Anatomic Pathology Services

Convergent Diagnostics is trusted by physicians, patients and other laboratories alike for the most accurate and reliable pathology services, with sub-specialty expertise in inflammatory and neoplastic skin disorders, ocular disease and surgical pathology.

Convergent Diagnostics Pathology is lead by Dr. Joshua Gapp, a leading pathologist and one of the few in the U.S. that specializes in skin and eye disease. In addition, Convergent Diagnostics premier surgical pathology services include expertise in areas such as breast biopsies / cores, gynecology biopsies, blood smears, fine needle aspiration and podiatry.

Skilled Professional Service | Fast & Accurate Results

All biopsies sent to Convergent Diagnostics are processed in our state-of-the-art laboratory, overseen by our quality assurance program. Most biopsy results are reported within 24 hours of specimen receipt by our full-time board-certified pathologists who are always available by phone to discuss your case. Our pathologists believe partnering with physicians and hospitals for a community-based approach to diagnostics and treatment puts the focus back on the patient.

Our OneSource service includes:

Board-Certified Sub-Specialists
Conservative Use of Ancillary Testing
All Biopsies and Excisions Processed On-Site
Direct Phone Line to Convergent Diagnostics Pathologist Who Signs Out Your Case
Customized Reporting Options, With EMR Interface and Web Access Capabilities
Barcoding System for Case/Slide Identification Speeds Results and Accuracy
Reports Available Within 24 Hours of Specimen Receipt
Complimentary Direct Billing of Insurance or Patient

Recognized Expertise

All Convergent Diagnostics pathologists are board-certified by the American Board of Pathology (ABP). In addition, Convergent Diagnostics dermatopathologists are board-certified by the American Board of Dermatology and ABP, and Convergent Diagnostics ocular pathologists are certified by the American Board of Ophthalmology and ABP.

The pathologists at Convergent Diagnostics are considered key opinion leaders in their field of expertise and are actively involved in teaching, research and publication in peer-review journals.

Dermatopathology

Diagnostic Expertise of Skin Disorders Including:

Pigmented Lesions (Melanoma)
Metastatic Neoplasms
Soft Tissue Neoplasms
Vulvar Biopsies
Primary Cutaneous Neoplasms (Basal Cell, Squamous Cell Carcinomas)
Adnexal Neoplasms
Inflammatory Skin Diseases
(Including Blistering Diseases, Lupus Erythematosus, Vasculitis)
Ocular Adnexa (Eyelid, Conjunctiva, Orbit)
Nail Disorders
Alopecia

Diagnostic Consultation

Problem cases previously submitted to other laboratories and second opinion requests are routinely accepted at Convergent Diagnostics. Previously biopsied tissues, microscopic slides and tissue blocks that may have been prepared elsewhere may be presented.

Routine Histopathology

The majority of skin biopsies and excisions are successfully analyzed using routine histopathology (H&E). Special stains and ancillary testing are ordered only when necessary or when requested by the clinician.

Evaluation of Tumor Margins

All excisional biopsies are examined and sectioned to ensure accurate representation and orientation of margins on slides.

Special Histochemical Stains

Inflammatory and other skin diseases may require special staining to detect certain cell types or infectious agents such as fungi and mycobacterium.

Immunohistochemistry (IHC)

A full range of antibodies against tissue and cellular biomarkers are available for evaluation of neoplasms including epithelial tumors, lymphoproliferative malignancies and poorly differentiated spindle cell tumors.

Immunofluorescence (Direct & Indirect)

Complex skin or mucosal specimens are tested for autoimmune blistering, connective tissue, inflammatory diseases and other dermatoses including:

Pemphigus and Pemphigoid Groups
Dermatitis Herpetiformis
Lupus Erythematosus & Other Collagen Vascular Diseases
Vasculitis versus Urticaria
Porphyria Cutanea Tarda
Lichen Planus – Direct on Skin Biopsies
Lichen Planus – Indirect on Serum to Detect Circulating Skin Antibodies

Immunopathology / Molecular Diagnostics

Many dermatological diseases demonstrate cutaneous lymphoproliferative processes. Adjuvant molecular testing may be utilized for diagnosis, staging and treatment recommendations. Testing may include flow cytometry, B cell & T cell receptor gene rearrangement studies, BRAF mutational analysis, FISH, and electron microscopy.

Ocular Pathology

A variety of unusual and unique disease processes affect the eye and surrounding tissues. General pathology laboratories are not likely to have experience in interpreting lesions of the eye and ocular adnexa (conjunctiva, eyelid, lacrimal system, and orbit).

