Specialties

Pathology Services

Information

We offer a wide-range of pathology services and consultations to meet your needs supported by our highly-skilled pathology and laboratory teams.

Autopsy Pathology

Autopsy is available, at no charge, for inpatients within an IU Health hospital. Consent must be provided by the legal next of kin. The treating physician must complete the proper IU Health autopsy consent form for the facility requesting the service. Autopsy consent and procedures are part of the Medical Staff procedures within each IU Health hospital.

Cytopathology

Service

• SurePath and conventional Pap tests, nongynecologic fluids, and fine needle biopsies
• High Risk HPV and Genotyping on the SurePath Vial
• Automated Pap test processing
• Correlation of cytology with previous cytology/biopsy
• Pap test 2-3 turn around time for normals, 4-7 days for abnormal
• View production schedule

Specimen Transportation

• Pap test kits and overnight mailers or courier service available upon request

Pap Testing and HPV

• NEW Pap Test Collection Training Video using SurePath Pap Vial with double opening insert.
• Read for cytopathology guidelines complete instructions on sending Pap testing.
• HPV High Risk testing and Genotyping out of SurePath Vial
• Complete requisition form completely with patient and billing information
• Contact client services at 317.491.6000 for courier pick up.

Non GYN Cytology

• Read cytopathology guidelines for complete instructions on non-gynecologic cytology on fine needle biopsies, body cavity fluids, washings, scrapings, brushings, and urine specimens.
• Complete requisition form completely with patient and billing information.
• Contact client services at 317.491.6000 for courier pick up.

Fine Needle Aspiration (FNA)

• Please call 317.491.6000 or 800.433.0740 to schedule an appointment.
• Fine needle aspiration can be performed on at outpatient basis at Methodist, University, Riley, North, West, Ball and Arnett. They cannot be performed at any outlying sites.

Dermatopathology

Communication

• The dermatopathologist contacts the clinician when final biopsy results require discussion.
• A final report is automatically faxed to the requesting clinician.
• The dermatopathology office staff and pathology outreach coordinator make regular contact with your office to ensure continued high quality service.

Specimen Preparation

• Routine specimen supplies include the following: formalin-filled bottles, biohazard bags, requisition forms, canisters and UPS return service bags.
• Immunofluorescence Kits (4 tubes included in each): One tube for light microscopy (formalin fixative), Two tubes for immunofluorescence (Michel's solution), One empty tube for serum submission for indirect immunofluorescence and one requisition form, and UPS supplies (see next bullet)
• One requisition form (pdf, 121K) for each kit -- please complete this form in its entirety and return it with the biopsy.
• Telephone number to call for UPS or courier pick-up. UPS return service bags with attached pre-paid return mailing labels (when client is outside courier pick-up area).

When Submitting Specimen(s) for:

• Immunofluorescence only: Please return all of the vials in the kit (even those you do not use) so that we may recycle them.
• H&E and Immunofluorescence: Place the H&E in the tube labeled "light microscopy" (formalin fixative) and submit both specimens together in their respective vials.
• Gene rearrangement: Place tissue in tube labeled "light microscopy" (formalin fixative). Do not submit in any other fixative.

Specimen Transportation

• Call 800.433.0740 to request free immunofluoresence kits or routine specimen materials and prepaid return mailers.
• Tissue should be shipped at room temperature.
• Do not freeze solutions or specimens.
• An all-weather transport solution is available during winter temperatures.
• UPS (United Parcel Service): Place the skin specimen kit in the UPS return "LabPak" bag along with a completed Pathology Laboratory requisition form (pdf, 121K) and all corresponding paperwork (please include a copy of the patient's insurance card).
• If sending by USPS (United States Postal Service): Please require a "signature confirmation" on receipt.
• Courier (if local): Complete the requisition form (pdf, 121K) and include with the specimen. Call 317.491.6000 for courier pick-up.
• Skin biopsy specimen transport supplies will be automatically replaced according to the number received. For additional supplies, please call the client services or the anatomic pathology outreach coordinator at 800.433.0740 or 317.491.6000

Expertise

• Difficult inflammatory and pigmented lesions
• Cutaneous lymphomas
• Extensive immunohistochemical panels
• Comprehensive immunofluorescence
• Gene rearrangement studies

Hematopathology

The division of hematopathology includes routine and special hematology, bone marrow lab, flow cytometry, hemostatsis and thrombosis and urinalysis. See the home page test menu for specific specimen collection information.

