Discussion:
Histonet Digest, Vol 140, Issue 6 Specimen loss
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Steve McClain
2015-07-08 17:47:28 UTC
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My goodness 7% tissue loss is ridiculous.
What fool published that?

A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?

"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy,
one to be eschewed and denounced,
or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.

I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****
Blazek, Linda
2015-07-08 18:40:27 UTC
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Dear Mr. Cantankerous, :)

So how would you gross a colon biopsy that was <0.1 cm and probably mucus?

-----Original Message-----
From: Steve McClain [mailto:***@mcclainlab.com]
Sent: Wednesday, July 08, 2015 1:47 PM
To: ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

My goodness 7% tissue loss is ridiculous.
What fool published that?

A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?

"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy, one to be eschewed and denounced, or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.

I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****
Steve McClain
2015-07-09 11:52:35 UTC
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Ms. Blazek,
To clarify the matter, I read the cited paper by SR Owens,
and I interpret those data differently,
and in my opinion, the 7% figure for "lost" specimens is incorrectly quoted.
The majority of his cases where there was a difference between the number of fragments submitted
and the fragments observed on the slide involved a gain in number due to fragmentation in 5% of cases.
Where tissue was "lost" (0.6% had fewer fragments at embedding and 6% had fewer on the slide)
that mainly appeared to occur during the microtomy phase, due to exhaustion of the fragment in the block.

Owens gives no indication there were any cases where all tissue was lost.
Nor does he specifically define the minimum size to be counted as a fragment, e.g., how small is a fragment.

These data do not support the daily loss of all fragments in a specimen block or the expectation that tissue will not survive processing.

In UPMC protocol They wrap all specimens, ink the tissue with eosin (erythrosine) at the grossing bench and cut two levels at 40 microns.

Steve A. McClain, MD
631 361 4000

-----Original Message-----
From: Blazek, Linda [mailto:***@digestivespecialists.com]
Sent: Wednesday, July 08, 2015 2:40 PM
To: Steve McClain; ***@lists.utsouthwestern.edu
Subject: RE: Histonet Digest, Vol 140, Issue 6 Specimen loss

Dear Mr. Cantankerous, :)

So how would you gross a colon biopsy that was <0.1 cm and probably mucus?

-----Original Message-----
From: Steve McClain [mailto:***@mcclainlab.com]
Sent: Wednesday, July 08, 2015 1:47 PM
To: ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

My goodness 7% tissue loss is ridiculous.
What fool published that?

A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?

"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy, one to be eschewed and denounced, or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.

I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****
Simmons, Christopher
2015-07-09 12:02:32 UTC
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As one of the lead participants in the cited study....
We never "lost" specimens.
Did we have fewer than was noted on the casette from gross, yes. Could we attribute that to mucoid samples, yes and no.
We counted everything, even dust like particles, hence the 6% fewer on the slide.
Keeping in mind that a full face is needed for any diagnosis, these particles were exhausted from the block achieving this.
We also kept track of those specimens that either fragmented during processing or when they were handled by the embedding technicians.
WE DO NOT LOSE 7% OF OUR TISSUE.
The protocol is to wrap 0.2-0.3cm and below in biopsy paper. This makes more work for the grossers/embedders, but it is better than fishing samples apart from the ball in the corner they become during processing if you don't.
Now that we are clear (hopefully) can we drop this pointless thread?


Chris Simmons B.S., A.S., HTL(ASCP)

-----Original Message-----
From: Steve McClain [mailto:***@mcclainlab.com]
Sent: Thursday, July 09, 2015 7:53 AM
To: Blazek, Linda; ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

Ms. Blazek,
To clarify the matter, I read the cited paper by SR Owens, and I interpret those data differently, and in my opinion, the 7% figure for "lost" specimens is incorrectly quoted.
The majority of his cases where there was a difference between the number of fragments submitted and the fragments observed on the slide involved a gain in number due to fragmentation in 5% of cases.
Where tissue was "lost" (0.6% had fewer fragments at embedding and 6% had fewer on the slide) that mainly appeared to occur during the microtomy phase, due to exhaustion of the fragment in the block.

Owens gives no indication there were any cases where all tissue was lost.
Nor does he specifically define the minimum size to be counted as a fragment, e.g., how small is a fragment.

These data do not support the daily loss of all fragments in a specimen block or the expectation that tissue will not survive processing.

In UPMC protocol They wrap all specimens, ink the tissue with eosin (erythrosine) at the grossing bench and cut two levels at 40 microns.

