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Butter R, Halfwerk H, Radonic T, Lissenberg-Witte B, Thunnissen E. The impact of impaired tissue fixation in resected non-small-cell lung cancer on protein deterioration and DNA degradation. Lung Cancer 2023; 178:108-115. [PMID: 36812759 DOI: 10.1016/j.lungcan.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVES The objective is to assess the impact of the quality of tissue fixation in surgical pathology on immunohistochemical (IHC) staining and DNA degradation. MATERIALS AND METHODS Twenty-five non-small cell lung cancer (NSCLC) resection specimens were analyzed. After resection, all tumors were processed according to the protocols in our center. In haematoxylin and eosin (H&E) stained tissue slides, adequately- and inadequately fixed tumor areas were microscopically demarcated, based on basement membrane detachment. In 10 IHC stains ALK (clone 5A4), PD-L (clone 22C3), CAM5.2, CK7, c-Met, KER-MNF116, NapsinA, p40, ROS1, TTF1) the immunoreactivity in H-scores was determined in adequately- and inadequately fixed, and necrotic tumor areas. From the same areas DNA was isolated, and DNA fragmentation in base pairs (bp) was measured. RESULTS H-scores were significantly higher in H&E adequately fixed tumor areas in IHC stains KER-MNF116 (H-score 256 vs 15, p=0.001) and p40 (H-score 293 vs 248, p=0.028). All other stains showed a trend towards higher immunoreactivity in H&E adequately fixed areas. Independent of H&E adequatelty- or inadequately fixed areas, all IHC stains showed significant different IHC staining intensity within tumors, suggesting heterogeneous immunoreactivity (H-scores: PD-L1 123 vs 6, p = 0.001; CAM5.2 242 vs 101, p=<0.001; CK7 242 vs 128, p=<0.001; c-MET 99 vs 20, p=<0.001; KER-MNF116 281 vs 120, p=<0.001; Napsin A 268 vs 130, p = 0.005; p40 292 vs 166, p = 0.008; TTF1 199 vs 63, p=<0.001). DNA fragments rarely exceeded a length of 300 bp, independent of adequate fixation. However, DNA fragments of 300 and 400 bp had higher concentrations in tumors with short fixation delay (<6 h vs >16 h) and short fixation time (<24 h vs >24 h). CONCLUSIONS Impaired tissue fixation of resected lung tumors results in decreased IHC staining intensity in some parts of the tumor. This may impact the reliability of IHC analysis.
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Affiliation(s)
- Rogier Butter
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Halfwerk
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Teodora Radonic
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands
| | - Birgit Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands
| | - Erik Thunnissen
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers, VU University Amsterdam, Amsterdam, The Netherlands.
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Tasangtong B, Henry CS, Sameenoi Y. Diameter-based inkjet-printed paper devices for formaldehyde analysis in foods. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.109408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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d'Ettorre G, Caroli A, Mazzotta M. Minimizing formaldehyde exposure in a hospital pathology laboratory. Work 2021; 69:209-213. [PMID: 34024804 DOI: 10.3233/wor-213470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The safety and health of healthcare workers employed in pathology laboratories and exposed to formaldehyde (FA) is a matter of concern worldwide, as several health effects have been observed in workers resulting from exposure to FA, both short and long-term. OBJECTIVE The study was aimed to describe the strategy implemented in a hospital pathology laboratory to minimize workers' exposure to FA through interventions to working environment and workforce. METHODS The NIOSH 2016 method for detecting gaseous FA was adopted to perform personal and area active sampling of FA. The samples were subsequently analyzed by High Performance Liquid Chromatography. The exposure to FA was measured before and after improvement interventions. RESULTS The pre-intervention step showed FA levels exceeding the threshold limit values (TLV) established by ACGIH, both the time-weighted average (TLV-TWA) and short term exposure limit (TLV-STEL); after the improvement interventions, the median concentrations of personal and area FA sampling were respectively of 0.025 ppm (Range = 0.023-0.027) and 0.023 ppm (Range = 0.022-0.028) and significantly lower than pre-intervention step (p < 0.05) and below the TLV-TWA and TLV-STEL established by ACGIH. CONCLUSIONS In our study the workers' involvement in the risk management of FA exposure together with engineering improvements revealed a strategic way to minimize the FA pollution in the studied laboratory. Healthcare companies should consider the need to ensure the workers' participation in the management of occupational hazards, including FA, to reach the goal of healthy workplaces.