Ocular Diagnostics

Gross and Histology of Tissues that Need Special Handling
Sebaceous Cell Carcinoma of The Eyelid
Eyelid Tumors, Benign and Malignant
Conjunctival Pigmented Lesions
Corneal Disease
Corneal Transplant
DSEK Evaluation
Acanthamoeba
HSV 1,2 Analysis
Intraocular Tumors, Such as Retinoblastoma and Uveal Melanoma
Enucleation
Glaucoma
Fine Needle Biopsy
Temporal Artery Biopsy

Specialized Services

Special Stains – Histological
Immunohistochemistry
Immunofluorescence
Rapid Turnaround Time
Same-Day Service Available; (Please Inquire)
Consultation or Second Opinions of Difficult Cases
Coordination of all Ancillary Testing and Diagnostic Reporting

SURGICAL PATHOLOGY

At Convergent, our focus is compassion for the patient. We understand that timely, accurate results matter. Our pathologist who performs the analysis is always available by phone to answer questions or guide you through tough treatment decisions or recommendations.

Superior Diagnostics

Bone Marrow Aspiration and Biopsy, Including CT Guided (Regional Only)
Breast Pathology
- ER/PR
- Her-2/Neu by IHC, FISH, And PCR
Cytopathology
- Non-Gynecologic (Including Breast Ductal Lavage)
- Fine-Needle Aspiration Biopsy & Interpretation
Dermatopathology
- Neoplastic and Inflammatory Diseases of the Skin
Endocrine Pathology
Fine Needle Aspiration, With / Without Imagining & Interpretation
Genitourinary Pathology
Gynecological Pathology
Hepatic and Gastrointestinal Pathology
Histopathology
Ophthalmic Pathology
Oral and Maxillofacial Pathology
Podiatric Pathology
Soft Tissue Pathology
Surgical Pathology

Complementary Services

Bone Marrow Collection Assistance and Sample Preparation, At Your Site (Local Only)
Fine Needle Aspiration Collection Assistance and Sample Preparation (Local Only)
Tumor Board Participation
Rapid TAT ≤ 24 Hours, In-House Testing
Coordination of All Pathology Laboratory Testing and Results
Requisitions, Specimen Collection Kits, Regional Couriers, Shipping, Reporting
Options, Billing

Comprehensive Testing

Evaluation Of Tumor Margins
Histopathology
Special Stains
IHC / ISH
Immunofluorescence
Infectious Disease Detection
Immunopathology / Molecular Diagnostics / FISH / Cytogenetics & Other Esoteric Testing

Strategic, Evidence Based Medicine

Save time and money tailoring diagnostics and testing to the individual patient. Many biopsies are successfully analyzed using routine histopathology (H&E). We coordinate all pathology testing, and esoteric tests are ordered for diagnosis, staging and treatment recommendations only when necessary or when requested by the clinician.

Convergent utilizes the most case appropriate reflex and ancillary testing including flow cytometry, molecular analyses (e.g. PCR, sequencing), FISH, and cytogenetics, providing the clinician with easy to read summary diagnostic reports.

Podiatric Medicine

Diseases of the lower extremities require specialized medicine. Convergent Diagnostics’ board-certified dermatopathologists provide unparalleled diagnostic interpretation and clinician support for all types of skin, soft tissue and nail disease, allowing podiatrists to provide the best possible patient care.

Specialized Diagnosis

Diagnosis of Skin Lesions, Soft Tissue, Bone and Nail Disorders
Tumor and Inflammatory Skin Diseases Biopsy Interpretation
- Nail Bed | Matrix | Apparatus

Concise Reports, Delivered Fast

Diagnostic Reports Available ≤ 24 Hours
Dermatopathologists Readily Available by Phone for Consultation
Access Reports Securely Online, with No Software to Purchase or Install

Unparalleled Client Services

FNA Procedure Training for Clinicians
FNA Interpretation, with Physician Office Collection Available
Complimentary Billing of Medicare and Third-Party Insurance*

*Convergent Diagnostic Laboratories is committed to high-quality, affordable patient care. We are an in-network provider for laboratory and pathology services on all major medical plans. We are sensitive to the fact that some patients have no insurance or high-deductible insurance plans and we remain committed to maintaining very patient-friendly billing policies.

Tissue Staining

Hematoxylin & Eosin (H&E)

The most widely used tissue stain is the combination of both the Hematoxylin and Eosin stains (H&E stains). This type of staining protocol is inexpensive, provides quick turn-around, and can be used to diagnose a wide variety of histopathic medical conditions.

