As automation transforms the manual work processes in the histopathology laboratory, “floaters” may become a thing of the past
Any histotechnologist and pathologist familiar with the manual work processes commonly in use in histopathology laboratories knows about “floaters.” These are the pesky artifacts that are a consequence of the common practice of manually processing tissue through the series of H&E linear baths required for the proper staining of these samples prior to analysis by anatomic pathologists.
“Floaters” are a relevant example of why manual work processes in the histopathology laboratory can be the source of errors and mistakes. Certain types of floaters—including floaters consisting of malignant tissue fragments—have the potential to contaminate the patient specimen. This can negatively impact patient safety and even contribute to a misdiagnosis of the patient. Moreover, the issue of floaters has been around for decades, because the manual work processes involving the H&E (hematoxylin and eosin stain) linear baths have remained relatively unchanged during this time.
Replacing Manual Work Processes in the Clinical Pathology Laboratory
However, the dominance of manual processes in the histology laboratory is about to end. In recent years, a number of lab industry vendors have introduced advanced instrument systems that replace specific manual work processes in histopathology with an automated workflow.
This has several immediate benefits. First, automation can reduce the rate of errors and mistakes compared to a manual work process. Second, automation typically reduces variability in how the specimen is handled during processing. In turn, that produces a higher quality outcome while reducing variability. Third, use of automation can improve the productivity of the staff in the histopathology lab and contribute to reduced costs.
These are important benefits for all anatomic pathology laboratories. The latest-generation of automated systems for use in the histology laboratory are transforming what was basically a manual workflow to process tissue and produce glass slides for the pathologists’ review. Nowadays, it is common to find lots of automation in the state-of-the-art histology laboratory.
To illustrate the benefits that accrue to a histology laboratory that evolves from a workflow that is primarily made up of manual work processes—to a streamlined specimen processing production line that is dominated by automated work processes—the problem of floaters in H&E staining provides a relevant case study.
Study Found Floaters on as Many as 3% of Anatomic Pathology Slides
For example, in 1996, the College of American Pathologists (CAP) conducted a retrospective review and found that contaminate tissue fragments were detected on approximately 3% of anatomic pathology slides. These contaminate tissue fragments ranged from just a few cells to entire extraneous tissue sections.
One pathologist who has studied the problem of floaters and how automation can be used to reduce contaminates, and improve the quality of the finished glass slides, is John B. Carpenter, M.D., who works at Pacific Pathology Partners and Harrison Medical Center in Silverdale and Bremerton, Washington. He recently authored a White Paper titled “Risk of Misdiagnosis Due to Tissue Contamination May be Higher for Certain Specimen Types: Changes to laboratory staining techniques offer opportunity to reduce contamination events.” In his White Paper, Dr. Carpenter evaluates the different sources of contaminates in the histologic processing of tissue specimens. He identifies the types of tissue specimens that are recognized to have a higher risk at diagnosis if contaminated during processing.
Histology and Clinical Laboratory Managers
For clinical laboratory administrators who manage histology laboratories, this White Paper also includes information about different workflow and process improvement arrangements that can improve the quality of tissue processing, while also contributing to improved productivity and reduced costs.
Dr. Carpenter’s White Paper can be accessed at the darkdaily.com website by using this link http://darkdaily.com/white-papers/risk-of-misdiagnosis-due-to-tissue-contamination-may-be-higher-for-certain-specimen-types-changes-to-laboratory-staining-techniques-offer-opportunity-to-reduce-contamination-events-31411#Form. It is available as a PDF, which means it can be easily downloaded so you can immediately read it. Also available are a number of other Dark Daily White Papers addressing the management and operation of clinical laboratories.
It is timely for histology laboratories and anatomic pathology groups to consider how automation can improve the performance of manual work processes in the processing of tissue for pathological analysis. Public reporting of providers’ patient safety records and the quality of their patient outcomes is a trend that is increasing. Thus, revisiting the issue of “floaters” in the histology laboratory would be appropriate.