[Histonet] Pathology modernisation

Thu Apr 22 11:18:03 CDT 2004

You are right in your thoughts about non-gynae - it should/could be part
of histology. I have always regarded cytology as a rather challenging
way of making a tissue diagnosis. So is Gynae-cytology, but it is so
vast and so damned boring that it should be kept apart.

That said, non-gynae cytology has suffered from the onslaught of
trucuts, endoscopy and to some extent, radiology. (I *do* wish
radiologist wouldn't make histologic diagnoses).

For these reasons, I think it's dying on its feet.

AGREED.

I have written before about how good ThinPrep is for non-gynae stuff,
and it looks as if the likely centralisation of LBC machines will mean
that non-gynae will continue to be pursued amidst piles of overlapping
cells and blood, just when we had this opportunity for it to be
otherwise. (BTW, and for Kemlo, I do mean ThinPrep, as that is the only
system of which I have had experience).

I accept your limited experience, but your point remains valid

Also BTW, for the majority who do not know about pathology modernisation
in the UK, its political speak for centralisation and cost cutting -
nothing to do with modernisation at all.

Or maybe it could limit the power of the Consultant. Introduce evidence
based testing, demand management and effective clinical pathways? Nah,
you are right, aint gonna happen!

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path  Consultant
Pathologist  Rotherham General Hospital  South Yorkshire  England
        terry.marshall <@t> rothgen.nhs.uk

-----Original Message-----
From: Kemlo Rogerson [mailto:kemlo <@t> tiscali.co.uk]
Sent: 22 April 2004 08:48
To: histonet <@t> pathology.swmed.edu
Subject: [Histonet] Pathology modernisation

Leaving behind Terry's fixation on fixation I would like, for once, to
ask a serious question.

Pathology modernisation in London appears to be 'ahead of the game', I
assume because in London Pathology modernisation was already happening
before it became a National Sport. The advent of LBC means that, to
justfy a Processor, then Labs may have to merge or employ a 'hub and
spoke' method of delivering Cervical Cytology. I don't wish to get into
a LBC debate as I have had enough of that to last me a lifetime. I am
assuming that what I have just said is the future; collaboration or
merging to produce a workload that can use the capacity of T3000,
multiple T2000 or a SurePath processor.

But where does Non Gynae stand in all this? Traditionally, it has been
the remit of the Cytology Lab to service Pathology's Non-Gynae
commitment, but is that logical? I assume Non-Gynae will be served by
either a T2000 or something SurePath can come up with; it may be we stay
with traditional methods. My question is, given that many histological
techniques are carried out on Non-Gynae specimens, could Non-Gynae sit
within Histology. It would divorce it from the 'Pap Factory' scenario
and could place it fairly and squarely where, in my opinion, it belongs.
Could Non-Gynae Cytology actually find its 'place in the sun' if it was
within the Histology Department of Cell Path? 

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Mr Kemlo Rogerson MSc DMS MIBiol CBiol FIBMS 
Sho Dan BSK
Tel: 0208 970 8414
Mob: 07830 196072
Mobile E-Mail kemlorogerson <@t> 3mail.com
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-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Steven
E. Slap
Sent: 21 April 2004 20:09
To: Marshall Terry Dr,Consultant Histopathologist; Kemlo Rogerson; kevin
williams; histonet <@t> pathology.swmed.edu
Subject: RE: [Histonet] Microwave Processing

Hello again HistoNetters

Yes, there are these hybrid mixtures called coagulative fixatives.
They are usually combinations of ethyl alcohol and polyethylene
glycol, and, occasionally, acetic acid. They do not cross-link
proteins. The PEG helps prevent the shrinkage associated with the
use of ethanol as a fixative.

The advantage of all these mixtures is that, no cross-linking having
taken place, no subsequent antigen retrieval (or "unmasking") of the
proteins would be necessary for IHC. Dr. Boon has a good chapter on
them in support of her "Boon-Fix".

To muddy the waters further, there are still other non-formalin
fixatives, which are neither coagulative fixatives, nor cross-linking
fixatives, based on glyoxal, such as Anatech's "Prefer", but which
still are said to chemically "fix" the tissue. I'll leave the
mechanism of their chemistry to the experts.

best regards,
Steven Slap

At 3:51 PM +0100 4/21/04, Marshall Terry Dr, Consultant Histopathologist
wrote:
>Kemlo asks:
>
>"Am I talking a load of..........."
>
>Inevitably:-)
>
>Kemlo,
>
>You talk as if formalin was the only fixative. What about the group
>called, oddly enough, coagulative fixatives? Now .... I wonder how they

>work. Let me see ...... Furthermore, you flit between the several
>different subjects in an unstructured way.

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