Service

• 24-hour turn around time for most cases
• Read guidelines for flow cytometry
• Read guidelines for hemostasis and thrombosis
• Read instructions for submitting bone marrow samples

Personalized Communication

• The hematopathologist contacts the physician when the biopsy findings require discussion. A faxed final report will follow.
• The pathology outreach coordinator and hematopathology office staff make regular contact with your office to ensure quality of service

Expertise

10-Color Flow Cytometry

• Leukemia and lymphoma profiles
• T- and B-cell subsets (CD4 )
• Customized clinical/research protocols
• Flow cytometry requisition form

Hemostasis and Thrombosis

• Extensive in-house test menu
• Special panels
• Experienced, dedicated technical staff and pathology consultation
• Hemostasis and thrombosis requisition form
• Hemostasis and thrombosis collection chart

Immunohistochemistry

• Extensive panels of B- and T-cell markers
• Prognostic and diagnostic markers
• Numerous antibodies for evaluation of bone marrow and infection-associated hematologic diseases
• Immunohistochemistry Ab requisition form

Molecular Diagnostics

• Immunoglobulin heavy chain (IgH) gene rearrangement
• T-cell gamma receptor gene rearrangement
• BCL 2 and BCL1 translocation assays
• Paraffin-embedded tissue testing
• CLL and AML NGS Panels on larger resection specimens

Specimen Preparation & Transportation for Leukemia/Lymphoma

Immunophenotyping

• Bone Marrow Aspirate
• Send in a heparinized tube (use sodium heparin) at room temperature.
• Also send one bone marrow aspirate smear.
• Read instructions for submitting bone marrow samples
• Bone Marrow requisition

Peripheral Blood

• Send at least 5 mL in heparinized tube (use sodium heparin) at room temperature.
• Also send a Wright's stained peripheral blood smear and CBC/diff results procured within 24 hours of collection of this sample.

Lymph Node or Other Solid Tissues

• If possible, send at least 5x5x5 mm of tissue in RPMI 1640 medium (this can be requested from our laboratory).
• Please keep the specimen at 2 to 8 degrees Celsius (wet ice) during transport (ice packs are sufficient).

Body Fluids

• Please keep transport time to a minimum for cerebrospinal fluids. At least 4,000 cells should be submitted. (Use the following formula for calculation: cell count/ul x total volume [in mL] x 1000 = number of cells available.)
• Transport on wet ice (2 to 8 degrees Celsius) is preferable.

Fine Needle Aspirates/Cores

• If core biopsies are used, please submit at least two cores. For both fine needle aspirates and core biopsies, use RPMI 1640 medium and keep the specimen in 2 to 8 degrees Celsius during transport (ice packs are sufficient).

Specimens for T- and B-Cell Subsets, Paroxysmal Nocturnal Hemoglobinuria and Immunodeficiency Work-Up (Peripheral Blood Only)

• Submit 5 mL of peripheral blood in sodium heparin. Include CBC/diff results performed within 24 hours of collection of flow cytometry sample.
• Deliver specimen to the flow cytometry laboratory within 48 hours.

What to Do

• Call the flow cytometry laboratory at 317.491.6000 before sending.
• Include a completed requisition form.
• Send specimens by courier or overnight delivery. If sending on Friday, please specify Saturday delivery.

Liver Pathology

Service

• 24 - 48 hour turn around time for biopsies/slides
• Same-day processing for biopsies arriving before 11 a.m.
• Verbal and faxed results

Expertise

• Steatohepatitis
• Cirrhosis
• Chronic viral hepatitis
• Cholestatic and autoimmune diseases
• Liver transplant biopsy evaluation
• Non-neoplastic liver pathology
• Liver tumors -- primary or metastatic
• Drug-related liver disease

Specimen Preparation & Transportation

Specimen Preparation

• Collect a CT-guided needle biopsy. Use an 18-gauge needle.
• Place the specimen in a leak-proof container filled with formalin.
• Place the container in a styrofoam mailer and then into the red- and white-striped sleeve.
• Please contact the outreach coordinator at 800.433.0740 for special requests, such as electronmicroscopy or metabolic work-ups. (EM must be transported in glutaraldehyde.)