Using this staining protocol, a transparent tissue section is colored through a chemical reaction, and to a trained pathologist much of the microscopic anatomy of the tissue is revealed.

Hematoxylin will stain the nucleus of the cell a shade of blue; Eosin will stain the extracellular matrix and cytoplasm a shade of pink. Other structures of the tissue will be stained with different hues, shades and combinations of these two colors. The H&E stain will show the pathologist the overall layout and distribution of cells and provide an overview of a tissue structure. With this staining technique, a pathologist can easily differentiate between the nuclear and cytoplasmic parts of a cell.

However, H&E staining does not always provide enough contrast to differentiate all tissues, cellular structures, or the distribution of chemical substances. In these more specific or unique cases, “special stains” and alternative methods are used.

Special Stains

“Special stain” is a technique used when hematoxylin and eosin staining (H&E) does not expose all of the elements, microorganisms or particular tissue structures that a pathologist needs in order for the physician to make a diagnosis. “Special stain” is a process that generally uses a chemical or dye that has a likeness to the tissue component that is to be demonstrated. This process allows the presence / or absence of certain cell types, structures and/or microorganisms to be viewed microscopically by a pathologist.

Advanced Stains

“Advanced stains” are very different in method and purpose and are separated into a third category of staining. Advanced stains target specific proteins or RNA/DNA sequences through the use of immunohistochemical (IHC) or immunoperoxidase tests.

Advanced stains are helpful in detecting certain types of cancer. Some stains can help distinguish specific elements in cancer cells that influence a patient’s diagnosis and whether or not the patient is likely to benefit from a specified drug regimen.

Staining works like this:

An immune protein “antibody” will connect itself to certain “antigen” substances that are included on or in the human cell. Each connection of “antibody” to “antigen” is an exact fit.

Both normal cells and cancer cells have distinctive “antigens.” If cells have a precise “antigen”, they will attract the “antibody” that fits the “antigen.” To find out if the “antibodies” have been attracted to the cells, chemicals (we call them stains) are added that make the cells change color only if a certain “antibody” (and, therefore, the “antigen”) is present.

There are hundreds of “antibodies” used for IHC tests. Some are quite exclusive, meaning that they only react with a particular type of cancer. Others may react with a few types of cancers, so several “antibodies” may be tested to decide what type of cancer is present. In assessing these results (along with the cancer’s appearance and other related medical information) it’s often possible to categorize the cancer in a way that can help select the best remedy and patient outcome.

Convergent sub-specializes in histology and special testing for dermatological and ophthalmic issues, as well as surgical pathology. We have dedicated lab resources and staff in-house to get you accurate results faster, with less cost and worry to your patient.

Board-Certified Sub-Specialists
Conservative Use of Ancillary Testing
All Biopsies and Excisions Processed On-Site
Direct Phone Line to KDL Pathologist Who Signs Out Your Case
Customized Reporting Options, with EMR Interface and Web Access Capabilities
Barcoding System for Case/Slide Identification Speeds Results and Accuracy
Reports Available Within 24 Hours of Specimen Receipt
Complimentary Direct Billing of Insurance or Patient

Melanoma and other skin-related diseases are complex, and a misread specimen can have serious consequences for a patient. The ability of more challenging cases to be quickly reviewed on-site by several specialty pathologists enhances the speed and quality of the diagnosis.

Fine Needle Aspiration

Allows for Immediate Preliminary Results
Simple, Accurate, Fast and Economic
Minimal Discomfort for The Patient
Identify Cancer, Infection, or Relieve Cyst Fluid
Available for Both Palpable and Non-Palpable Lesions
Breast, Thyroid, Lymph Nodes, Salivary Glands, and Soft Tissue Masses
Ultrasound- or CT-Guided Biopsy Available

Quick and Reliable Diagnosis

The Convergent Pathologist Immediately Contacts the Referring Physician with
Malignant Results
Reports are Faxed to the Physician’s Office Upon Completion
Diagnostic Sensitivity Is ≥ 90% Percent for Malignant Tumors
Bard Core Biopsy Done Immediately Following FNA In Difficult Cases

Collection Available at Your Practice (Local Area Only)

Convergent Pathologist is Available to Perform FNB at Your Office
Convenience for You and Your Patient
Timely Diagnosis, Get Results the Same Day

Pathology Support for Physicians Performing Their Own FNA (Local Area Only)

Convergent Staff On-Site: Assistance With Fixation, Slide Prep And Perform
Final Diagnosis
Convergent Pathologist On-Site: Analyze Collection For Non-Diagnostic
Or Inadequate Specimen
Convergent Pathologist: Train You To Perform FNA And Enhance Your
In-Office Procedures (CPT Codes: 10021, 10022 With Imaging)

Convergent also has expertise in performing bone marrow aspiration and biopsy, including CT guided biopsy and is available to provide on-site collection and sample preparation.

