Breast fixation is a problem if the grosser only
fixes in formalin.  One has to be aware that Her2/neu
is only approved for Bouins or NBF fixation.  I talked
to Dako the other day and they are working on a
protocol for alcohol-formalin fixation, but it still
is not ready for general use.  I have two solutions
presently.  
1. I try to do the receptors and Her2/neu on the
stereo or needle biopsy, as most of our tumors are
initially diagnosed with one of these two procedures. 
Our surgeons and radiologists give us plenty of tissue
from these procedures to do these ancillary tests.  We
put all breast bxs on a processor that only has NBF as
a fixative.  No problem cutting the needle bxs.
2.  When I get a localization, lumpectomy or
mastectomy and there was no needle bx, I take one
section of the tumor and fix that in NBF and the rest
of the breast/lumpectomy goes in Dissectaid which is
an alcohol-formalin acetic acid product from Decal
Chemical Company to fix overnight.  This product is
similar to Pen Fix.  After fixation one can cut 1mm
slices because the tissue is very firm.  The lymph
nodes also turn white and are easier to find.
3.  When I get a breast bx that has a possibility of
being a cancer, I fix it in NBF overnight and cut it
thinner the next day.  I work with our histotechs on
this as I know the problems they have trying to cut
this type of tissue.  Our pathologists when they gross
just don't seem to get that just because you can fit
it in a cassette doesn't mean you can get a slide from
big thick fatty tissue.  Remember the old saying
garbage in--garbage out!!

Mary Latino, Path Ass't
Nyack Hospital
Nyack NY 10960

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