[Histonet] guidelines

Mon Jan 15 12:16:41 CST 2007

The question I have is what do you do when you have to start moving
results times back and the clinicians are already breathing down your
neck for the DX.  I like the idea that you take a piece of tissue and
process it ahead of the rest this solves the issue of getting a
diagnosis, or you could even do a frozen section (if possible).  Has
anyone looked at microwave processing as the answer to this??  Has the
FDA approved breast studies on microwave processed tissue?  I note the
the current quote that was given states, as long as it is in occordance
with the same result, that it is ok, does not cut it. What if you are a
lab that is sending out blocks to have this study done and you are not
fixing the specimen adequatley??  What if you do not do the studies but
do the image analysis on the HER2 block??

Jesus A. Ellin HT ASCP
Yuma Regional Medical Center
Histology Systems Technologist
Pathology Information Systems
928-336-7444 or 928-336-1144
Fax: 928-336-7319

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Douglas
D Deltour
Sent: Monday, January 15, 2007 10:56 AM
To: 'Patsy Ruegg'; 'Webb, Dorothy L'; Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] guidelines

You can use an alternative fixative if you would like. 

This is from APPENDIX E Tissue Handling Requirement and Control
Materials

"Any alteration of standard conditions, such as use of alternative
fixatives, microwave fixation, or alternative processing methods, must
be validated against standard methods of testing before a test routinely
using these conditions is offered in a laboratory. Validation must
consist of testing of the same samples with the alternative fixative
buffered formalin using the same HER2 testing method to demonstrate
concordance of the result."

http://arpa.allenpress.com/pdf/i1543-2165-131-1-18.pdf

Douglas D. Deltour HT(ASCP)

Histology Supervisor

Professional Pathology Services, PC

One Science Court

Suite 200

Columbia, SC 29203

(803)252-1913

Fax (803)254-3262

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-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Patsy
Ruegg
Sent: Monday, January 15, 2007 12:00 PM
To: 'Webb, Dorothy L'; Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] guidelines

Dorothy et al,

One reason for the new Her2 guidelines from CAP is that there has been a

discrepancy in results when samples are not adequately fixed in formalin

and/or alcohol fixed.  If the sample is not adequately cross linked by

formalin fixation before it is processed, alcohols can damage or destroy
the

Her2 protein making it unavailable for detection.  Your best bet is to
fix

the sample for 24 hrs. in formalin, then it will be protected from

processing and can be retrieved but at least it is still there.  I know,
who

has time to fix for 24hrs., well an approach to that could be that you
take

a piece of the sample and process it quickly for the H&E, while leaving

another piece to fix for 24hrs., by the time the H&E is read and Her2

ordered your sample will be properly fixed, will withstand paraffin

processing, then you do the IHC on the fixed piece.  Requiring a minimum
of

6 hrs fixation in formalin is how CAP is starting to address this
problem.

I expect that I am opening up a can of worms here but I think this is
what

this is about.  Studies have been done in labs using alcohol fixatives

and/or inadequate formalin fixation that show a drop in up to 30% of

positive Her2 cases.  That should be telling.

Patsy

-----Original Message-----

From: histonet-bounces <@t> lists.utsouthwestern.edu

[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Webb,

Dorothy L

Sent: Monday, January 15, 2007 9:00 AM

To: Histonet <@t> lists.utsouthwestern.edu

Subject: [Histonet] guidelines

With the new Her2 guidelines from CAP, how is everyone planning on

handling not using alcoholic fixation of fatty breast tissue?  We have

been using Davidson's on mastectomy and lumpectomy specimens (not needle

bx.s) and I have a dedicated processor with the first two stations of an

alcoholic formalin fixative.  My pathologists want these breast

specimens to not be placed in these type of fixatives in lieu of the new

regs and I am already seeing underprocessed fatty breast tissue.  Does

anyone have a longer processing time for their breast (fatty) specimens

they would be willing to share with me?

Also, does anyone have a dedicated pneumatic tube system for your OR

directly to histology for small specimens?  Our facility is looking into

this and I would appreciate any feedback!!

Thanks ahead of time for any help in this area..I love this valuable

access to my fellow histology lab workers!!

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