Please contact Convergent client services to learn more about FNA or to schedule an appointment at 865.584.1933. FNA’s performed by Convergent (if not at your office) will be at the East Tennessee Healthcare Center located at 1450 Dowell Springs, Knoxville, TN 37909.

SPECIMEN PREPARATION – DERMA

Convergent is committed to providing rapid, accurate pathologic identification of skin disease. Proper biopsy & excision techniques and specimen storage transport are fundamental to rapid, superior diagnostics. Below are recommended guidelines for specimen preparation and shipment.

Biopsy Guidelines

Examples for typical lesions:

Neoplastic disease: Biopsy most abnormal-appearing site within lesion or the edge of an actively growing lesion. (Excisions of melanoma and other malignancy should be performed with at least a 5-mm margin of normal surrounding skin). Shave or other biopsy method may be preferred for benign growths. Label as involved skin.
Dermatitis Herpetiformis: Biopsy normal-appearing skin, 0.5-1.0 cm away from
lesion. Label as perilesional skin.
Lupus Erythematosus: Biopsy involved areas of skin such as erythematous or active borders to confirm the diagnosis of lupus erythematosus, either discoid or systemic. Label as involved skin. Avoid ulcers, old lesions, and facial lesions, if possible.
Uninvolved, non-exposed skin is the preferred site to detect a lupus band as may be found in systemic lupus erythematosus. Label as uninvolved, non-exposed skin.
Pemphigus and Pemphigoid Groups: Biopsy erythematous perilesional skin or
mucosa. Obtain tissue adjacent to active lesions while avoiding erosions, ulcers,
and bullae. Label as perilesional skin.
Porphyria Cutanea Tarda: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin.
Vasculitis versus Urticaria: The erythematous or active border of a new lesion is
preferred. Avoid old lesions and ulcers. Label as involved skin. (If appropriate skin lesion is not present, diagnosis may sometimes be made from uninvolved skin.)
Alopecia: Specimen should be taken from areas of active inflammation, ideally
at the border of a bald patch. Biopsy should be at least 3 mm in depth and
diameter to include hair bulbs located in hypodermis. A transversal section in
relation to cutaneous surface is recommended. Label as involved skin.

Frozen Sections

Frozen section evaluation is available locally. Call for more information.

Routine Histopathology (H&E and IHC)

Promptly place skin and other tissue biopsies and excisions in fixative solution (10% buffered formalin or similar).
Nail clippings and any debris from under the nail should be promptly placed in
fixative solution (10% buffered formalin or similar) by the submitting physician.
(May also be sent dry). This debris holds the nail fungus and is needed to determine the diagnosis.
Specimen container should be large enough to hold the tissue sample AND enough fixative solution to entirely surround the specimen (optimal ratio of fixative to tissue volume is 10-20:1).
Label specimen container with patient’s name and anatomic site of biopsy or
excision and place in plastic bag with requisition. Requisition should include the
patient’s name, date of birth, social security number, submitting physician, date
specimen obtained, clinical history and diagnosis. Billing information and results reporting requests should also be included.
Performed on skin or mucosal biopsies received fresh, frozen or in Michel’s transport medium. Cannot be performed on specimens fixed in formalin.
Fresh specimens should be kept cool on wet gauze and be received within 40
minutes of removal from the patient.
Frozen samples should be placed in OCT medium or in an airtight container and
sent on dry ice.
Specimens submitted in Michel’s transport medium should be placed in Michel’s immediately after removal and arrive at the laboratory within 5 days.

Direct Immunofluorescence Examination

Performed on skin or mucosal biopsies received fresh, frozen or in Michel’s transport medium. Cannot be performed on specimens fixed in formalin.
Fresh specimens should be kept cool on wet gauze and be received within
40 minutes of removal from the patient.
Frozen samples should be placed in OCT medium or in an airtight container and
sent on dry ice.
Specimens submitted in Michel’s transport medium should be placed in Michel’s immediately after removal and arrive at the laboratory within 5 days.

Indirect Immunofluorescence Examination

Performed on serum samples or red-topped tube of blood, sent fresh and received in the laboratory within two days.
Tubes should be placed in a plastic bag with absorbent material and shipped in
a crush-proof container.

Immunopathology, Molecular Diagnostics & Special Studies

Lymphoma workups, FISH, flow cytometry, gene rearrangement studies, and electron microscopy are available. Please call the laboratory for instructions.

