[Histonet] Re: ER/PR, HER2


Mary Beth Kaulahao asks:

>>Help! What's going on with HER2 and ER/PR? 
Our pathologist went to a meeting and came back to tell us 
the breast [tissue] must be in formalin 6 hrs but no more than 48 hrs. 
Now he wants to start the processor fri night for over the weekend 
and let the tissues process then sit in paraffin from Saturday AM till Monday AM. 
We process a LOT of small bladder and GI biopsies.. is this good for them?? 
What is anyone else out there doing?<<

Everyone out there is very confused.

You can read a rather muddled account of the problem in CAP Today a month or so ago.

Clearly you can't let tissue sit in hot paraffin for two days, though some are advocating doing it. 
Any deviation from fixation time (or fixation in anything other than neutral buffered formalin)
results in a clinically unproven procedure.

But if the bureaucrats and managers want tissue to sit in hot paraffin for two days, 
then we're going to have to say no to them.

It's unproven, but I would think that transferring tissue to 70% ethanol after overnight
fixation in NBF, and holding it in ethanol until it can be processed, would
be preferable.

A better, though unorthodox solution would be to do a small processor run Friday night, 
and have the pathologist-on-call embed the tissue on Saturday morning.

About time pathologists learned to embed!

Bob Richmond
Samurai Pathologist
Knoxville TN

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