[Histonet] RE: New Cap Guidelines for Her2 and ER/PR

Wed Oct 13 10:05:27 CDT 2010

OK I usually do not like to chime in on this, but here I go.  How can a
true validation of a specific target be obtained if the wiggle room is 6
to 48 hr, or 8 to 72 hr.  Where is the precision and accuracy on the
results for this testing if you are going to be varying process for the
weekend vs weekday?  This is the flaw in the guidelines in my
perspective, when this much time is allowed it is like anything else.
We are going to go the path of least resistance to change, instead of
what is right.  I know that as techs we always want the best, but are
pushed to produce next day.  Techs for years have been saying more
fixation is needed on tissue.  Well enough of that.

What we do is we hold at 12 hours of fixation for all specimens no
matter what?  We document ischemic cold time through our LIS, to include
time placed in formalin, and time of first cut.  We feel that all
specimens need the same fixation times.  This is imperative to
standardize the process, but once again we also have our processors set
up in such a way that they come off at different times and our
production of H an E is in sync with this.  It might sound like a lot,
but we get most of our work done around 96 to 97 % of cases within 24
hours or less using conventional processing techniques.  

With the future relying more and more on, patient centered care, through
personalized medicine, we need to really look on how we can do the
optimal requirements, not do the minimal requirements to reach our
goals.

Jesus Ellin  

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Kuhnla,
Melissa
Sent: Wednesday, October 13, 2010 7:45 AM
To: Phyllis Thaxton; Mahoney,Janice A; Mike Pence; Joyce Cline;
histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

For the weekend, we have our processor set for 36 hours in formalin and
then a hold in 70%. This allows for complete fixation and cuts down on
prolonged time in 70%

________________________________

From: Phyllis Thaxton [mailto:dchihc <@t> yahoo.com] 
Sent: Wednesday, October 13, 2010 10:32 AM
To: Kuhnla, Melissa; Mahoney,Janice A; Mike Pence; Joyce Cline;
histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

 We run a weekend (Friday til Monday AM)  breast run where the tissues
are in 10% NBF for 8 hours, then in 70% alcohol for 48 hours in order to
complete processing on Monday morning. So far no problems.

Phyllis Thaxton HT(ASCP)QIHC
DCH Regional Medical Center
Tuscaloosa, AL 

________________________________

From: "Kuhnla, Melissa" <Melissa.Kuhnla <@t> chsli.org>
To: "Mahoney,Janice A" <Janice.Mahoney <@t> alegent.org>; Mike Pence
<mpence <@t> grhs.net>; Joyce Cline <Joyce.Cline <@t> wchsys.org>;
histonet <@t> lists.utsouthwestern.edu
Sent: Tue, October 12, 2010 12:02:32 PM
Subject: RE: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

I disagree.  Prolonged formalin fixation (over 48 hrs), diminishes
signals

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of
Mahoney,Janice A
Sent: Tuesday, October 12, 2010 12:05 PM
To: 'Mike Pence'; Joyce Cline; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

Formalin fixation time does not impact the results of FISH as it does
IHC.
Jan M
Omaha

-----Original Message-----
From: Mike Pence [mailto:mpence <@t> grhs.net]
Sent: Tuesday, October 12, 2010 11:00 AM
To: Mahoney,Janice A; Joyce Cline; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

I don't think it matters if you do Her2 by FISH or IHC the time is still
48hr. I hope I am wrong, but I don't think I am.

Mike

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of
Mahoney,Janice A
Sent: Tuesday, October 12, 2010 10:25 AM
To: 'Joyce Cline'; histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR

We have decided to reflex to FISH those breasts that do not fall within
the recommended formalin fixation time.  We do work on Saturdays so it
is only the rare 3 day weekends that this comes into play. Jan M Omaha

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Joyce
Cline
Sent: Tuesday, October 12, 2010 10:10 AM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] New Cap Guidelines for Her2 and ER/PR

Does anyone have any experience with storing formalin fixed breast
tissue in 70% before processing?  I am trying to comply with the new
guidelines set forth by CAP and ASCO with regard to Her2 and ER/PR and
since my lab does not operate on the weekend we have been well above the
48 hour recommended formalin fixation time.  Does 70% affect
antigenicity for either Her2 or ER/PR?  Any information or suggestions
will be greatly appreciated.  Thanks :)

Ronda Souders
Hagerstown Medical Laboratory
301-665-4980
fax 301-665-4941
ronda.souders <@t> wchsys.org<mailto:ronda.souders <@t> wchsys.org>

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