Improving quality of biopsy specimens from children with suspected solid malignancies

Aims Molecular methods for the detection of cytogenetic abnormalities in paediatric solid tumours are of increasing diagnostic and prognostic importance. However these require unfixed tissue to be sent at the time of biopsies. An audit of biopsies conducted at KK Hospital from March to September 2009 showed that 25% were sent in formalin, of which 6% had significant diagnostic delays as a result. A collaborative team from different clinical disciplines was set up to improve the quality of biopsy specimens, such that unfixed tissue was sent 100% of the time. Methods Using Clinical Practice Improvement Project (CPIP) tools, the team was able to identify three core areas requiring improvement: lack of formal workflows, lack of knowledge on need for unfixed specimens, and poor communication between clinicians and laboratory staff. A series of key changes were implemented to correct these areas of deficiency. Results The team was able to achieve the target of biopsy specimens sent unfixed 100% of the time with no diagnostic delays within 4 months. Conclusion Good collaboration between different clinical disciplines with the aid of CPIP tools can dramatically improve the quality and diagnostic yield of biopsy specimens sent from children with suspected malignancies.