Steve A. McClain, MD
631 361 4000

-----Original Message-----
From: Blazek, Linda [mailto:***@digestivespecialists.com]
Sent: Wednesday, July 08, 2015 2:40 PM
To: Steve McClain; ***@lists.utsouthwestern.edu
Subject: RE: Histonet Digest, Vol 140, Issue 6 Specimen loss

Dear Mr. Cantankerous, :)

So how would you gross a colon biopsy that was <0.1 cm and probably mucus?

-----Original Message-----
From: Steve McClain [mailto:***@mcclainlab.com]
Sent: Wednesday, July 08, 2015 1:47 PM
To: ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

My goodness 7% tissue loss is ridiculous.
What fool published that?

A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?

"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy, one to be eschewed and denounced, or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.

I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****

_______________________________________________
Histonet mailing list
***@lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet

Richard Yeo
2015-07-08 19:19:02 UTC
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Steve,
I totally agree that 7% tissue loss is extremely high.
Saying that when you have an experienced pathologist that looks at a specimen and only sees mucoid material he knows that it is most likely that the reagents in the processor are going to dissolve it.
We have a very low rate of loss, probably one to two blocks per thousand processed. That's.01-.02%.
No one wants to lose any tissue specimen and put the patient through it again but it happens.

Rich Y

Sent from my iPhone
Post by Steve McClain
My goodness 7% tissue loss is ridiculous.
What fool published that?
A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?
"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy,
one to be eschewed and denounced,
or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.
I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****
_______________________________________________
Histonet mailing list
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Kienitz, Kari
2015-07-08 20:44:13 UTC
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whoa! 7% of specimens? Working in a high volume colonoscopy laboratory for 4 years, I've only had two specimens that were so minute there was nothing at embedding. Bio-wraps or lens paper is a must.


Kari Kienitz HT, (ASCP)
Histology Laboratory
Gastroenterology-EAST
The Oregon Clinic
1111 NE 99th Ave
Portland, OR 97220
503.935.8311
***@orclinic.com




CONFIDENTIALITY WARNING: This e-mail and any attachments are for the exclusive and confidential use of the intended recipient. If you are not the intended recipient, please do not read, distribute or take action in reliance upon this missive. If you have received this in error, please notify the sender immediately by reply e-mail and delete this message and its attachments from your computer system. Thank you
________________________________________
From: Steve McClain [***@mcclainlab.com]
Sent: Wednesday, July 08, 2015 10:47 AM
To: ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

My goodness 7% tissue loss is ridiculous.
What fool published that?

A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?

"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy,
one to be eschewed and denounced,
or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.

I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****
STEVEN PINHEIRO
2015-07-08 21:24:01 UTC
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Raw Message
I was the one that started the inquiry, however SO there is no confusion, my lab is NOT the one with the 7% loss.

Steve Pinheiro
708-327-2642


-----Original Message-----
From: Kienitz, Kari [mailto:***@orclinic.com]
Sent: Wednesday, July 08, 2015 3:44 PM
To: Steve McClain; ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

whoa! 7% of specimens? Working in a high volume colonoscopy laboratory for 4 years, I've only had two specimens that were so minute there was nothing at embedding. Bio-wraps or lens paper is a must.


Kari Kienitz HT, (ASCP)
Histology Laboratory
Gastroenterology-EAST
The Oregon Clinic
1111 NE 99th Ave
Portland, OR 97220
503.935.8311
***@orclinic.com




CONFIDENTIALITY WARNING: This e-mail and any attachments are for the exclusive and confidential use of the intended recipient. If you are not the intended recipient, please do not read, distribute or take action in reliance upon this missive. If you have received this in error, please notify the sender immediately by reply e-mail and delete this message and its attachments from your computer system. Thank you ________________________________________
From: Steve McClain [***@mcclainlab.com]
Sent: Wednesday, July 08, 2015 10:47 AM
To: ***@lists.utsouthwestern.edu
Subject: Re: [Histonet] Histonet Digest, Vol 140, Issue 6 Specimen loss

My goodness 7% tissue loss is ridiculous.
What fool published that?

A 0.8% "loss of tissue" is beyond me.
Would any one advertise in the local paper that your center of excellence lab loses nearly 1% of your specimens?

"possibly too small to survive processing" is in my opinion, a self-fulfilling prophesy, one to be eschewed and denounced, or beaten out of the grosser who dares use that description for it is an expectation of failure.
That grosser would not last a week around me.
I would walk them to the train station and ask them not to return.

I felt less cantankerous before I read that one.
Steve A. McClain, MD
631 361 4000
****

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Histonet mailing list
***@lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet
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http://lists.utsouthwestern.edu/mailman/listinfo/histonet

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