[Histonet] Histonet Digest, Vol 140, Issue 5

Terri Braud tbraud at holyredeemer.com
Tue Jul 7 13:24:42 CDT 2015

In the article reference below, they estimate tissue loss at 7%.  In my lab, our pathologists would croak if we had tissue loss at this high of a rate.  But with that said, we do have a 0.8% "loss of tissue".  Without exception, they have been extremely small pieces that could have been mucous, and they have been frequently described as "possibly too small to survive processing".
We've had a cassette discarded during processing twice in 10 years, however we save all trash until the tissue has been embedded and the piece count and block log verified.  In both cases, we were able to go back to the gross station trash and retrieve the cassette. 
We use blue pads to hold bx tissue in the cassette but the pieces are placed on the pad as if on a grid. 
One piece: direct center
Two pieces:  [:]
Three pieces: [:.]
Four pieces: [::] and so on.
If they are wrapped in lens paper, we use a special folding technique and write a target on the paper and place the tissue on the bulls eye.
Large sections of skin are held in place with a single blue pad and are always placed in the cassette the same way at gross.  
For a bisected punch, [:]
For a serial sectioned ellipse submitted in one cassette, it is tip, x-sect, x-sect, tip [.//.]
For a multicassette skin ellipse, it is both tips in the first cassette, and x-sections in the following serial cassettes.
If it's there, then the grosser should have communicated to the tech, "may not survive processing" or "very tiny" on the gross worksheet notes. Often, the gross person will have another set of eyes look at a questionable piece, if they think it may not survive processing.
We hold techs accountable to match the piece count and it is inexcusable to lose a section of skin at embedding or cut through a specimen.
If a pathologist orders recuts where tissue might be cut away, then the tech must notify the pathologist before proceding and a note is placed in the computer that the tissue will be cut away.
We hold all papers or blue pads of missing specimens until the gross dictation is reviewed and the pathologist notified.
With special care at grossing, we seldom have an incident because the embedders know exactly where to find the tissue and if the tissue is possibly mucous or a spec, that may not survive processing, then it usually is noted at gross and is reported as "tissue not sufficient for processing" with a suggestion to repeat biopsy based on clinical findings.
Owens, SR.; Wiehagen, L.; Simmons, C.; Sikorova, A.; Stewart, W.; Kelly, S.; Nestler, R.; Yousem, SA. (Dec 2011). "Numerical fidelity of endoscopic biopsy fragments in the processing sequence of a university surgical pathology laboratory.". Arch Pathol Lab Med 135 (12): 1561-4. doi:10.5858/arpa.2011-0020-OA. PMID 22129184.
Sorry to be so long winded, but I hope this helps.
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Holy Redeemer Hospital Laboratory
1648 Huntingdon Pike
Meadowbrook, PA 19046
Ph: 215-938-3676
Fax: 215-938-3874

-----Original Message-----

   1. Specimens lost during processing. (STEVEN PINHEIRO)
Message: 1
Date: Mon, 6 Jul 2015 18:28:21 +0000
Looking for help in analyzing the entire scope of the process. There is not much published data (that I can find) and I am hoping this group can lend some expertise.
Our rate is higher than we would like it to be. There is no consistent size at risk although GI and Derm biopsies are the biggest involved group. We have broken it down into steps.

1.       Can be lost at grossing- either never loaded into the cassette at all, or cassette was discarded. Thus we hold on to our waste and can search for misdirected cassettes if need be.

2.       Lost in the processor itself. Most are wrapped. If large enough not to be wrapped, we would not expect the processor to eat them, so assume cassette lid not properly closed. Frankly the highest number of losses we're seeing is no tissue found in cassette by embedders.

3.       I am being told that we can't use micromesh cassettes in our microwave processors (Milestone Pathos) and want to know if anyone is.

4.       Tissue not seen at embedding. Again no way to tell when the tissue disappeared. We know that tiny tissue can spring out during the opening at embedding but I don't know how else to examine or limit this step.

5.       Tissue can be exhausted during microtomy. Rare but noteworthy.
I am hoping people can tell me about their procedures for dealing with "specimens that don't survive processing", what safeguards they have in place, and to some extent what your own lab percentage  or experience is.
Apologies in advance for the length of the message, but could really use your help.

Steven Pinheiro, MBA, MLS(ASCP)DLMCM
Manager Anatomic Pathology and Cytology
Loyola University Medical Center
2160 S First Ave, Bldg 110 Rm 2214
Maywood, IL 60153
708-327-2642 (O)
708-327-2620 (F)
spinheiro at lumc.edu<mailto:spinheiro at lumc.edu>

"You must do the thing you think you cannot do"
   E. Roosevelt

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