The impact of pre-analytic variables on tissue quality from clinical samples collected in a routine clinical setting: Implications for diagnostic evaluation, drug discovery, and translational research

Abstract

The increasing application of biomarkers in both clinical practice and research has led to a greater emphasis on optimal sample preparation for such assays. However, in most institutions, current practices involved in tissue handling are highly variable and these variations can affect the quality of specimens used for analysis of macromolecules of potential clinical and research interest. In an attempt to address this important emerging issue, and to standardize tissue handling at our institution, the Surgical Pathology Laboratory has implemented an active tissue acquisition program in collaboration with the staff in the operating rooms and the Department of Surgery. Designated technical personnel from our laboratory assigned to the operating rooms are contacted as soon as a specimen is available. They are then responsible for collection of the specimen, checking accuracy on both the requisition and specimen label, and transportation of the specimen to the laboratory. With this implementation, we have seen significant improvements in the median time to fixation and the total number of specimens placed into formalin within 1h of surgical removal from the patient. Rather than pushing an already busy OR staff to deliver specimens in a more timely fashion, we have found that a joint collaboration between departments, and proactively "pulling" specimens into the laboratory was more successful in achieving our goal of standardizing tissue handling and minimizing the time from surgical removal to the start of fixation. In addition, the type of tissue fixation and the time in fixative has the potential to impact the quality of tissue samples for molecular analysis of routinely collected clinical samples. These important issues will be reviewed in this chapter.