Inking the Specimen

INKING THE SPECIMEN

·         Various Water/organic fluids insoluable inks and colored powders can be used to mark critical points on the specimen.

·         These dyes and powders may help orient both the gross specimen and the histologic section. For example, colored tattoo powder sprinkled on the outer surface of a cystic mass can be used to distinguish between the outer and inner aspects of the cavity.

·         Similarly, India ink can be painted on the surgical margins so that they can be easily recognized at the time of histologic examination.

·         Indeed, many times the critical distinction of whether a neoplasm extends to the surgical margin depends entirely on the absence or presence of ink.

·         Given the important implications of an inked surface, these inks should be carefully and judiciously applied to the gross specimen.

·         Keep in  mind that just as the effective use of inks can facilitate the histologic interpretation, the careless and improper use of these inks can befuddle the microscopic findings.

·         The implications of sloppily applied ink that runs across a surface where it does not belong will be disastrous.

·         The following guidelines outline the proper application of inks:

o   If possible, apply ink before sectioning the specimen.

o   Do not use excessive ink. 

o   Dry the surface of the specimen with paper towels before applying ink.

o   When applied to a dry surface, ink is more likely to stick to the desired surface and less likely to run onto other areas of the specimen.

o   Allow the ink to dry before further processing the specimen.

o   Do not cut across wet ink, as the knife is likely to carry the ink onto the cut surface.

Cassette Dimensions

Inside dimensions for a screened cassette are: 2.5 x 2.0 x 0.3cm

Inside dimensions for a standard slotted cassette are: 3.0 x 2.5 x 0.3cm

Routine tissue sections submitted in standard slotted cassettes should be no larger than 2.5 x 1.5 x 0.3cm to allow for proper processing.

Screened Cassettes

• Distinct advantages to using screened cassettes with small tissue biopsies;

1.Negates the need to wrap samples, a big time saver.

2.Positive seal created when properly closed.

3.Prevents cross-contamination with other tissues during processing

Cost is a major Disadvantage

For Small Biopsies

• Number of Pieces Each Container - To the best of your ability, give an accurate count. Check the container (to include the lid!) and req. for a reference to the number of pieces submitted.

Often samples are fragmented. In this case, count the number of significant pieces, give size(s), and add the descriptor “fragmented”. Additional Descriptors for Number

• Additional descriptors for number of pieces; Multiple(>10) - Give aggregate dimensions with average size each. Do not submit more than 5 per cassette.  Myriad – too many to count (fragments), give aggregate dimensions. Filter thru screened cassette.

• State the size(s) of the tissue(s) received: Always stated in the context of mm.’s or cm.’s Do not use inches. If you start the case using mm.’s, then use mm.’s throughout. If you start the case with cm.’s, then use cm.’s throughout. Ex. 0.4cm or 4mm.  Whole cm.-Do not use decimal point and zero.

• Referencing the size(s) of the piece(s): If only one, self explanatory. If two or more of the same size, then state as: __ mm. or cm. each. If two of different sizes, then state as: __ and __ mm. or cm. each.

If three or more with different sizes, then state as: ranging from __ mm. or cm. to __mm. or cm.

Cores - • Whenever possible, give exact count of tissue cores. Not necessary to give the diameter of the cores in most cases, but always give the length of each core.

• Indicate formalin exposure times with cores.

Biopsy Tissue Configurations

Irregular /Fragmented/ Cores/Polypoid/Sessile/Pedunculated

Punch Biopsies(Derms)- • Elipses(Derms)/• Shaves (Derms)

To Cut or Not To Cut!

• Most diagnostic cases do not require additional cutting or inking.

• Polyps >5mm should have their bases inked and be bisected.

• Punch biopsies >4mm should also be bisected.