NBSTSA Surgical Specimen Handling & Documentation — Questions and Answers
Question 1: When a surgical specimen is handed off the sterile field, what is the FIRST step the circulating nurse should take?
- Place the specimen in formalin immediately
- Label the specimen container with patient information before placing the specimen inside (Correct answer)
- Send the specimen to pathology via pneumatic tube
- Photograph the specimen for the operative record
Correct answer: Label the specimen container with patient information before placing the specimen inside
The container must be labeled with patient identifying information BEFORE the specimen is placed inside. Labeling after placement risks specimen mix-up. Required information typically includes patient name, MRN, date, surgeon, specimen source/site, and laterality when applicable.
Question 2: An intraoperative frozen section is ordered during a mastectomy. What is the PRIMARY purpose of this test?
- To preserve the specimen for permanent pathology review
- To provide a rapid intraoperative pathologic diagnosis that guides the ongoing procedure (Correct answer)
- To sterilize the specimen before sending it to pathology
- To document the specimen's gross appearance before fixation
Correct answer: To provide a rapid intraoperative pathologic diagnosis that guides the ongoing procedure
A frozen section allows the pathologist to examine tissue within approximately 15–20 minutes while the patient remains on the table. The surgeon uses these results to make real-time decisions — for example, whether surgical margins are clear or whether a lymph node contains malignant cells.
Question 3: Which fixative is most commonly used to preserve surgical tissue specimens for routine permanent pathology?
- Normal saline
- 10% neutral buffered formalin (Correct answer)
- Glutaraldehyde
- Isopropyl alcohol
Correct answer: 10% neutral buffered formalin
10% neutral buffered formalin (NBF) is the universal standard fixative for routine surgical pathology. It preserves tissue architecture and cellular morphology for histologic examination. Normal saline keeps tissue temporarily moist but does not fix it. Glutaraldehyde is reserved for electron microscopy.
Question 4: When should a surgical specimen NOT be placed in formalin?
- When the specimen is a bone biopsy
- When a frozen section or microbiologic culture has been requested (Correct answer)
- When the specimen is obtained laparoscopically
- When the specimen is larger than 5 centimeters
Correct answer: When a frozen section or microbiologic culture has been requested
Formalin kills microorganisms and alters tissue architecture in ways that prevent frozen section processing and destroy viable cells needed for culture. Specimens sent for frozen section analysis or microbiology cultures (bacterial, fungal, AFB) must be sent fresh — without fixative — to the appropriate lab.
Question 5: Which of the following pieces of information is REQUIRED on a surgical specimen label?
- Patient's home address and insurance carrier
- Patient name, medical record number, specimen source/site, and surgeon's name (Correct answer)
- Anesthesia type used and total operative time
- Patient's known allergies and current medication list
Correct answer: Patient name, medical record number, specimen source/site, and surgeon's name
Specimen labels must include patient identifiers (name and MRN), the anatomic source and site of the specimen (with laterality when applicable), and the operating surgeon's name. This is the minimum required to ensure correct pathology reporting and prevent misidentification errors.
Question 6: During a sentinel lymph node biopsy, the surgeon uses a radioactive tracer and/or blue dye. Why must the scrub tech understand the specimen handling protocol for this procedure?
- The blue dye will permanently stain instruments and must be removed before sterilization
- The radioactive node must be sent fresh (without formalin) to nuclear medicine, then to pathology for frozen section (Correct answer)
- The patient must be placed in isolation postoperatively due to radiation exposure risk
- The blue dye indicates the specimen requires permanent section only, not frozen section
Correct answer: The radioactive node must be sent fresh (without formalin) to nuclear medicine, then to pathology for frozen section
Sentinel lymph node specimens follow a special chain of custody: the radioactive node is identified with a Geiger counter intraoperatively, then sent fresh (never in formalin) to nuclear medicine for counting and subsequently to pathology for frozen section analysis. Adding formalin would destroy the radioactive signal and prevent frozen section processing.