Specimen Transportation

• Send tissue at room temperature by overnight express. Submit blocks for iron and copper determination:
  • LM: Transport in 10 percent buffered formalin
  • EM: Transport in 2 percent glutaraldehyde
  • IF: In rare instances involving metabolic concerns, transport in Michel's fixative
• UPS: Place the liver biopsy specimen kit in the UPS return "LabPak" bag along with a completed requisition form and all corresponding paperwork. Fax the submission form and the patient's demographic information to 317.491.6419 before sending the biopsy. Complete the top portion of the UPS label and contact UPS for pick-up.
• Courier (if local): Complete the requisition form and include with the specimen. Call 317.491.6000 for courier pick-up.
• Liver biopsy kits will be provided upon request and will be automatically replaced at the end of each month. For additional kits, please contact the outreach coordinator at 800.433.0740.

Neuropathology

Expertise

• Neuroncology
• Disorders of the muscle and peripheral nerve
• Neurodegenerative disorders -- Federally funded Alzheimer Disease Center

Expeditious Turn Around Time

• Routine muscle biopsies: three to four days
• Routine consults: 24 hour

Personalized Communication

• A confirmation is faxed upon receipt of the specimen identifying the pathologist interpreting the case and providing contact numbers.
• The pathologist contacts the physician when the biopsy findings require discussion. A faxed final report will follow.
• The pathology outreach coordinator and neuropathology office staff make regular contact with your office to ensure quality of service.

Specimen Preparation and Transportation

• Laboratory hours are Monday - Friday 7:30 am - 3 pm
• Closed on weekends and holidays. Specimens are not accepted after-hours or on weekends.
• All specimens must arrive in our lab no later than 2 pm

Muscle Biopsy

Contact

• Contacting Neuropathology prior to sending specimens ensures that laboratory staff are available to receive the fresh specimen.
• Please call 317.491.6329 at least 24 hours in advance to provide patient information.
• Contact the laboratory immediately when a biopsy has been canceled.
• Call 317.491.6329 with technical questions about specimen collection.
• To schedule a courier for specimen pick-up or for case inquiries, results, and reports, please contact Client Services at 1.800.433.0740 or 317.491.6000.
• To register the patient with us, please complete the requisition form and fax it to 317.491.6419.
• Send the requisition form and all accompanying information, including the most recent clinical information, with the biopsy.

Specimen Collection

• Adhering to the muscle biopsy collection directions below will prevent delay in processing your specimens.
• Fresh sample required.
• Muscle samples must be at least 20mm in length and 10mm in diameter.
• One large piece of muscle is required (vastus lateralis, deltoid, or biceps). Submitting small fragments and poor samples will hinder proper processing/testing and a new sample may be requested.
• Wrap muscle loosely in gauze that has been moistened with three drops of saline and place in plastic specimen cup with lid. Oversaturating muscle with saline will compromise the integrity of the muscle, as well as testing.
• Do not introduce the following materials to sampled muscle tissue:
  • No thread or stitches or sutures
  • No clamps or tongue depressors
  • No pins or needles
  • No fixative
  • No cautery

Transportation

• Whether sending by courier or overnight, fresh muscle biopsies should always be kept cool during transport.
• Place sample in specimen cup, place in biohazard bag, and transport on ice packs. Never use dry ice.
• Include completed requisition form with specimen and label exterior of package with: Indiana University Health Pathology Laboratory
  
  350 W. 11th Street
  Neuropathology Lab Room 4001
  Indianapolis, IN 46202-4108

Nerve Biopsy

Contact

• Complete the requisition form
• Contacting Neuropathology prior to sending specimens is recommended. This ensures that laboratory staff are available to receive the specimen.
• Please call 317.491.6329 at least 24 hours in advance to provide patient information.
• Contact the laboratory immediately if a biopsy has been canceled.
• For technical questions regarding specimen collection, call 317.491.6329.
• To schedule a courier or for case inquiries, results and reports, contact Client Services at 1.800.433.0740 or 317.491.6000.

