[Histonet] Histonet Digest, Vol 196, Issue 3 Incomplete sectioning
Steve McClain
SteveM at mcclainlab.com
Wed Mar 4 13:04:18 CST 2020
Two methods to avoid incomplete sectioning are:
1) ink the specimens well, using acetic acid (vinegar) to fix the ink, thereby making the ink easier to see in the block
2) have a microscope or 10 x lens adjacent to the microtome to allow for visual inspection.
One of my histotechs used an old (really old- had a mirror for a light source) for years. Gradually as scopes are upgraded, the 'retired microscopes can be put to use in the lab.
It is unfair to the histotechs that their work is judged by pathologists w microscopes, when the histotechs do not have access to the same tool, but life is not fair.
Thanks,
Steve A. McClain, MD
McClain Labs
45 Manor Road Smithtown, NY 11787
631 361-4000 cell 631 926-3655
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Today's Topics:
1. Re: [EXTERNAL] Re: Incomplete cross sections of all tissue in
blocks (Perl, Alison)
2. Re: Incomplete sectioning (Terri Braud)
3. Cutting benchmarks (Hagon, Christopher (Health))
4. Looking for a sliding microtome (Chaitanya Kolluru)
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Message: 1
Date: Tue, 3 Mar 2020 18:36:12 +0000
From: "Perl, Alison" <aperl at caremount.com>
To: 'John Garratt' <john.garratt at ciqc.ca>, Amy Self
<ASelf at tidelandshealth.org>, 'John Garratt via Histonet'
<histonet at lists.utsouthwestern.edu>
Subject: Re: [Histonet] [EXTERNAL] Re: Incomplete cross sections of
all tissue in blocks
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Each of our techs is responsible for fully facing their blocks and getting a representative section. If the docs see something is amiss (epidermis missing, incomplete cross section, etc), they can order a Technical Recut rather than a routine Recut. Unfortunately, it sounds like you (or someone else of authority), has to give some feedback/coaching that the sections are insufficient, particularly if it's a recurring problem. Is it one tech that needs a 1-on-1 convo, or a meeting with the whole staff to address widespread issues?
Alison Perl, HTL(ASCP)CM
Anatomic Pathology Manager
CareMount Medical
(914) 302-8424
aperl at caremount.com
-----Original Message-----
From: John Garratt via Histonet [mailto:histonet at lists.utsouthwestern.edu]
Sent: Tuesday, March 3, 2020 12:02 PM
To: Amy Self; histonet at lists.utsouthwestern.edu
Subject: [EXTERNAL] Re: [Histonet] Incomplete cross sections of all tissue in blocks
I suggest that each histotech is responsible for the blocks they cut and they cut the deepers on the their own blocks when they are requested. With feedback on the reason for the deeper from the pathologists they (the techs) will become more confident and learn how deep to cut.
John
On Tue, Mar 3, 2020 at 7:31 AM, Amy Self via Histonet <histonet at lists.utsouthwestern.edu> wrote:
> Good Morning HistoNetters,
>
> I am reaching out to the histonet in hopes to get some suggestions from you on how to handle incomplete cross-sections of tissue in blocks. We are a small lab so this has not been an issue in the past but now that we are growing and our staff has increased I am getting feed-back from pathologist that the sections of tissue are not complete. They are asking for too many deepers that possibly could be avoided if it was cut deep enough to begin with. I have been given some managerial type duties ? which I don?t like cause I know nothing about managing people and I need to approach this but I need to approach this issue correctly. Do you have the histotech compare his/her cut slides to the block to make sure that a complete cross-section is obtained and is this documented somehow? Any and all suggestions I need.
>
> Thanks in advance for your help and as always you all rock.. ?
>
> Amy Self
> Histology Lab Senior Tech
> Lab
> Tidelands Georgetown Memorial Hospital
> 606 Black River Road
> Georgetown, SC 29440
> (843) 520-8711
> ASelf at tidelandshealth.org
> Our mission: We help people live better lives through better health.
>
> NOTE:
> The information contained in this message may be privileged, confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to this message and deleting it from your computer.
> Thank you.
> _______________________________________________
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Message: 2
Date: Tue, 3 Mar 2020 20:46:17 +0000
From: "Terri Braud" <tbraud at holyredeemer.com>
To: "'histonet at lists.utsouthwestern.edu'"
<histonet at lists.utsouthwestern.edu>
Subject: Re: [Histonet] Incomplete sectioning
Message-ID:
<48E053DDF6CE074DB6A7414BA05403F801C1B77C52 at HRHEX02-HOS.holyredeemer.local>
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A quality check can be accomplished in 2 places. It can be done at cutting, but it should already be being done and it doesn't seem to be working.
Ideally, the stained H&E should be checked against the block face as it is pulled from the coverslipper to be given to the pathologist. Then it can be handed immediately to the tech that made the original error to "do over"
Also, a common excuse will be "it was embedded poorly". The answer to that is that it is the cutting tech's responsibility to hand back a poorly embedded block for it to be re-embedded if they feel that they can't get a representation section.
Remember, it could also be poorly cut gross, too.
Then you can nip it in the bud before the slide reaches the pathologist, and you can quickly identify who is turning out inferior sections and counsel them appropriately if needed.
