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What can be done to maximise tissue sufficiency?

  • Perform core biopsies to obtain more tissue than is possible with bronchoscopic and needle biopsies
  • Implement a sample prioritisation algorithm for the work-up of non-resection lung cancer specimens
  • Minimise the frequency of re-cutting blocks – ideally sections for all ancillary tests should be cut in the same session
  • Two strategies may be employed to maximise tissue availability
  1. Perform minimally invasive sectioning for an initial look and preliminary diagnosis, rather than cutting deep into the block to get largest diameter of the biopsy on the initial slides
  2. Cut multiple unstained sections and keep them stored until preliminary diagnosis has been made and ancillary testing is requested
  • Have the most experienced technician conduct the cutting to avoid contamination and preserve tissue
  • Ultra-thin sections (approximately 3–5 μm) are ideal for routine staining and IHC
  • Avoid diagnostic IHC studies and histochemical stains that may not be essential to establish a histopathological diagnosis – a simple panel of one squamous cell carcinoma marker (p40 or p63) and a single adenocarcinoma marker (TTF-1 or mucin) should be sufficient to classify most cases
  • Consider parallel predictive IHC (e.g. ALK, ROS) during diagnostic IHC work-up, to shorten turn-around times, save tissue and reduce costs
  • Mark the most suitable tumour area on the slide (area with the least amount of necrosis, blood, mucus or inflammation) so that the optimal tumour content is extracted from the paraffin-embedded material
  • Enrich material for tumour cells by manual micro-dissection

Dietel M et al. Thorax. 2016;71:177-84.
Travis WD et al. WHO classification of tumours of the lung, pleura, thymus and heart (WHO classification of tumours, vol. 7, 2015).
Lindeman NI et al. J Mol Diagn. 2013;15:415-53.
Aisner D et al. Arch Pathol Lab Med. 2016;140:1206-20.