Specimen Collection (Collect using either method below)

• Adhering to the peripheral nerve biopsy collection directions below will prevent delay in the processing of your specimens.
• Sural nerve samples must be at least 30-40mm in length.

Method 1: 10 Percent Formalin Fixed

• Handle specimen gently and place in 10 percent neutral buffered formalin immediately.
• DO NOT CUT NERVE INTO FRAGMENTS. One long piece of nerve is required. Submitting small fragments and poor samples will hinder proper processing/testing and a new sample may be required.
• Clamps, pins, sutures, stitches and tongue depressors should NOT be used for transporting nerve biopsies. These items damage and delicate tissue.

Method 2: Preserved in Glutaraldehyde (Recommended for overnight shipments)

• Items needed: 3 percent glutaraldehyde, screw-top tube, index card.
• Handle specimen gently.
• DO NOT CUT NERVE INTO FRAGMENTS. Place fresh sural nerve on index card (cut to be slightly bigger than nerve but still able to fit in test tube) and let it adhere for 30 seconds.
• Fill test tube with 3 percent glutaraldehyde. Place the nerve with index card into the test tube and close tightly. The nerve should be completely submerged in glutaraldehyde.
• On test tube, write patient's name and time that the tissue was placed in glutaraldehyde.

Transportation

• Once samples are collected and placed in fixative, they can be sent via courier.
• Label the exterior of the package with the address listed below.
• Include completed requisition form with specimen and label the exterior of the package:
  
  Indiana University Health Pathology Laboratory
  350 W. 11th Street
  Neuropathology Lab Room 4001
  Indianapolis, IN 46202-4108

Ophthalmic Pathology

Expertise

• Corneal biopsies, buttons and scrapings
• Cytology of vitreous and aqueous fluids
• Enucleations, eviscerations, exenterations
• Eyelid biopsies
• Iris biopsies
• Lacrimal system
• Extraocular muscle biopsies
• Optic nerve and optic nerve meninges
• Orbital tissues
• Temporal artery
• Slide consultations

Expeditious Turn Around Time

• 24-hours for most ophthalmic specimens (unless special studies are necessary for diagnosis)
• Same-day interpretation on slide consultations
• Five working days for enucleation and exenteration specimen

Personalized Communication

• A confirmation is faxed upon receipt of the specimen identifying the pathologist interpreting the case and providing contact numbers.
• The pathologist contacts the submitting physician when the biopsy findings require discussion. A faxed final report will follow.
• The pathology outreach coordinator makes regular contact with your office to ensure quality of service.

Specimen Preparation and Transportation

• Complete the requisition form and fax the form and the patient's demographic information to 317.491.6419 before sending the biopsy.
• Place the specimen in the proper fixative (indicated below) and transport in a leak-proof hard plastic container placed in a zip-lock bag along with the submission form and all accompanying information, including the most recent clinical information.
• Place all in a box or mailing tube filled with packing materials (paper towels, etc.)

Specimen Collection

• Autopsy eye, ciliary body, conjunctiva, enucleation, evisceration, exenteration, eyelid, iris, lacrimal system, muscle, optic nerve, pterygium, skin, trabecular meshwork, temporal artery biopsy: 10 percent neutral buffered formalin
• Corneal Buttons: Formalin is not a universal fixative for corneal tissue. Please call 800.433.0740 before surgery when the anticipated diagnosis will require the following:
  • electron microscopy
  • immunofluorescence or
  • the detection of crystalline substances, as fixation depends of the type of test required
• Foreign Body: Please call 1.800.433.0740 before sending.
• Slide and Block Consultation: Place slides in a plastic slide mailer - do not send in a flat cardboard or plastic mailer.
• Special Procedure Specimen Collection - Call 800.433.0740 prior to surgery.
• Corneal Scrapings for Acanthamoeba: Transport in Saccomanno fixative
• Electron Microscopy: Transport half of the specimen in 2.5 percent glutaraldehyde and half in 10 percent neutral buffered formalin.
• Fine Needle Aspiration and Vitreous (intraocular biopsy, fluid and eye tissue fragments): Transport in an equal amount of Saccomanno fixative.
• Immunohistochemistry and Metabolic Diseases (gout, cystinosis, storage disease) - Call for specific instructions.

