[Histonet] holes in derm tissue sections

[Steve McClain]

Generalized Holes commonly present with one of two scenarios.

Scenario One-a  Histotech may be sloppy about allowing sections to dry thoroughly before warming or baking.
Scenario Two is generalized, showing up with slides from every Histotech, and representing unstabilized foci where paraffin did not penetrate, eg a processing failure.
Label it as a QI event, call it "catastrophic tissue loss".
With that mindset,
Examine slides microscopically.
Establish baseline: Measure one whole day by examining every slide and counting how many have holes or unstable collagen.
Secondarily Pay attention to/ record tissue size.

Simple Remedies-Three processing areas to examine.
Change your processing alcohols, using NEW, not recycled.
Change your xylenes, NEW, not recycled.
Rotate paraffins and Lengthen time in last clean paraffin by 25%.
Measure again.
Examine the remaining failures.

"catastrophic tissue loss" may sound a bit harsh,
but I have special fondness for derm and hold them to a higher standard.
Derm labs which cannot reliably find satellite metastasis of melanoma are XXX007.
So label it for what it is- "catastrophic tissue loss".
Then put your foot on the gas and fix it urgently,
and follow-up those remaining failures.
Even if long-term you change your processing program
or process according to size
 or take formalin off your processors.
or more drastically, change behavior among grossers to assure proper fixation and slicing of excision specimens.

#4 POST-FIX large blocks, those  >10mm after gross slicing to proper thickness,
place cassettes in fresh formalin for several hours.
Change formalin on grossing bench daily.
If you post-fix on the tissue processor, change or rotate formalin daily.
Dirty formalin smells bad but does not fix well.
The sniff test is inaccurate for determining formalin activity.

#5 Spreading out cassettes in processing baskets allows for more diffusion.  Not more than two high.

Stay with it
Steve
Steve A. McClain, MD
McClain Labs, LLC 45 Manor Road, Smithtown, NY 11787 631 361 4000