Leave it to Vinnie to pull the rabbit out of the hat!

Akemi


Specializing in Histology, SS, IHC, & Microarray
Akemi Allison-Tacha BS, HT (ASCP) HTL
President
Madison, WI
Cell: 		(925) 788-0900
E-Mail:		akemiat3377@yahoo.com



On Jan 12, 2007, at 11:42 AM, Vinnie Della Speranza wrote:

> Douglas,
> I have not read through the guideline which is quite a lengthy  
> document but I'll comment on your questions with my best guess.  
> others who've thoroughly studied the guideline are free to disagree.
>
> my understanding and what I believe is the basis for the creation  
> of this guideline is that previous lack of correlation of Her 2  
> results when comparing needle core results with lumpectomy. Our  
> needle cores arrive in formalin and given their relatively small  
> size, concern about adequate fixation of needle cores is much less  
> likely to arise than the lumpectomy samples, which arrive unfixed  
> and may sit before being grossed in and placed into formalin. This  
> variation is largely the root cause of a failure of results to  
> correlate between needle cores and the lumpectomy specimen, in my  
> opinion.
>
> In addition, it might be difficult for most labs to determine with  
> any degree of accuracy exactly how much fixation time a needle core  
> received since the lab can't control when the sample is introduced  
> into formalin. not so with lumpectomy samples.
>
> I believe the standard intends that lumpectomy specimens arrive at  
> Pathology fresh and that these are to be cut down and placed in  
> fixative with minimum delay. in addition, minimum and maximum  
> fixation times are proposed (no less than six hours in formalin, no  
> more than 48). if you typically start your processor on Friday  
> evening with a delay start with tissues sitting in formalin, this  
> upper fixation limit may be an issue for you.
>
> in regard to your question " Does this mean that the sample that is  
> not placed in cassettes is not to be fixed?" the answer is NO. they  
> are just insisting that specimens be cut down to reasonable  
> thicknesses before immersion in formalin.
>
> Vinnie
>
>
>
>
>
> Vinnie Della Speranza
> Manager for Anatomic Pathology Services
> Medical University of South Carolina
> 165 Ashley Avenue  Suite 309
> Charleston, SC 29425
> Ph: 843-792-6353
> fax: 843-792-8974
>
>>>> "Douglas D Deltour"  01/12/07 11:10AM >>>
> Has anyone had a chance to decipher this new guideline for HER2  
> testing? I
> think that overall it is a good idea but I have an issue with  
> appendix E. It
> says that "Fixation times for needle biopsies have not been  
> addressed."  Why
> put out a guideline when the initial HER2 testing is done on the  
> needle
> biopsy?
>
>
>
> It also says "Breast specimens, after appropriate gross inspection and
> designation of margins, should be promptly sliced at 5- to 10-mm  
> intervals
> and fixed in formalin (unsliced samples should not be fixed). The  
> interval
> between tissue acquisition and fixation of
>
> breast specimens should be as short as possible." Am I off on this  
> one by
> thinking that "unsliced samples should not be fixed" means that the  
> breast
> should be delivered fresh? Does this mean that the sample that is  
> not placed
> in cassettes is not to be fixed? What do you do with the unsliced/ 
> unfixed
> sample then? I need some coffee! Someone straighten me out.
>
>
>
>
>
> http://arpa.allenpress.com/pdf/i1543-2165-131-1-18.pdf
>
>
>
> Douglas D. Deltour HT(ASCP)
>
> Histology Supervisor
>
> Professional Pathology Services, PC
>
> One Science Court
>
> Suite 200
>
> Columbia, SC 29203
>
> (803)252-1913
>
> Fax (803)254-3262
>
>
>
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