[Histonet] RE: Breast CAP requirements

[Joanne Clark]

We have a tech come in on the weekends to embed so the fixation never exceeds 48 hours.  We keep a log to record the fixation times of all our breast cases.  For needle core biopsies if the client has written the time the specimen was taken on the requisition, we record that time otherwise it is the time we received it in the lab.  With breast lumpectomies or mastectomies the fixation time starts once the specimen has been grossed and blocked, not before.  With each report we have a blurb stating the fixation time of the specimen.  It goes something like:  'The specimen has been fixed for a minimum of 12 hours to a maximum of 48 hours in accordance with CAP breast fixation guidelines for Her2Neu testing'.  Sometimes though, courier delivery causes delays and its already been over 48 hours when we receive them in the lab.  For instance a client does a breast needle core biopsy on a Friday but we do not receive the specimen until the following Monday. In these instances we record on the report that the specimen has had greater than 48 hours fixation.  We do not do the Her2Neu testing in house and when we send them out for testing we have to record on the outside consultants requisition the fixation time. 

Sometimes its impossible not to go over the 48 hours and when it happens we just record it in the report.

Joanne Clark, AAS,HT(ASCP)
Histology Supervisor
Pathology Consultants of New Mexico

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Message: 1
Date: Fri, 03 Feb 2012 12:51:47 -0500
From: "Richard Cartun" <Rcartun <@t> harthosp.org>
Subject: Re: [Histonet] Breast IHC testing
To: "histonet <@t> lists.utsouthwestern.edu"
	<histonet <@t> lists.utsouthwestern.edu>,	"Gale Limron"
	<GaleL <@t> unionhospital.org>
Message-ID: <4F2BD863.7400.0077.1 <@t> harthosp.org>
Content-Type: text/plain; charset=US-ASCII

Those are recommendations from the CAP.  You can experiment and then validate longer fixation times.  Several papers have come out over the past two years demonstrating little, if any, impact on immunoreactivity for ER, PR, and HER2 when breast tissue has been fixed longer than 72 hours.  In my opinion, minimizing cold ischemic time, making sure the tissue does not dry out, and taking "thin" slices of tissue (2-3 mm) for fixation and processing are probably more important than time in formalin.  Hopefully, ASCO and CAP will change their recommendations based on these studies. 

Richard

Richard W. Cartun, MS, PhD
Director, Histology & Immunopathology
Director, Biospecimen Collection Programs
Assistant Director, Anatomic Pathology
Hartford Hospital
80 Seymour Street
Hartford, CT  06102
(860) 545-1596 Office
(860) 545-2204 Fax


>>> Gale Limron <GaleL <@t> unionhospital.org> 2/3/2012 10:24 AM >>>
I would like to know what other hospitals are doing with breast specimens that are resected on Friday and are in formalin longer than the maximum number of hours that CAP allows for ER/PR  and HER2/neu testing. We are running into this problem since we don't currently work Saturday hours.
Thank you!
Gale Limron CT,HT (ASCP)
Histology Supervisor
Union Hospital
659 Boulevard
Dover, Ohio 44622
330-343-3311 ext 2562



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