laboratory repertoire or on this list as performed elsewhere
IHC
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
Immunohistochemistry tests where the antibody is in the repertoire, but the antibody is not available in-house.
IHC
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
HER2 FISH Breast CA
FISH
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
ROS-1 IHC (Basildon)
IHC
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
ROS-1 IHC (Queen's)
IHC
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
ROS-1 IHC (Queen's)
IHC
UHB, Molecular Diagnostics, Mindelsohn Way, Birmingham B15 2TH
Test not performed in-house
Ros-1 FISH (Queen's)
FISH
UHB, Molecular Diagnostics, Mindelsohn Way, Birmingham B15 2TH
Test not performed in-house
ALK FISH (Queen's)
FISH
UHB, Molecular Diagnostics, Mindelsohn Way, Birmingham B15 2TH
Test not performed in-house
ALK FISH (Basildon)
FISH
HSLAD, 19 Fitzroy St, Bloomsbury, London W1T 4BP
Test not performed in-house
MLH-1 Promoter Hypermethlyation testing
Other
Clinical Genomics Department Molecular Diagnostics and Cytogenetics, The Centre for Molecular Pathology The Royal Marsden Hospital NHS Foundation Trust 15 Cotswold Road, Sutton Surrey SM2 5NG
Test not performed in-house
HPV ISH
ISH
The Royal London Hospital
 If an equivocal result and test is unreadable.

24-hour urine collection

Why do I have to collect this sample?

Your doctor has requested the measurement of various substances in your urine. The best way to measure these is to use all the urine you have passed during a 24-hour period.

A large plastic urine collection bottle will be provided for this test. For some tests you may require two collection bottles.

Urine collection bottles can be collected from the Blood Tests department at Queen’s Hospital or the Pathology department, on the first floor of King George Hospital. Please do not use your own collection bottle.

Some urine bottles may contain liquid to preserve the substance that is being tested. Please do not discard this liquid, avoid skin contact and do not drink this liquid.

Do not urinate directly into the bottle. If you accidentally splash your skin or eyes with some of the liquid wash the area with lots of water. It may sting but should not cause harm.

For some tests a blood sample may also be required, which should be taken on the morning following the end of the 24-hour urine collection period.

24-hour urine bottle with liquid and a blood sample taken on the following day.

Type of samples required

Creatinine clearance

24 hour urine bottle and a blood sample taken on the following day.

Stone screen

Two 24 hour urine bottles (one bottle with liquid) - urine must be collected over two separate 24 hour periods.

Other test

24-hour urine bottle

What should I do before I start collecting my sample?

It may help if you find a clean funnel or jug that you can use to collect the urine and transfer it into the urine collection bottle provided by the hospital. Please do not use your own container. Choose a day when you are certain you will be able to collect all your urine; this will probably be a day when you are not likely to be going out for a long time.

How do I collect my sample?

  1. On the label of the urine collection bottle, fill in your full surname, full first name and date of birth.
  2. When you get up in the morning, for example 7.30am completely empty your bladder into the toilet (whether or not you feel the need). Fill in the start date and time on the bottle.
  3. From now on, every time you empty your bladder collect all the urine into the urine collection bottle. Remember to us a clean funnel or jug to make this easier.
  4. The next day, at the same time as you started, completely empty your bladder into the bottle (whether or not you feel the need). Fill in the finish date and time on the bottle.
  5. Repeat this if you need to collect two 24-hour urine samples.

What else do I need to know?

Eat and drink normally on the day of collection unless your doctor has told you otherwise. If possible, please keep your sample in a cool place, out of the sun and away from radiators.

Please avoid faecal contamination of the urine by emptying your bladder into the bottle before emptying your bowels.

Who do I tell if I have a problem?

If you accidentally pass any urine into the toilet instead of the bottle or if the bottle was not big enough you will need to start the test again and you will need to get a new urine collection bottle. The Blood Test department staff can give you a new bottle so you can repeat the collection.

What do I do with the sample when i have finished?

Make sure the lid is done up tightly. As soon as it is convenient to do so, within a day or so, bring the bottle(s) and the test request form to the blood test area at Queen’s Hospital or the Pathology department, first floor King George Hospital as soon as possible, between 8.30am and 4.30pm, Monday to Friday.

Please remember to have your blood test if required by your doctor.

How will I find out the results?

The results of the test will be sent back to the doctor who requested the test as soon as the analysis is complete. Depending on the tests being done this could be anything from several days to a few weeks.

Where can i get more information?

www.labtestsonline.org.uk is a website with information about hospital laboratories and laboratory tests.

If you have any further queries about why this test is being done, please speak to the doctor or consultant who requested the test.

Please follow these instructions carefully. Failure to do so will make it difficult for your doctor to interpret the results and you may have to do it again.

For any queries, please ring between 9am and 5pm:

King George Hospital Pathology department on 0208 970 8021

Queen’s Hospital Phlebotomy department on 01708 435 498

If you need help with communicating with us, please let us know. You can call us on 01708 435 454 / 020 8970 8234 or email bhrut.pals@nhs.net.

If you are deaf or unable to communicate with us using telephone or email, we have a text service which can be contacted on 07800 005 502.

 

Useful information and key documents (Pathology)

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