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Affiliation(s)
- Gabriele d'Ettorre
- Local Health Authority of Brindisi, Health Unit of Occupational Prevention and Protection, Brindisi, Italy
| | - Anna Caroli
- Local Health Authority of Brindisi, Health Unit of Occupational Prevention and Protection, Brindisi, Italy
| | - Mauro Mazzotta
- University of Salento, Occupational Medicine, Lecce, Italy
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Yu Z, Xie Q, Zhao Y, Duan L, Qiu P, Fan H. NGS plus bacterial culture: A more accurate method for diagnosing forensic-related nosocomial infections. Leg Med (Tokyo) 2021; 52:101910. [PMID: 34052680 DOI: 10.1016/j.legalmed.2021.101910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Traditional autopsy and microscopic examination of pathological sections are the "gold standard" for the cause of death diagnosis. However, in some special cases, such as the deaths caused by bacterial infections, pathological sections are not always sufficient to provide convincing evidences for determining the causes of death. In recent years, with the development of Next Generation Sequencing (NGS), clinical medicine has already introduced it into the diagnosis of difficult diseases, which is rare in forensic pathological diagnoses. Here, we applied an NGS-based method combined with bacterial culture to examine a special case in which the deceased was suspected of having suffered from nosocomial infections. Results of the NGS and bacterial culture showed that Enterococcus and Acinetobacter baumannii, which are the most common bacteria causing nosocomial infections, were abundant in blood and hydropericardium of the deceased. Combining medical records and the results of the dissections, we proved that the death was actually caused by MODS which was the adverse consequence of nosocomial infections. In this case, the combination of NGS and bacterial culture was used to identify the pathogen which had caused the death. The results of NGS not only shorten the period of diagnosis, but also greatly increase the credibility of traditional anatomy and results of bacterial culture, which is expected to be further applied for forensic practices in the near future.
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Affiliation(s)
- Zhonghao Yu
- School of Forensic Medicine, Southern Medical University, Guangzhou, 510515 Guangdong, China
| | - Qiqian Xie
- School of Forensic Medicine, Southern Medical University, Guangzhou, 510515 Guangdong, China
| | - Yifeng Zhao
- Nanjing Zhenghong Judicial Identification Institute, Nanjing, 211800 Jiangsu, China
| | - Lizhong Duan
- Beijing Municipal Public Security Bureau, 102600 Beijing, China
| | - Pingming Qiu
- School of Forensic Medicine, Southern Medical University, Guangzhou, 510515 Guangdong, China.
| | - Haoliang Fan
- School of Forensic Medicine, Southern Medical University, Guangzhou, 510515 Guangdong, China; School of Basic Medicine and Life Science, Hainan Medical University, Haikou, 571199 Hainan, China.
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Annaratone L, Marchiò C, Sapino A. Tissues under-vacuum to overcome suboptimal preservation. N Biotechnol 2019; 52:104-109. [PMID: 31150841 DOI: 10.1016/j.nbt.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022]
Abstract
The accuracy of histopathological diagnosis is strictly reliant on adequate tissue preservation, which is completely dependent on pre-analytical variables. Among these variables, the time interval between the end of surgical excision to the onset of fixation (the cold ischemia time) may adversely affect preservation of tissue morphology, influencing the interpretation and reproducibility of diagnosis. During this time interval, the activation of enzymes may produce autolysis and degradation of antigens and nucleic acids, thus potentially affecting immunocytochemical and molecular results. Several studies have described under-vacuum at 4 °C storage of fresh surgical specimens as a safe and reliable method to control cold ischemia and preserve fresh tissues, as well as to standardize fixation times and implement tissue-banking. This review article gives a systematic overview of the advantages and drawbacks of the use of under-vacuum tissue preservation and cooling in surgical pathology, highlighting the impact this procedure may have on diagnostic and experimental pathology. It also documents our experience acquired within daily practice and national and international projects.
