Re: [Histonet] HER2 and the 48 hour rule

From:Patti Loykasek

Dear Dan,
Welcome to the new world of Her2 testing! There will definitely be changes
in the lab as a result of the ASCO/CAP Her2 testing guidelines. I urge all
techs to get a copy of the guidelines and read them.
That being said, the time in fixation is important for Her2 testing. With
heat retrieval I think that too little fixation is worse than >48 hours, but
for now we must comply with 6-48 hours. I was taught (a long time ago) that
it is best practice for the weekend schedule fixation to reflect the rest of
the week, and that  it is preferable to leave the tissue longer in xylene.
That xylene would have less bad effects than longer time in formalin.  A
longer time in alcohol would be deleterious to many IHC stains, and not
recommended for Her2.
Whatever schedule changes you decide to implement, hopefully you can test
your new schedule on some tissue before full implementation of a new
processing schedule.

Patti Loykasek BS, HTL, QIHC
PhenoPath Laboratories
Seattle, WA

> Hello Histonetters!
> Maybe this has been discussed before, and if it has, I apologize in
> advance, but I need a little input. Now that the CAP has mandated a 6
> -48 hour window of fixation time for specimens that may have Her-2 neu
> performed, what are you doing about weekend specimens? We JUST (after
> 25+ years) got rid of the need for techs to come in on Saturdays, and
> would like to be able to continue this trend. However if a breast bx is
> done at an outside account on a Thursday afternoon, and does not get
> grossed by our staff until Friday, right now a our processors are set to
> start up Sunday afternoon for Monday morning (Kind of over 48 hrs). So
> here are my questions:
> Do you set up the processor to sit in 70% OH after the formalin fix? Do
> you let it sit in the paraffin from Saturday until Monday? (Is heat too
> prolonged?)
> Or do I have to break the news to staff that if their name is up, and a
> breast bx comes in, they're coming in Saturday am?
> We do not have a microwave processor (yet), but soon.
> Any and all responses will be greatly appreciated!
> Daniel R Peterson HT(ASCP)
> Histopathology Section Head
> Meriter Laboratories
> (608)-267-6557
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