RE: [Histonet] guidelines

From:"Douglas D Deltour"

You can use an alternative fixative if you would like. 


This is from APPENDIX E Tissue Handling Requirement and Control Materials


"Any alteration of standard conditions, such as use of alternative
fixatives, microwave fixation, or alternative processing methods, must be
validated against standard methods of testing before a test routinely using
these conditions is offered in a laboratory. Validation must consist of
testing of the same samples with the alternative fixative buffered formalin
using the same HER2 testing method to demonstrate concordance of the




Douglas D. Deltour HT(ASCP)

Histology Supervisor

Professional Pathology Services, PC

One Science Court

Suite 200

Columbia, SC 29203


Fax (803)254-3262





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-----Original Message-----
[] On Behalf Of Patsy Ruegg
Sent: Monday, January 15, 2007 12:00 PM
To: 'Webb, Dorothy L';
Subject: RE: [Histonet] guidelines


Dorothy et al,

One reason for the new Her2 guidelines from CAP is that there has been a

discrepancy in results when samples are not adequately fixed in formalin

and/or alcohol fixed.  If the sample is not adequately cross linked by

formalin fixation before it is processed, alcohols can damage or destroy the

Her2 protein making it unavailable for detection.  Your best bet is to fix

the sample for 24 hrs. in formalin, then it will be protected from

processing and can be retrieved but at least it is still there.  I know, who

has time to fix for 24hrs., well an approach to that could be that you take

a piece of the sample and process it quickly for the H&E, while leaving

another piece to fix for 24hrs., by the time the H&E is read and Her2

ordered your sample will be properly fixed, will withstand paraffin

processing, then you do the IHC on the fixed piece.  Requiring a minimum of

6 hrs fixation in formalin is how CAP is starting to address this problem.

I expect that I am opening up a can of worms here but I think this is what

this is about.  Studies have been done in labs using alcohol fixatives

and/or inadequate formalin fixation that show a drop in up to 30% of

positive Her2 cases.  That should be telling.



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


[] On Behalf Of Webb,

Dorothy L

Sent: Monday, January 15, 2007 9:00 AM


Subject: [Histonet] guidelines


With the new Her2 guidelines from CAP, how is everyone planning on

handling not using alcoholic fixation of fatty breast tissue?  We have

been using Davidson's on mastectomy and lumpectomy specimens (not needle

bx.s) and I have a dedicated processor with the first two stations of an

alcoholic formalin fixative.  My pathologists want these breast

specimens to not be placed in these type of fixatives in lieu of the new

regs and I am already seeing underprocessed fatty breast tissue.  Does

anyone have a longer processing time for their breast (fatty) specimens

they would be willing to share with me?


Also, does anyone have a dedicated pneumatic tube system for your OR

directly to histology for small specimens?  Our facility is looking into

this and I would appreciate any feedback!!


Thanks ahead of time for any help in this area..I love this valuable

access to my fellow histology lab workers!!


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