RE: [Histonet] Re: HER2 fixation time

From:Rene J Buesa

Nobody is against (at least not I) a fixation standard. What I am trying to find out is the rationale for that specific standard. Why 48 and not more hours? What would be the QUALITATIVE difference of the results? When I emphazise qualitative is not because of disdain, but because of the fact that a qualitative result is less "demanding" of the way it is reached.
  Quantitative results NEED stringent procedures and quality control because at the end the amount to be quatified can be compromised if the protocol is not followed as prescribed. That is all, not because the quality (more or less + cells and score) is to be considered as less important to the patient.
  René J.

"Della Speranza, Vinnie"  wrote:
  I think we are forgetting that this "qualitative result" has large therapeutic implications for the patient. 

If your results are different from mine, are we really doing our best for the patient?

This is the whole premise behind the attempt to standardize and frankly you have to start somewhere, so why not fixation? I for one am fine with the additional headache of working out the fixation tracking if it helps just one individual. But like many of you I do hope that the fixation time limit is expanded beyond 48 hours.

Vinnie Della Speranza
Manager for Anatomic Pathology Services
165 Ashley Avenue Suite 309
Charleston, South Carolina 29425
Tel: (843) 792-6353
Fax: (843) 792-8974

-----Original Message-----
From: [] On Behalf Of Rene J Buesa
Sent: Thursday, January 24, 2008 2:37 PM
To: Dawson, Glen
Subject: RE: [Histonet] Re: HER2 fixation time

Is now "Big brother" in the histology business? 
All this standardization to get to a QUALITATIVE result? 
Where are the "standard" photomicrographs printed identically with the same standard color quality prints to compare with?
I know of two color blind pathologists and three with poor vision.
René J.

"Dawson, Glen" wrote:

Once we all agree to fix our tissues for EXACTLY the same amount of time in the same fixative (supplied by the same vendor of course), what do we do with all of the other factors involved to reach this pipe dream of national standardization? 

The next step must be a requirement for all of us to work in the same hermetically sealed, mass produced "pre-fab" labs that can all provide identical water sources, temperatures, humidity, elevation/pressure, etc... We must all agree to use identical antigen retrieval methods, kits/detections, chromagens, etc... provided by the same "super vendor" with the same lot numbers. This may be feasable with all the buyouts in our industry but remains highly unlikely. 

Lastly, we must all agree to invite in only the same gremlins since they seem to thrive in so many laboratory environments.

My point is, the new CAP HER2 guidlines are a fruitless attempt to standardize a procedure that has too many factors involved to achieve true, nation-wide standardization. The current discussion on the fixation aspect needs to be tempered by the fact that it is still only one factor in many.

Does anyone else get that sick feeling that this is just the tip of the iceburg and calls for pre-fab kits and national standardization for many other tests are just around the corner?

Things that make you go HMMMMMM,

Glen Dawson BS, HT & QIHC (ASCP)
IHC Manager
Milwaukee, WI 

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