B Cell and T Cell Gene Rearrangement, BRAF & other DNA mutational analyses-
formalin-fixed tissue, frozen tissue & whole blood acceptable.
Flow cytometry- whole blood, bone marrow & some tissues, shipped ambient.
Specimen must be received within 24 hrs. of collection.

Review of Slides

Microscopic slides prepared elsewhere may be submitted for review. They should be labeled as above. Please send previous pathology reports, if available.

SPECIMEN PREPARATION – SURGICAL

Convergent Diagnostics is committed to providing rapid, accurate pathologic identification of surgical biopsies for breast, hematologic, gynecologic and other soft tissue diseases. Proper biopsy techniques and specimen storage transport are fundamental to rapid, superior diagnostics. Below are recommended guidelines for specimen preparation and shipment. Please contact client services for assistance.

Routine Histopathology (H&E and IHC)

Promptly place tissue biopsies and excisions in fixative solution
(10% buffered formalin or similar).
Specimen container should be large enough to hold the tissue sample AND
enough fixative solution to entirely surround the specimen (optimal ratio of
fixative to tissue volume is 10-20:1).
Label specimen container with patient’s name and anatomic site of biopsy
or excision and place in plastic bag with requisition. Requisition should include
the patient’s name, date of birth, social security number, submitting physician,
date specimen obtained, clinical history and diagnosis. Billing information
and results reporting requests should also be included.

Immunopathology, Molecular Diagnostics & Special Studies

Lymphoma workups, FISH, flow cytometry, gene rearrangement studies, and electron microscopy are available. Please call the laboratory for instructions.

B Cell and T Cell Gene Rearrangement, DNA mutational analyses- formalin-fixed
tissue, frozen tissue & whole blood acceptable may be acceptable.
Flow cytometry- whole blood, bone marrow & some tissues, shipped ambient (NO
Fixation). Specimen must be received within 24 hrs. of collection.

Review of Slides for Consultation

Microscopic slides prepared elsewhere may be submitted for review. They should be labeled as above. Previous pathology reports must accompany the slides.

Peripheral Blood Smears

Prepare peripheral blood smear on glass microscope slide labeled with patient
name and date. Smear is prepared on one side with a thin layer of fresh blood or
venous blood collected in a purple or green top blood tube. The smear should be
prepared as soon as possible and less than 2 hours from time of blood draw.
Use wedge slide technique: Place a drop of blood close to frosted end and use a
second slide at 30-40º angle to make the smear.
Air dry for 10 minutes and place in cardboard slide holder for transport at room
temperature.
Submit specimen and completed requisition following labeling instructions as
described above in Routine Histopathology.

Fine Needle Aspiration / Biopsy

Confirm patient identification with two identifiers. Confirm site of procedure.
Prepare and label 10 slides with patient name. Complete and label specimen
containers and requisition as described above in Routine Histopathology.
Expel a few drops of aspirated material over one slide. Use a second slide and
place it over the material on the first slide and gently pull the slide to make a
smear. Allow 2 or more of the slides to air-dry and place the remainder immediately
in 95% alcohol container.
If a lymphoma is suspected, place part of the sample in RPMI transport medium
for flow cytometry studies.
At the end of the procedure, rinse out the needle and tubing into a CytoLyt
solution.
If an infection is suspected, save material for culture and sensitivity.

Bone Marrow Aspirate and Biopsy

Confirm patient identification with two identifiers. Confirm site of procedure.
Complete and label specimen containers/slides and requisition as described
above in Routine Histopathology. Label 14 slides with patient name. Label one
EDTA (purple top) blood tube, one bone marrow transport tube and two B-Plus
Fixative containers with two identifiers.
After the first syringe of bone marrow aspirate is obtained, prepare 5 bone marrow
aspirate smears and air dry. Place remaining bone marrow aspirate in a 10%
Formalin container.
The second syringe of bone marrow aspirate: Place half in an EDTA purple top
tube and the rest in a Bone Marrow transport solution tube. Invert purple top tube
gently to mix with anticoagulant.
Bone marrow core biopsy is placed on a slide, remove any blood clot and then
place the biopsy on a new slide. Use a second slide to roll the biopsy gently to
make a touch prep. Make 4-5 touch prep slides and air dry. Then place the bone
biopsy in a B-Plus Fixative container.
Send CBC and peripheral blood smears collected from patient as well.
Indicate special studies to be performed (e.g.; Flow Cytometry, Cytogenetics for
Chromosome Analysis, FISH for MDS, myeloma, CLL or molecular studies as needed).