[Histonet] ER/PR HER2 Redux

[Richard Cartun]

It is difficult for many Anatomic Pathology Laboratories to document the exact time in formalin for breast specimens.  Here at Hartford Hospital, we have PAs, Residents, Surgical Pathology Fellows, and Pathologists doing the gross dissection on breast specimens throughout the day in different locations.  In addition, our tissue processors start at different times.

We demand that our interventional radiologists and our breast surgeons document on the pathology requisition the "formalin contact time" when they place the specimen into formalin.  We take the responsibility of documenting the "formalin contact time" when the specimen is received fresh here in Pathology.  If this is not done, I contact the responsible party and inform them that we have a "Biospecimen deficiency" and tell them that they must always document the "formalin contact time" for breast specimens.  I think in the near future we will be doing this for most cancer specimens that we see in our laboratories.

Our tissue processors have 4 hours of formalin on them for large specimens like breast excisions.  The majority of our processors are started around 5:30 p.m. every evening.  Therefore, we have a policy in place that states that breast specimens (not needle core biopsies) must be in formalin prior to 3:30 p.m.; if not, they are held until the next day.  This allows at least 6 hours of formalin fixation (ASCO/CAP guideline) for all large breast specimens.  For smaller breast specimens like needle cores and mammotome biopsies, I have validated that 4.5 hours is sufficient for reliable immunohistochemical and molecular testing.

I don't believe that it is necessary to document the "total fixation time" on the pathology report.  You need to develop a policy that ensures that the 2007 ASCO/CAP guidelines are followed or you can choose to do your own validation of fixation times on-site.

Finally, please keep in mind that fixation time is only one piece to the puzzle.  Minimizing ischemic time, making sure that the tissue does not dry-out, and taking "thin" (2 mm) tissue sections for processing are probably equally important, if not more.

Richard



Richard W. Cartun, Ph.D.
Director, Histology & Immunopathology
Director, Biospecimen Collection Programs
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 545-1596
(860) 545-0174 Fax

>>> "Nita Searcy" <NSEARCY <@t> swmail.sw.org> 7/6/2009 1:37 PM >>>
Funny, I thought I had this issue taken care of but we are once again discussing it! 

What are others doing to verify formalin fixation times? Is it "good enough" to have a blanket statement in the report that we are in compliance of the 6-48 hour required time ( we have fixation time on container dictated into report & we process on the weekend )  or is the actual hours of fixation ( time in formalin container+ time in processor = total fixation time) documented into the report?

And do you document ALL? So that even those that are unsuspected (reductions) get a fixation ( just in case). 

Discussion on Wednesday.

Thanks

Nita Searcy, HT/HTL (ASCP)
Scott and White Hospital
Division Manager, Anatomic Pathology
2401 S. 31st. Street 
254-724-2438
Temple, Texas, 76502
nsearcy <@t> swmail.sw.org 


254-724-2438