[Histonet] Breast Fixation with fixatives other than Formalin

Marcum, Pamela A PAMarcum <@t> uams.edu
Mon Jan 23 10:07:58 CST 2012

We bread loaf each breast and then allow nothing to be processed with less than 6 hours in the cassette plus processor time for formalin.  It is a rule if the breast is not in cassettes before 3PM it cannot go on the processor.  We follow the guidelines and in most cases the breast fix overnight, loafed.  Then the residents will cassette it for processing leaving us well within the 48 hour maximum for Her2Neu.  If they are late on Friday we process Saturday and take the tissue off on Sunday so we bent no rule for the formalin fixation.  

The pathologists were unhappy with the idea and then they stopped getting raw meat with really bad artifact so they are now happy.  We did not look at alternatives due to the validation process.  If we could get our residents to properly gross thinner breast (and all) all tissue we could possibly shorten some times.  Since they don't gross thin enough they have learned to like Histology better. 

Pam Marcum

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of WILLIAM DESALVO
Sent: Monday, January 23, 2012 9:50 AM
To: carol.fields <@t> northside.com; histonet
Subject: RE: [Histonet] Breast Fixation with fixatives other than Formalin

10% Formalin for the fixative and Xylene in the tissue processing are the FDA approved method for Her2. That said, you have to properly manage the tissue and fixative or adding days to the process will not improve the result. I would suggest that you approach your problem form a different aspect. 10% formalin is a fine fixative for breast tissue, but it will not  penetrate you tissue samples that are greater then 5 cm thick. ASCO/CAP suggest that for larger samples, >5 cm, the tissue should be "loafed" into slices not greater than 5 cm for fixation. This provides only 2.5 cm of distance the fixative needs to travel. I am a strong proponent that the samples selected for processing and placed into the cassette should be <3 mm thick. If you dissect the specimen and the tissue is not "fixed", then once the sample is in the cassette, make sure you have adequate fixation, stay w/in the ASCO/CAP guidelines, but at least 6 hrs fixation when you get the "raw" <3mm sample in the cassette. I would also look at the processing schedule you use for tissue sample processing. With thick specimens, >3mm, the schedule will need to be extended, 10-12 hrs total processing time, and you may continue to get varying results. If you select thin samples and apply adequate fixation time once you have a sample in the cassette, you will get consistent results. With proper sample size and fixation you can consistently process to paraffin in less than 2 hrs, using the Xpress rapid tissue processor. Standardize and create precision in your sampling and fixation and I know you will have superior and consistent results.      

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


> Date: Mon, 23 Jan 2012 09:47:38 -0500
> From: Carol.Fields <@t> Northside.com
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] Breast Fixation with fixatives other than Formalin
> Hi Netters,
> Could you please let me know who all is using breast fixatives other 
> than 10% formalin and what do you do about CAP requirements? I would 
> also like to get in touch with Dr. Richard Cartun because I think he 
> has done studies on this for Her2. Our docs will not let us use 
> anything other than formalin because of CAP regs and the result is a 
> lot of raw breast tissue. This is even holding the tissue for a couple days.
> Any help with this would be appreciated.
> Thank you,
> Carole
> Carole Fields, HT (ASCP)
> Histology Supervisor
> Northside Hospital
> Atlanta, GA 30342
> carol.fields <@t> northside.com
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