A rapid triage protocol to optimize cold ischemic time for breast resection specimens.

Area of Science:

• Anatomic Pathology
• Surgical Pathology
• Oncology

Background:

• Prolonged cold ischemic time (CIT) negatively affects estrogen receptor (ER), progesterone receptor (PR), and HER-2 biomarker accuracy in breast specimens.
• Current guidelines recommend a CIT of ≤1 hour for optimal biomarker studies.
• Formalin fixation is slow, necessitating specimen incision for adequate and rapid tissue preservation.

Purpose of the Study:

• To evaluate the efficacy of a rapid triage protocol designed to optimize CIT for breast specimens.
• To assess the impact of specimen type (excisional biopsy, lumpectomy, mastectomy) on CIT.
• To highlight the importance of timely fixation for all breast resections, regardless of initial diagnosis.

Main Methods:

• Retrospective analysis of 2821 breast specimens (excisional biopsies, lumpectomies, mastectomies).
• Evaluation of cold ischemic time (CIT) data and immunohistochemistry (IHC) performance.
• Implementation and assessment of a rapid triage protocol for optimizing specimen fixation.

Main Results:

• Of 2362 specimens with recorded CIT, 78.1% met the ≤1-hour guideline.
• Immunohistochemistry (IHC) was more frequently performed on lumpectomies and mastectomies compared to excisional biopsies.
• Excisional biopsies were less likely to have recorded CIT, yet IHC was still performed on 11.1% of these specimens.

Conclusions:

• A rapid triage protocol is effective in optimizing cold ischemic time (CIT) for breast specimens.
• All breast resections should be treated as potentially requiring biomarker studies, emphasizing the need for optimal CIT.
• Standardizing rapid triage ensures the reliability of ER, PR, and HER-2 testing for all breast cancer patients.