Renal Pathology

Service

• 24-hour turn around time for LM and IF
• 48-hour turn around time for EM
• Same-day processing for biopsies arriving before 11 am
• Digital images mailed or e-mailed to the clinician

Expertise

• Kidney transplant pathology
• Glomerulonephritis
• Drug toxicity and other interstitial renal diseases
• Cystic and congenital renal diseases
• Renal neoplasms

Communication

• Confirmation is faxed upon receipt of specimen.
• Pathologist calls the clinician when the biopsy has been completed to discuss findings. A faxed report and digital images will follow.
• Pathology outreach coordinator makes regular contact with your office to ensure continued high quality service.

Protocol

• Staining protocols include the following:
  • LM: H&E, PAS, Jones silver and trichrome stains
  • IF: IgG, IgA, IgM, C3, C1q, kappa, lambda, fibrinogen and albumin stains
  • EM: one or more glomeruli are examined as dictated by individual case.
• Call 800.433.0740 or 317.491.6423 for free biopsy kits and overnight mailers. Kits include the following:
  • Separate reagents for LM, IF and EM
  • Protocol for dividing the biopsy
  • Pathology Laboratory requisition, which includes billing information

Specimen Preparation & Transportation

Specimen Preparation

• Collection and dissection of needle biopsy: (use an 18-gauge needle)
• Place the EM sections of the core in the tube labeled "Glutaraldehyde."
• Place the LM section in the tube with the yellow "Formaldehyde" label.
• Place the IF section in the tube labeled for "Immunofluorescence."
• Place the tubes in the biohazard bag, place the bag with contents in the styrofoam container and then into the red- and white-striped mailer.

Specimen Transportation

• Please fax completed requisition form and face sheet to 317.491.6419, attention: Renal Biopsy.
• Place the renal biopsy specimen kit and all of the paperwork (including clinical information) into the UPS return "LabPak."
• Complete the top portion of the UPS label, and transport overnight by UPS.

Renal Biopsy Kits

• Will be automatically replaced at the end of each month. For additional kits, please contact Client Services at 317.491.6423.

Surgical Pathology

Service

• 24 - 48 hour turn around time for biopsies/slides
• Same-day processing for biopsies arriving before 11 am
• Verbal and faxed results
• View anatomic pathology production schedule
• All biopsies should be placed in formalin ASAP to ensure proper fixation.
• In the case of Breast biopsies, the time the tissue was placed in formalin should be documented on the test requisition.

Expertise

• Our Surgical Pathology Team of physicians has subspecialty expertise in:
• Autopsy and forensic pathology
• Breast pathology
• Cardiovascular pathology
• Dermatopathology
• Gastrointestinal pathology
• Gynecological pathology
• Liver pathology
• Neuropathology
• Ophthalmic pathology
• Pancreato-biliary Pathology
• Pediatric and perinatal pathology
• Renal pathology
• Urologic pathology

Protocol

• Electron Microscopy
• Histopathology
• Immunohistochemistry, see list of special stains
• Light microscopy

Specimen Transportation

• Read anatomic pathology guidelines
• Free specimen kits and overnight mailers or courier service available upon request
• See requisition form

Urologic Pathology

Service

• 24 - 48 hour turn around time for biopsies/slide

Expertise

• Nationally and internationally recognized experts in all aspects of urologic pathology including: kidney, urinary bladder, prostate and testis
• Expert opinion provided on cases sent from all around the world
• Expertise in ancillary techniques for the most specific diagnosis possible

Protocol

• Electron Microscopy
• Histopathology
• Immunohistochemistry, see list of special stains
• Light microscopy

Specimen Transportation

• Free specimen kits and overnight mailers or courier service available upon request
• Use special requisition form