The value of inking breast cores to reduce specimen mix-up.
ABSTRACT Accidental switching of tissue specimens in the histology laboratory can result in significant medical error. We sought to evaluate inking breast core needle specimens as a method to reduce the chance of specimen mix-up. We sequentially inked 1,000 consecutive breast core specimens with 6 different colors. Review of the color of the ink revealed 3 discrepancies: 1 related to blocks being switched, 1 related to incorrect labeling, and 1 was a typographical error. Inking of breast core specimens is a simple, inexpensive, and effective way to help reduce the chance of specimen mix-up.
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ABSTRACT: A recurring problem in surgical pathology practice is specimen mix-up and floater contamination. While many cases can be resolved histologically, a significant number remain unclear and may have serious clinical and medicolegal implications. To design a microdissection and genotyping assay to identify contaminating floater tissues in paraffin-embedded tissues that is optimized for small samples, and to use the assay to resolve a series of clinical cases with floater tissues. Twenty-one cases of possible tissue floater contamination in paraffin-embedded tissue blocks were included. Using 4 unstained, 4-microm-thick histologic sections, multiple sites were microdissected under direct visualization either by hand or by laser capture microdissection. Nonneoplastic and neoplastic tissues were sampled. Polymerase chain reaction was performed for a panel of 10 polymorphic microsatellite markers at 1p34, 3p26, 5q21, 9p21, 10q23, and 17p13. Allele size and content were analyzed semiquantitatively by fluorescent capillary electrophoresis, and the genotypes for the tissues in the paraffin-embedded tissue blocks were compared for identity. Tissue identification was successful in all cases, despite small tissue sample size and fixation effects. Comparative analysis of neoplastic tissue floaters and the presumptive source tumor was performed when possible to control for possible allelic loss or microsatellite instability. Microdissection and genotyping are effective and reliable means to objectively resolve problems of possible floater contamination. Even minute tissue samples provide sufficient DNA template for polymerase chain reaction microsatellite analysis. Because of the potential clinical implications of floaters, we recommend that all suspected floaters that would change a diagnosis from benign to malignant be subjected to genotyping assay to confirm the identity of the floater tissue.Archives of pathology & laboratory medicine 03/2003; 127(2):213-7. · 2.78 Impact Factor
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ABSTRACT: Identification of contaminating tissue fragments as "floaters" is a common problem in surgical pathology. They may be introduced at several steps in the processing of specimens, and they are capable of causing interpretative consternation. Using immunohistochemistry with monoclonal antibodies to blood group isoantigens A, B, and H, we studied nine cases in which floaters were present. In five of the study cases, discordant blood group immunostains allowed identification of the artifactual tissue fragments. By chance, the other four specimens contained probable floaters from patients whose blood groups were concordant with those from whom the "native" tissue had been obtained. These results indicate that in some instances, blood group immunostains may resolve interpretative difficulties surrounding floaters. It is likely that application of immunostains, directed at additional blood group antigens, will extend the utility of this procedure.Archives of pathology & laboratory medicine 04/1994; 118(3):293-7. · 2.78 Impact Factor
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ABSTRACT: A case report is presented in which an unexpected pathological diagnosis raised the possibility that biopsies of two patients were mixed-up. Since these biopsies were obtained from kidney transplant patients, the HLA-typings of both patients were known. We developed an immunohistochemical method using HLA-class I specific monoclonal antibodies to recognize the donor and recipient antigens in these biopsies. Using this method we could confirm the identity of the patients of whom the biopsies had been taken. This method, which uses the highly polymorphic HLA-system, is potentially useful for rapid and easy verification of the identity of specimens if a mix-up is suspected.Histopathology 10/1997; 31(3):284-8. · 2.86 Impact Factor
Am J Clin Pathol 2007;127:271-272 271
© American Society for Clinical Pathology
Anatomic Pathology / INKING BREAST CORES TO REDUCE MIX-UPS
The Value of Inking Breast Cores to Reduce
Andrew A. Renshaw, MD, Richard Kish, MHS, and Edwin W. Gould, MD
Key Words: Surgical pathology; Quality; Error; Inking; Breast core
A b s t r a c t
Accidental switching of tissue specimens in the
histology laboratory can result in significant medical
error. We sought to evaluate inking breast core needle
specimens as a method to reduce the chance of
specimen mix-up. We sequentially inked 1,000
consecutive breast core specimens with 6 different
colors. Review of the color of the ink revealed 3
discrepancies: 1 related to blocks being switched, 1
related to incorrect labeling, and 1 was a typographical
error. Inking of breast core specimens is a simple,
inexpensive, and effective way to help reduce the
chance of specimen mix-up.
