[Histonet] Process and hold?

[Richard Cartun]

I'm surprised that laboratories are not validating extended fixation times for their breast specimens rather than "jumping through all these hoops".  There are now several published articles demonstrating no reduction in immunoreactivity for ER, PR, and HER2 in breast specimens kept in formalin for 72 hours or longer (one of which is listed below).  Please remember that the "total time in formalin" is only one of the pre-analytic variables that can affect immunoreactivity.  Minimizing the cold ischemic time, making sure that the fresh tissue does not dry-out, and submitting "THIN" (2-3 mm) tissue sections for fixation and processing are equally, if not more important, than the total time that a specimen sits in formalin.

Tong LC, Nelson N, Tsourigiannis J, et al.:  The effect of prolonged fixation on the IHC evaluation of ER, PR, and HER2 expression in invasive breast cancer: A prospective study.  Am J Surg Pathol 2011;35:545-552.

A summation of their study; "... fixation for limited periods beyond 72 hours does not result in a reduction in assay sensitivity in the determination of ER, PR, or HER2 IHC status.".

Obviously, each laboratory must do their own testing and validation, but it can be accomplished with team work (Pathologists, PAs, and Histotechnologists working together).

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
(860) 545-2204 Fax


>>> Tom McNemar <TMcNemar <@t> lmhealth.org> 2/12/2013 1:56 PM >>>
Hello all,

I was wondering about processing breast specimens (needle cores) on Fridays.

We have asked our radiology department to try to avoid scheduling these breast biopsies on Fridays since we do not work weekends and are concerned about the extended time in formalin.

I am thinking that we can run these specimens on a second processor over Friday night and have someone from the clinical lab come up  and drain the paraffin.  The tissues would then sit in a warm moist retort until Monday morning when they would be embedded and cut.  I think the specimens would be fine.  Processing would be complete at that point and they would hold in the unopened retort chamber.

Our alternative is to have someone come in every Saturday morning just to remove and embed these specimens.....



Tom McNemar, HT(ASCP)
Histology Co-ordinator
Licking Memorial Health Systems
(740) 348-4163
(740) 348-4166
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