[Histonet] Tissue Processor Advice

[WILLIAM DESALVO]

There are so many good to great processors on the market, but all have their plus and minus issues. You really have to decide what your two or three most important issues will be and then rank them. With the trend in becoming more efficient/cost effective, reducing TAT and LEAN process improvement, I suggest you look to improve your process to match these trends and you will be lead to rapid tissue processing in a LEAN way. Couple the previously mentioned trends/issues with versatility of processing with your routine formalin fixed samples with molecular fixed samples on the same instrument, I suggest the Sakura Xpress (X50 or X120) rapid processors.
 
These instruments provide continuous loading, small batch and require a small volume of reagent for processing and then discard. The instruments do have a required reagent kit and there is a variable pre-processing protocol, depending on the tissue type and fat content. Using the reagent kit does allow for cost savings over conventional processing and I find the pre-processing allows for better precision processing techniques and protocols, we have never over processed tissues. Another great advantage is the increased velocity of the workflow as the instruments are continuous load (no cleaning cycle between batches) and small batch (1 to 40 cassettes). Loading 1 or 2 cassettes when a STAT or RUSH cases arrives and completes fixation does not interrupt the process or require special handling. An important factor to consider is that continuous load processing does assist in workload leveling, which can assist in reducing employee stress, increase productivity and error reduction. All these things lead directly to reduced TAT. Add the often overlooked advantage of removing Xylene from your tissue processing, and again, I suggest you consider the Xpress.
 
I was an early adopter (5+ yrs use) and continue to use the X120 (2 units). I have not experienced any instrument performance or maintenance issues. I have had three software upgrades and the instruments had to go down for several hours to install the upgrade. The X120 and now the X50 have two programming options 1+ hour or 2+ hour processing. The most LEAN factor is that after the first basket of up to 40 cassettes, the next one comes off 20 or 40 minutes later and you can continuously load. There is no other instrument that can allow you to process in as small as batch or provide the continuous delivery of cassettes. You can do rapid processing with all of the instruments you are considering, but conventional, one reaction chamber instruments will limit the number of times the instrument can be run each day and that increases the batch size.
 
Rapid processing does demand change in the way your lab does it's work. The first is standardization of gross dissection to <3 mm thickness. It does not matter the instrument, if you want to truly move into rapid processing, then you have to standardize your process in the gross room. The process of retraining and standardizing your gross room is well worth the effort. Another issue that you have to fully consider is how will specific fixation times affect your workflow. We now have specific guidelines for ER/PgR; Her2 and if you follow the NCI protocols for cancer tumors, you have to record your actual fixation times. Trying to manage all the different fixation times becomes difficult and will slow down your process. If you use your tissue processor to complete fixation, the processor will force you into larger batches. When you have to wait for tissues to complete fixation before starting your processing program, you also limit the number of times the processor can be run in a day. I find that separating fixation from processing is the best approach. You process specimens only when the optimal fixation time has been completed. Stop and consider all the different tissue types, size, fat content and required protocols, and you will see the value of a rapid processor that has small batch and continuous load capabilities. Meet all your fixation requirements and needs and only use the tissue processor for processing, not fixation. This is very LEAN concept and a concept that I believe you will need to embrace.

Whenever you have the opportunity to change your process, I always suggest you look to improve the process, use the latest process improvement techniques and select an instrument that will assist in the change and prepare you for future change. My philosophy is we cannot continue to do tomorrow what we do today and expect a different outcome or result. Just my thoughts and experience, I hope this will help you. Do not hesitate to contact me if you have any questions.

William DeSalvo, B.S., HTL(ASCP)
 

> Date: Fri, 22 Oct 2010 16:16:50 -0400
> From: caymanfleck <@t> gmail.com
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] Tissue Processor Advice
> 
> We are in need of some advice regarding rapid tissue processors. Models we
> are considering:
> 
> Sakura Xpress
> Leica Peloris
> Thermo STP 420
> 
> It seems none of these models are perfect in every respect. I'm interested
> in anyone's opinions of these processors and your experience with them.
> 
> All input is appreciated!
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