Experience with implementing the Tissue-Tek AutoSection® of the Schwarzwald‐Baar‐Klinikum in Villingen Schwenningen, Institute of Pathology

"The  different protocols  available  on  the  Tissue‐Tek  AutoSection^®  are  a  relief for us and a virtual guarantee for consistent quality.” Ms. Hummel

Background about the Pathology Institute:

The  Institute of  Pathology  at the  Schwarzwald‐ Baar‐Klinikum  in  Villingen  Schwenningen  has  18  employees,  including  three  specialists  and  several  assisting  doctors  with specialist training. 

Approximately 17,000 tissue tests per year are processed at this institute. Of which, about 500 are shavings. More than 90 percent of the samples are processed at the pathology department,  with  the  rest  via  the  medical  care  centre  and  external referring physicians. 

The lab works with one laboratory information system, prints both  the  cassettes  and  slides,  conventionally  dehydrates  with   the   Sakura^® Tissue‐Tek  VIP6^®,   cuts   the   tissue sections and stains them mainly with the Sakura Tissue‐Tek Prisma^® and Tissue‐Tek Film^®.

 For immunohistology and follow‐up reports (special stains, H&E repeats and further stages), the tissue sections are cut on the Sakura Tissue‐Tek AutoSection^®. 

What  led  you  to  purchase  the  Sakura  Tissue‐Tek AutoSection?

Every day we are challenged to meet the consistent quality expectations  for  each  tissue  section.  Especially  when  it  comes to serial and re‐cutting of a tissue block, the first tissue section should be just as good as the last. To achieve this, we previously had to align the block with a spirit level. One microtome in the laboratory was the standard and all others were aligned. To ensure proper alignment, we had to work with test blocks. In general, that procedure was very time‐consuming. 

Ever since I saw the Tissue‐Tek AutoSection at the Sakura stand during the Bamberger Morphology Day 2013, I wanted that instrument for our institute.

An important reason for our acquisition of the Tissue‐Tek AutoSection  was  that  we  were  suffering  recurring  tissue loss. We were constantly receiving more biopsies from our customers.  Almost  all  with  very  low  amounts  of  tissue.  To  ensure  that  we  had  enough  material,  we  always  had  to  make a few practice cuts, and often the spare section slides were not used. 

This  led  to  extra  working  hours  and  unnecessary  costs.  With  the  Tissue‐Tek  AutoSection  we  now  only  produce spare  section  slides  in  special  cases  such  as  for  bone  marrow cores. In other words, those that are actually dyed and reviewed.

How  do  you  use  the  Tissue‐Tek  AutoSection  in  your institute?

Usually  we  use  the  Tissue‐Tek  AutoSection  to  cut  all small  biopsies  such  as  pulmonary  PE  and  various  very  small  biopsies,  as  well  as  the  so‐called  re‐cuts  and  the required cuts for immunohistochemistry. These are typically secondary   sections,   made   after   the   inspection   of   the   H&E  staining  by  the  pathologist  to  determine  if  and  which  antibodies  need  to  be  stained  by  immunohistochemistry.  With  little  material  in  the  tissue  block,  this  is  often  like  walking a tightrope.

Even with special staining such as the PAS, Gomori, target Nielsen or Congo dyes, for us, the first tissue section needs to  have  the  same  average  quality  as  the  last  section.  It  is  therefore logical to cut the tissue block with the Tissue‐Tek AutoSection.  

Meanwhile, we are also using the instrument more and more for routine re‐cuts. The automatic alignment of the block on the Tissue‐Tek AutoSection is crucial for use and helps us  immensely.  Even  when  we  use  older  blocks  from  the  archive, (re)cuts with minimal tissue loss can be achieved. 

Our  department  works  with  the  Tissue‐Tek  AutoSection more and more every day. A growing number of MTAs cut with  the  Tissue‐Tek  AutoSection  and  enjoy  the  benefits described above. It’s great to work with this microtome, and completely worthwhile to be open to new techniques. 

