Table 1 Categories and issues identified as critical for optimizing the tumor-tissue journey

Education

● Lack of awareness of the problem

● Insufficient knowledge of the various steps of the process

● Lack of attribution of clear roles for each team member

● Lack of standardization of procedures

● Insufficient training

Communication

● Lack of communication among team members

● Lack of communication among institutional sectors or departments

● Lack of attribution of clear roles for each sector or department

● Insufficient provision of information to, or lack of access to, the pathologist

● Insufficient provision of feedback by the pathologist

Operating room and transport

● Unduly long time before the sample reaches the laboratory

● Distance between laboratory and hospital

● Insufficient basic infrastructure, leading to the use of improper containers for sample conditioning and inadequate fixation procedures

● Insufficient technological infrastructure, e.g., for digitalizing information

● Individual dynamics of operating rooms, e.g., with regard to time-out

● Logistic bottlenecks in some institutions

● Heterogeneity in organization systems

● Incorrect or incomplete labeling of the specimen

● Incorrect or incomplete forms accompanying the sample

● Poorly designed forms

● Lack of standardized identification packaging containing the specimen

● Incorrect packaging of the specimen, including omission of buffered formalin

● Unduly long time outside formalin, and use of non-buffered formalin

● Inadequate fixation or amount of formalin given sample dimensions

● Delayed transportation of the sample to the laboratory

Pathology laboratory

● Insufficient information upon receipt of sample

● Incomplete or unclear specification of procedures

● Incomplete information regarding time of tissue collection and immersion in formalin

● Delay in gross examination and sampling before fixation

● Frequent change in provider in public hospitals outsourcing pathology services