Breast Lumpectomy Specimens

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Allow the grumpy old pathologist to weigh in on this one.

Greg Good at Frye Regional Medical Center in Hickory NC [hey, do you guys
ever need a locum tenens pathologist over there?] writes:

>>We have discontinued performing frozen sections on breast lumpectomy
specimens to check margins a while ago....<< I'm certainly glad of that!
>>The pathologists are still cutting the specimens in the same day and were
inquiring if there is a different technique available for fixing these fatty
specimens. We are currently inking the entire specimen following fixation in
10% NBF.<<

There is no substitute for immediate inking, cutting of THIN pieces, and
fixation. If your pathologists are not cutting the pieces thin enough, they
need to improve their technique. Sharp knives (are they cutting into soft
polyethylene?), good light (a rarity in gross areas), and proper table height
for each prosector are essential. I know these are homely observations, but I
work in a lot of laboratories and I know how much trouble it is to get these
things done right.

Ideally, these thin sections should fix overnight before processing, but that
isn't always practical (though I'd like to know why!) Before changing to a
fixative other than 10% NBF, you must be sure that immune stains and
cytometric techniques will work with your new fixative. Assuming you send
these studies out, you need to call the reference laboratory and talk to
somebody who knows something (always a challenge with a well managed
reference laboratory).

Bob Richmond
Samurai Pathologist
Knoxville TN (right over the mountain when it ain't snowing)

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