What are the benefits for the material you cut, for you and for the pathologists?

For  the  material,  it  means  lower  tissue  loss.  Even  with the  smallest  amounts  of  patient  materials  (such  as  lung biopsies) we still produce good tissue cuts with the Tissue‐Tek AutoSection. 

It makes our work much easier and is also beneficial for the patient. They don’t have to undergo repeat tissue sampling and get a safe diagnosis. This helps us to meet the quality requirements, which is also important for our certification. 

For the MTA, the Tissue‐Tek AutoSection makes working easier.  We  can  ensure  that  the  quality  of  the  sections  and  patient material is sufficient.

The  different  protocols  available  on  the  Tissue‐Tek AutoSection  are  a  relief  for  us  and  a  virtual  guarantee  for  consistent quality.  

Using  the  Sakura  solution,  microtome  and  blade,  we create fewer deviations during sectioning. If we produce controls  for  immunology  ‘on  slide’,  we  can  control  tissue  blocks  where  the  cut  thickness  is  equal  to  the  tissue  sections. 

Again, the program embedded in the Tissue‐Tek AutoSection gives us consistent quality and therefore safety. This enables us to regularly pass the external quality assurance scheme tests. 

Since  the  Tissue‐Tek  AutoSection  aligns  the  block  and trims automatically, I can now perform extra activities. For example, I can clean the paraffin block of excess paraffin. It saves a lot of time. 

For the pathologist, satisfaction with the section quality is of the utmost importance. The goal of always achieving the same section quality is possible. Our pathologist saves time here  because  he  can  examine  the  tissue  section  without  repetition and can make the diagnosis. If re‐sectioning is required for immunohistochemistry or special staining, our senior doctor brings up the H&E for sectioning on our new ‘wonder microtome’. 

What  has  changed  for  you  with  the  Tissue‐Tek AutoSection?

Meeting the requirements has become easier. Thanks to the Tissue‐Tek AutoSection, we can be confident that we have sufficient material. Sections from the archive are simply the next  cut  on  from  the  last  cut  that  was  done  on  this  case.  We save time and minimise stress because we don’t have to  move  a  block  holder  manually.  We  can  count  on  the  reliable quality of the Tissue‐Tek AutoSection, and our work is therefore more relaxed. 

In which methods is your institute specialised?

The pathology in the Schwarzwald‐Baar Klinikum offers a wide range of services. Our pathologists work on all tissue submissions:  breast,  prostates  and  also  large  intestines  are sent to us by our customers. Mainly, the tissue comes from  our  hospital.  We  serve  a  total  of  seven  different organisations. 

How many MTAs are in your lab?

We have nine MTAs in total, and we offer both an early and late service.

Do you need more time to make tissue sections with the Tissue‐Tek AutoSection?

No,  absolutely  not.  We  are  now  much  more  comfortable  working   in   microtomy   for   immunohistochemistry   and   special stains. Due to the simplified and safe working on the Tissue‐Tek AutoSection, we no longer have to worry about the material and can offer high quality sections.  

How  do  you  see  standardisation  and  quality  versus  speed when cutting?

We are ISO certified and will undergo a re‐audit within a year, for which we expect to be re‐certified. We have included the Tissue‐Tek AutoSection in this quality process. 

Standardisation  for  cutting  is  a  very  important  factor  for  us  when  it  comes  to  consistent  quality  of  tissue  sections  and subsequent diagnostics. As mentioned above, the last tissue section should mirror the first section. Automating the sectioning operations brings a higher level of concentration on quality from the user. This is a nice side effect in terms of cutting speed and quality. 

Very  important  is  the  cleanliness  of  the  Tissue‐Tek AutoSection,   which,   of   course,   goes   for   any   other   microtome.  The  alignment  plate  behind  the  cutting  block  must  be  absolutely  clean,  otherwise  the  exact  alignment  would  no  longer  be  guaranteed  and  the  quality  of  the  material being cut would suffer.