RE: Breast Tissue

We try to ensure that radical mastectomy or large lumpectomy specimens are inked and quickly breadloafed (<1cm sections) in the gross room and floated in large vats of formalin. If orientation of the sections may be prolematic, you can pin them to wax blocks in the order cut, then cover with 4x4 gauze pinned to the wax block and invert the block into the formalin vat. The formalin should be changed periodically in the vat. Later in the day or the next day, the sections are cut in for the processor by the pathologist (or resident or PA) who hopefully ensures a < 2 mm thick specimen up to 2.0 by 1.5 cm surface area is placed in the cassette. We then hold the cassettes in fresh formalin in racks inside small plastic containers on a slow rotator that keeps the formalin moving. The racks are cut to fit cassettes rather like a processor rack but we always leave extra empty spaces for fatty tissues. Again the formalin is changed several times before loading on the processor in the early evening. We have the luxury of having multiple processors. One of our processors can be dedicated to a late large run (identical processing program to our regular large run) which will start later in the night than the usual run. If a specimen needs a little more fixing time but not necessarily held overnight, the extra time in formalin waiting for the late large run to start is sometimes just the ticket for success. Our PA, pathologists and residents are extolled from the start to avoid sending underfixed tissue to the processor. Better to be a day later than to ruin the tissue. (Reprocessing is usually not a very good option.) I will be happy to send the processor protocol if you email me directly with specific needs.