[Histonet] Changing dynamics in histotechnology

Morken, Timothy Timothy.Morken <@t> ucsfmedctr.org
Mon Sep 17 16:00:18 CDT 2012

Histology is going to have a huge manual component for a long time. Even though embedding has been automated to a certain extent it has not been accepted by many...yet. Automated sectioning is a long way off - and who would have the money to buy sectioning robots that could do as well as a human? Would it even be cost effective (and that IS the question!)? 

Much of this could be made much easier by proper application of grossing/processing/embedding procedures. But we can't even get pathologists to agree how long any particular tissue should be fixed - no matter what the literature says. Good luck standardizing grossing and tissue processing across a single large department, let alone the entire industry (though I know Bill has done wonders with this in his company). Simply due to that lack of standardization manual work will be with us for a LONG time since every block requires individual care and decision making by the person sectioning it. 

IHC is bread and butter to the lab now. ISH is coming along but still too rare to make much money off of it, if any at all. I don't think we do much more of it percentage wise than 20 years ago. 

The best IHC techs take interest in the cases, learn what the antibodies are for and pay attention to the staining they get (if they have time before the TAT deadline!).  They do research on diseases and can converse with pathologist about the results.

Molecular methods (ie, DNA/RNA, besides ISH) is quite different than histology. Completely different training required, though I have no doubt histotechs could do it, why would they hire a histotech when there are umpteen biochemists applying for every biology job advertised (including histology!!)?

Digital pathology is still "promising," just as it was 10 years ago, and will be "promising" 5 or 10 years from now unless a technology comes along to scan slides FAST - ie 10 seconds, not 5 minutes. Maybe someone will adapt the Lytro Light Field Camera to slide scanning. Seems a perfect match (google it!).

Barcoding is on the way in. We are going to have a system by June 2013. But it is in the growing stage and there are lots of tradeoffs. The hardware has just become available in the last 5 years to make it reliable. Now the vendors have to get going. Some have with great systems  - Ventana, possibly Leica, Omnitrax. The LIS vendors have fallen flat on their faces on this - totally missed the boat and ceded the specimen tracking space to histology and IHC vendors. Shows what happens when your company is too big and you don't pay attention to the possibilities. As recently as 3 years ago I had an LIS vendor technical person ask me what on earth I would use bar coding for in histology. I hope that guy has been fired by now for ignorance!

Of course one huge disadvantage to having histology and IHC vendors providing barcoding/tracking systems is some want to limit your choices to their instruments. That is a big bugaboo right now. But I understand Clinical Chemistry is dealing with the same issue - instrument vendors forcing certain parameters on the lab.

Training of histotechs is and always will be a problem. 95+% of histotechs are trained OJT. I think there is only one program on the west coast. So, for the most part forget formally trained techs (and those that are formally trained should make the most of it!). It is all dependent on individual initiative and the training skill of the lab managers they work for. NSH is doing a pretty good job - and I only say that because while the various meetings are great, only a small percentage attend. The vast majority of histotechs don't ever get outside training, either because they don't know about it, don't have the money, or their labs don't promote it.  A lot of techs work in labs whose managers consider advancement a bad thing - train a tech and they look for better pay elsewhere. How do you counter those types?

Most pathologists trained these days are clueless about histology and aren't concerned about  much else beyond ordering and getting their slides. Histology is a black box to them.  They wouldn't have a clue how to train a histotech if they had to.

All I can say on this is that everyone has to take care of themselves and their own advancement first. Hopefully those same people will see the value of training others in any way they can and promoting getting more involved with the entire system. 

Tim Morken

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Jesus Ellin
Sent: Monday, September 17, 2012 12:22 PM
To: Judy O'Rourke
Cc: histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] Changing dynamics in histotechnology

With mixed emotions I read this article, not because of its context or information, but rather the outlook for our future.  

I would like to pole on the histonet today, who is enter in:

1.  Digital Pathology
2.  Molecular Testing (ISH, PCR, Next Gene Sequencing) 3.  Automation Semi to complete 4.  Barcoding 

A good question to ask is, are we, as Histology professionals, positioned to make this change.  Case in point, how many people are signed up and preparing for this transition at the NSH convention this year?  

Sent from my iPad

On Sep 17, 2012, at 8:29 AM, "Judy O'Rourke" <jorourke <@t> allied360.com> wrote:

> Hello...
> In Clinical Lab Products' just-released September issue, the article 
> "Changing Dynamics in Histotechnology" addresses the challenges and 
> trends you face daily. William DeSalvo, B.S., HTL(ASCP), chair, NSH 
> Quality Control Committee, is quoted.
> Please share comments on CLP's Facebook page, where I've just posted 
> the
> article: 
> http://www.facebook.com/pages/Clinical-Lab-Products/56624886500#!/page
> s/Clin
> ical-Lab-Products/56624886500
> Thank you!
> Judy
> JUDY O'ROURKE |  Editor
> Clinical Lab Products
> 6100 Center Drive, Suite 1020, Los Angeles, CA 90045 office 
> 619.659.1065 | fax 619.659.1065 jorourke <@t> allied360.com | 
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