Re: Breast tissue processing

Grumpy geezer pathologist has made these comments before and will probably 
make them again.

It is possible to cut breast tissue thin enough to fix properly. It takes 
practice to learn to do it, more practice to learn to do it fast. If your 
pathologists don't have this skill, they need to acquire it.

Pathologists need to be strict about letting properly grossed breast tissue 
fix overnight when it needs to. They need to remind surgeons that the patient 
needs a right diagnosis, not a fast one.

Acid fixative fixation considerably accelerates fixation of properly cut 
breast tissue. I used to use Davidson's fixative for this purpose, but I'm 
reluctant to use it today when so many special techniques depend on my 

One of my locum tenens clients is an elderly man (he's only nine years 
younger than I am, and his vision is even worse than mine) who never learned 
to cut breast tissue. My first day there, when I'm signing out cases he 
grossed the previous Friday (so they fixed over the weekend!) the breast se
ctions are horrible. I bitch at the technologists. (We all know the routine 
well by now.) They show me the blocks. The blocks are disgusting. We 
reprocess the blocks. The sections are still horrible.

Then for the next two weeks, they cut me flawless sections of the tissue I 
gross for them.

Bob Richmond
Samurai Pathologist
Knoxville TN

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