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

[Amos Brooks]

Hi,
    I'm going to have to disagree with this approach. Lumping all specimens
into the same procedure (fixation/processing time) is in no way a step
toward individualized care that is so often discussed. Doing this ignores
the basic fundamental differences between the specimens. A liver is
different from a breast and a brain. Likewise a particularly fatty breast is
different from a fiberous one, or one that is cut smaller than the one the
other pathologist (or PA) stuffed into a cassette. Each of these situations
needs to be addressed differently from fixation to processing times and to
be entirely honest staining times in many cases. I fear you may be
oversimplifying the situation and calling it standardization.

All the best,
Amos


Date: Wed, 13 Oct 2010 08:05:27 -0700
From: "Jesus Ellin" <JEllin <@t> yumaregional.org>
Subject: RE: [Histonet] RE: New Cap Guidelines for Her2 and ER/PR
To: "Kuhnla, Melissa" <Melissa.Kuhnla <@t> chsli.org>,       "Phyllis Thaxton"
       <dchihc <@t> yahoo.com>,     "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>
Message-ID:

 <29BE166A2CF48D459853F8EC57CD37E8021C68C9 <@t> EXCHANGECLUSTER.yumaregional.local
>

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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