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Affiliation(s)
- Laura Annaratone
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Str. Provinciale 142 km 3.95, 10060, Candiolo (Turin), Italy.
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Str. Provinciale 142 km 3.95, 10060, Candiolo (Turin), Italy.
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6
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Mastracci L, Gambella A, Bragoni A, Pigozzi S, Pastorino L, Vanni I, Tosi I, Campora M, Fiocca R, Grillo F. Coping with formalin banning in pathology: under vacuum long-term tissue storage with no added formalin. Histochem Cell Biol 2019; 151:501-511. [PMID: 30604285 DOI: 10.1007/s00418-018-1765-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Abstract
Formalin is toxic and has recently been classified as carcinogenic leading to a proposed European formalin ban. But, the pathology use of formalin has however been completely overlooked, and this is proving to be a relevant issue, as no alternative, reliable, tissue fixative is available. Various systems have been proposed to reduce formalin use and exposure; long-term storage and disposal of formalin is also a problem. With this in mind, under vacuum sealing (UVS) systems have been proposed for transportation/storage, however, for how long tissue retains its characteristics (morphological and molecular) is unknown. This study aims to compare histology specimens stored by formalin immersion (FI) and specimens stored after fixation with UVS technique with no additional formalin, at different time periods. Twenty tissue samples (10FI; 10UVS) were stored for different time periods (15 days, 1-2-3-6-12 months) for a total of 120 samples, compared with regard to their morphology, histochemistry, immunoreactivity (24 specific antibodies) and DNA status. All samples showed well-preserved morphology and overlapping staining quality. A significant reduction in immunoreactivity was however identified in the various time periods, particularly for heat pre-treated nuclear antigens, and this commenced earlier (1 month) for FI. UVS storage showed higher DNA content than FI but slightly poorer DNA integrity. These results add important knowledge to the use of UVS in daily practice, as long-term storage of pre-fixed tissue in UVS is not detrimental to the quality of tissue while having the boon of using very little formalin with less operator exposure and lower disposal costs.
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Affiliation(s)
- Luca Mastracci
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy. .,IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
| | - Alessandro Gambella
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy
| | - Alberto Bragoni
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy
| | - Simona Pigozzi
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Lorenza Pastorino
- Genetics of Rare Tumors Laboratory, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Irene Vanni
- Genetics of Rare Tumors Laboratory, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - Ilaria Tosi
- IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Michela Campora
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy
| | - Roberto Fiocca
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Federica Grillo
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, via De Toni 14, 16132, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
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Nybo M, Cadamuro J, Cornes MP, Gómez Rioja R, Grankvist K. Sample transportation – an overview. Diagnosis (Berl) 2018; 6:39-43. [DOI: 10.1515/dx-2018-0051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/22/2018] [Indexed: 01/25/2023]
Abstract
Abstract
Transportation of blood samples is a major part of the preanalytical pathway and can be crucial in delaying laboratory results to the clinicians. A variety of aspects however makes sample transportation a complex, challenging and often overlooked task that needs thorough planning and dedicated resources. The purpose of this review is to outline the options available for this task and to emphasize the preanalytical aspects that need consideration in this process, e.g. performance specifications for sample transportation as stated in ISO standards 15189 and 20658, quality control of automated transportation systems, monitoring of sample integrity parameters and temperature surveillance in general and for external samplers in particular. All these are tasks that the laboratory must assure on a daily basis in terms of continuous quality control, and simultaneously the laboratory must remain alert to alterations in clinical demands (sample frequency, turn-around-times) and new regulations within this area (e.g. the recent General Data Protection Regulation from the EU).
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Affiliation(s)
- Mads Nybo
- Department of Clinical Biochemistry and Pharmacology , Odense University Hospital , Sdr. Boulevard 29 , Odense 5000 , Denmark
| | - Janne Cadamuro
- Department of Laboratory Medicine , Paracelsus Medical University , Salzburg , Austria
| | - Michael P. Cornes
- Department of Clinical Chemistry , Worcestershire Acute Hospitals NHS Trust , Worcester , UK
| | | | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University , Umeå , Sweden
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