Pre-Analytics of Pathological Specimens in Oncology by Manfred Dietel Christian Wittekind Gianni Bussolati & Moritz Winterfeld

Author:Manfred Dietel, Christian Wittekind, Gianni Bussolati & Moritz Winterfeld
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

3 Current Projects and Goals in Italy

In 2012, the Ministry of Health in Italy co-funded together with Milestone srl (Bergamo, Italy—http://​www.​milestonemedsrl.​com/​histopathology/​index.​php) a joint (public–private) project entitled “Standardizing tissue handling in pre-analytical procedures: technological, environmentally-safe innovation in solid tumour processing” (Project Code: RF-2010-2310674). The project proposes novel approaches to the neglected issue of tissue handling in pre-analytical procedures, taking into account both public health problems and practical innovation in solid tumour processing.

The aims of the project were:1. To standardize and validate the use of Under Vacuum Sealing and Cooling (UVSC) procedure for handling and preserving fresh surgical specimens before fixation.

To overcome the concern related to the use of formalin in the surgery room we have proposed the use of an innovative vacuum biospecimen transfer system (tissueSAFE-Milestone, Italy) [2]. Our aim was to restrict the use of formalin only in pathology labs, where this toxic agent is carefully handled with hoods and gloves in safe environmental conditions. Tissue transfer in UVSC conditions meets the requests of both health authorities and workers by reducing the exposure to formaldehyde; furthermore, the cost related to the UVSC are lower than those related to the traditional transport in formalin immersion.

Standardising the temperature of transport and storage is another important issue. In transplantation pathology it has been shown that a rapid induction of hypothermia at 0–4 °C by perfusion of organ with specific solutions better preserves organ viability [3, 4]. It seems that it is the prompt cooling that principally influences preservation. For instance, Kristensen and colleagues [5] have shown that storage at 4 °C preserved tissues to a higher degree than storage at room temperature, independently of whether the tissue was subjected to vacuum sealing or not. We have proposed the transfer of surgical specimens vacuum-sealed using a chilled plastic box at 4 °C [6]. Our results suggest the avoidance of insulating air around tissues with the UVSC system allows faster cooling at 4 °C. We are working on the rapid reduction of temperature to preserve as much as possible the tissue viability, and the integrity of phosphorylated proteins and of nucleic acids.

The other problem is to monitor the cold ischemia time (which corresponds to the UVSC time) that starts when the specimen is excised and ends with placement in a suitable tissue fixative. When dealing with cell cultures and xenograft implantations researchers may ideally wish to collect the sample for experiments directly in the surgery room in order to keep the cold ischemia time as short as possible. However, any such sampling may lead to problems for pathologists in terms of correct gross evaluation of tumour samples (status of surgical margins, staging etc.). UVSC may therefore represent a valuable strategy to allow tissue sampling for research purposes and proper preservation of tissue specimens for gross evaluation. However, the results of our project show that although UVSC maintains cell viability even after 70 h, the percentage of cell death increases for longer UVSC times [7].

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