Specimen mix-up is a potentially devastating source of
medical error in the histology laboratory. When the potential
for a mix-up is noticed, there are several methods to determine
the identity of a particular specimen.1-10However, when a lab-
oratory is processing a relatively large number of cases that
have similar physical and clinical features, recognizing that a
case has been switched can be extremely difficult. To ensure
that the correct tissue is cut for each specimen, we have been
inking breast core specimens with different color inks for sev-
eral years. While we are aware that other groups have also
used this technique, we are unaware of any literature quantify-
ing the effectiveness of it. To address this, we reviewed our
experience with inking a large series of breast core specimens.
Materials and Methods
We reviewed 1,000 breast core needle biopsy specimens
interpreted between December 1, 2005, and May 31, 2006, at
Baptist Hospital of Miami, Miami, FL. All breast core needle
biopsy specimens were obtained by radiologists and consisted
of 11-, 12-, and 14-gauge core needle biopsy specimens per-
formed under ultrasound or stereotactic guidance; 11-gauge
cores were obtained using vacuum assistance.
All specimens were received fixed and placed in a nylon
bag by the radiologist. At the time of grossing, each specimen
was directly inked through the bag in one of 6 colors. The col-
ors were always applied in the same sequence. The dissector
would write the color used on the original requisition slip and
dictate the color for the gross description. Each block was then
routinely processed and entirely sectioned to produce at least
5 slides and 2 levels per slide.11
Am J Clin Pathol 2007;127:271-272
© American Society for Clinical Pathology
Renshaw et al / INKING BREAST CORES TO REDUCE MIX-UPS
When the slides from the cases were reviewed, the
pathologist compared the color of the ink in the tissue with
that written in the gross description.
Of the 1,000 consecutive breast core specimens reviewed,
the color of ink revealed 3 discrepancies (0.3%). In 1 case, the
discrepancy related to blocks being switched and the incorrect
specimen placed on the slide. This error was identified by
review of the color of the tissue on the slides and correlation
with the colors dictated by the prosector and the ink left in the
tissue blocks. In the second case, the correct blocks were sec-
tioned and tissue placed on the correct slides; however, the
incorrect labels were placed on the slides. The error was iden-
tified as in the first case, and, in addition, the correct slide
number was written on the slide under the label. In the last
case, a discrepancy appeared to be present, but on review, it
was discovered that the color of the ink was incorrectly typed
in the gross description.
The purpose of this article is simple. We demonstrated
that routine inking of breast core specimens allows rare inad-
vertent specimen mix-ups to be identified and corrected
before a diagnosis is given. While the incidence of this is rel-
atively low, because of the relatively high number of cases
received by this laboratory, this problem occurs several times
It is certainly true that some of these errors could be iden-
tified by other means. If the pathologist routinely examined
the number of the case written under the label, he or she could
have identified our second case. It is also true that when the
clinical history and the pathologic findings do not match,
additional testing can demonstrate the identity of specific tis-
sue specimens.1-10However, this testing is complex and
expensive and would rarely be used unless a significant clini-
cal suspicion was identified. As the clinical presentations of
more and more of our cases become similar, the ability to
identify such cases becomes less likely.
However, inking works in every single case and is easy
and inexpensive to perform. It is true that inking is not perfect.
It is possible that 2 cases with the same ink could be mixed up
and we would be unable to distinguish this problem. Our solu-
tion to this problem has been to use 6 ink colors, making this sce-
nario less likely. It is also true that in some cases a discrepancy
raises the possibility of a mix-up when none is present, as in
our case 3. However, from review of the original submission
form and the tissue blocks, it is easy enough to determine
whether this is the case. It is our opinion that advantages of
this technique far outweigh the disadvantages. We believe the
technique can be used for a wide variety of specimens, includ-
ing prostate biopsies, in which the possibility of inadvertent
switching of specimens might be an issue.
We have shown that routine inking of breast core speci-
mens is an easy and inexpensive way to reduce the possibility
of specimen mix-up.
From the Department of Pathology, Baptist Hospital of Miami,
Address reprint requests to Dr Renshaw: Dept of Pathology,
Baptist Hospital of Miami, 8900 N Kendall Dr, Miami, FL 33176.
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molecular genotyping assay to confirm the identity of tissue
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ABH blood group antigens to resolve problems in identity
of tissue specimens. Arch Pathol Lab Med. 1994;118:293-297.
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Rapid verification of the identify of questionable specimens
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