[Histonet] Re: Policy on Floaters

[Robert Richmond]

Dr. Soo-Jin Cho asks:

>>Hello, I'm a resident at UCSF currently working on a QA/QI project regarding floaters, with the ultimate goal of formulating a departmental policy regarding floaters.  Despite extensive searching on the internet and the Histonet archives, I have not found any concrete examples of policies at other institutions and was hoping someone could help me out in this regard.<<

Several people have already offered some very useful advice. From the
pathologist's viewpoint, I'd distinguish between section floaters
(which usually aren't the direct concern of the pathologist or
pathologist's assistant) and tissue floaters (which definitely are).
The usual cause of tissue floaters is carry-over of tissue fragments
during grossing. I almost never have this problem myself - where I've
seen problems is with an overloaded P.A. who's working too fast.

I've always been ridiculed for proposing that it would be worthwhile
to have about five sets of the basic dissecting tools (scalpel,
scissors, ruler, tweezers, etc.) and toss them into a pot of water
between each case, then stop and wash them off after five cases. (This
arrangement would of course violate the Good Management Principle that
a pathologist may have only one set of tools.)

Certain cases - such as papillary urinary tract and ovarian tumors -
are notorious creators of floaters and should be grossed last, or
right before the placentas at any rate.

The worst floater incident I've ever seen occurred in a small lab that
mostly saw skin biopsies. A lens paper wrapper (this was over 20 years
ago) came open in processing and spilled out the cell block contents
from a peritoneal fluid specimen. The specimen contained papillary
fragments from an ovarian tumor. I found those fragments in the slides
from 26 different cases (fortunately none of them was diagnostically
difficult). Follow-up with the attending physician found that he was
totally surprised by the results - the cancer was quite unsuspected in
a woman with rapidly progressing ascites.

I was taught to write "floater" on the slide with an appropriate pen,
and initial the slide also. The problem should almost never be
mentioned in the pathologist's report.

Bob Richmond
Samurai Pathologist
Knoxville TN