Hope this helps. Terri
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supervisor
Laboratory
Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
ph: 215-938-3689
fax: 215-938-3874
Care, Comfort, and Heal
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Message: 1
Date: Tue, 3 Mar 2020 15:31:59 +0000
From: Amy Self <ASelf at tidelandshealth.org>
To: "histonet at lists.utsouthwestern.edu"
<histonet at lists.utsouthwestern.edu>
Subject: [Histonet] Incomplete cross sections of all tissue in blocks
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Good Morning HistoNetters,
I am reaching out to the histonet in hopes to get some suggestions from you on how to handle incomplete cross-sections of tissue in blocks. We are a small lab so this has not been an issue in the past but now that we are growing and our staff has increased I am getting feed-back from pathologist that the sections of tissue are not complete. They are asking for too many deepers that possibly could be avoided if it was cut deep enough to begin with. I have been given some managerial type duties ? which I don?t like cause I know nothing about managing people and I need to approach this but I need to approach this issue correctly. Do you have the histotech compare his/her cut slides to the block to make sure that a complete cross-section is obtained and is this documented somehow? Any and all suggestions I need.
Thanks in advance for your help and as always you all rock.. ?
Amy Self
Histology Lab Senior Tech
Lab
Tidelands Georgetown Memorial Hospital
606 Black River Road
Georgetown, SC 29440
(843) 520-8711
ASelf at tidelandshealth.org
Our mission: We help people live better lives through better health.
NOTE:
The information contained in this message may be privileged, confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to this message and deleting it from your computer.
Thank you.
------------------------------
Message: 2
Date: Tue, 03 Mar 2020 17:01:55 +0000
From: John Garratt <john.garratt at ciqc.ca>
To: Amy Self <ASelf at tidelandshealth.org>,
"histonet at lists.utsouthwestern.edu"
<histonet at lists.utsouthwestern.edu>
Subject: Re: [Histonet] Incomplete cross sections of all tissue in
blocks
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I suggest that each histotech is responsible for the blocks they cut and they cut the deepers on the their own blocks when they are requested. With feedback on the reason for the deeper from the pathologists they (the techs) will become more confident and learn how deep to cut.
John
On Tue, Mar 3, 2020 at 7:31 AM, Amy Self via Histonet <histonet at lists.utsouthwestern.edu> wrote:
> Good Morning HistoNetters,
>
> I am reaching out to the histonet in hopes to get some suggestions from you on how to handle incomplete cross-sections of tissue in blocks. We are a small lab so this has not been an issue in the past but now that we are growing and our staff has increased I am getting feed-back from pathologist that the sections of tissue are not complete. They are asking for too many deepers that possibly could be avoided if it was cut deep enough to begin with. I have been given some managerial type duties ? which I don?t like cause I know nothing about managing people and I need to approach this but I need to approach this issue correctly. Do you have the histotech compare his/her cut slides to the block to make sure that a complete cross-section is obtained and is this documented somehow? Any and all suggestions I need.
>
> Thanks in advance for your help and as always you all rock.. ?
>
> Amy Self
> Histology Lab Senior Tech
> Lab
> Tidelands Georgetown Memorial Hospital
> 606 Black River Road
> Georgetown, SC 29440
> (843) 520-8711
> ASelf at tidelandshealth.org
> Our mission: We help people live better lives through better health.
>
> NOTE:
> The information contained in this message may be privileged, confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to this message and deleting it from your computer.
> Thank you.
> _______________________________________________
> Histonet mailing list
> Histonet at lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet
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Message: 3
Date: Tue, 3 Mar 2020 21:21:08 +0000
From: "Hagon, Christopher (Health)" <Christopher.Hagon at act.gov.au>
To: "histonet at lists.utsouthwestern.edu"
<histonet at lists.utsouthwestern.edu>
Subject: [Histonet] Cutting benchmarks
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UNCLASSIFIED
Hello Histonetters,
Just wondering if anyone has had any benchmarks put in place in regards to blocks cut or slides produced per histotech/scientist per day? I realise that there are differing levels of complexity per block, we range from 1 slide per block to 21 one micron sections per renal block. Has any lab has WHS involved as far as Repetitive Strain Injuries are concerned?
I'm not looking for any definitive answers that I'll hold anyone to, just if anyone has expectations of maximum throughput. We have a tracking system that we can accurately see how much work each person is doing. There seem to be limits on how many cases a pathologist can report in a day (again, varying levels of complexity) but what about for lab staff?
Any thoughts greatly appreciated.
Chris Hagon | Senior Scientist, Anatomical Pathology
Phone: (02) 5124 2874 | Email: christopher.hagon at act.gov.au<mailto:christopher.hagon at act.gov.au>
ACT Pathology | Canberra Health Services | ACT Government
Canberra Hospital | Building 10 Level 1 | PO Box 11, Woden ACT 2606 | health.act.gov.au
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Message: 4
Date: Tue, 3 Mar 2020 18:15:07 -0500
From: Chaitanya Kolluru <cxk340 at case.edu>
To: histonet at lists.utsouthwestern.edu
Subject: [Histonet] Looking for a sliding microtome
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Hi,
I'm searching online for a microtome where the sample is fixed and the
knife is moving. The microtome cutting movement needs to be motorized and
automatic.
Is there a microtome that has this functionality or is this something that
simply does not exist?
Thank you!
--
Chaitanya
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