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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0043-1774752
Review Article

Optimization of Tissue Handling and Processing in the Era of Precision Medicine: A Practical Recommendation from a Multidisciplinary Panel of Indian Experts

Rajiv Kumar Kaushal
1   Department of Pathology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
,
Santosh Menon
1   Department of Pathology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
,
Omshree Shetty
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
3   Molecular Pathology and Translational Medicine Laboratory, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
,
Tanuja Shet
1   Department of Pathology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
,
Sangeeta Desai 
1   Department of Pathology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
3   Molecular Pathology and Translational Medicine Laboratory, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
,
Anurag Mehta
4   Department of Laboratory Services, Molecular Diagnostics and Transfusion Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
,
Anuradha Choughule
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
5   Molecular Laboratory, Department of Medical Oncology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
,
Bivas Biswas 
6   Department of Medical Oncology, Tata Memorial Hospital (TMC), Kolkata, West Bengal, India
,
Divya Midha
7   Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
,
Gurudutt Gupta
8   Department of Histopathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
,
Jaya Ghosh
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
9   Department of Medical Oncology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
,
Jay Mehta
10   Department of Oncopathology, Neuberg Oncopath, Mumbai, Maharashtra, India
,
Kumar Prabhash
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
9   Department of Medical Oncology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
,
Sayed Mahmood Nadeem
11   Department of Pathology, Nilam and NG Medicare, Kolkata, West Bengal, India
,
S P. Somashekhar
12   Department of Surgical Oncology, Aster DM Healthcare - GCC, Bengaluru, Karnataka, India
13   Department of Surgical Oncology, Aster International Institute of Oncology - GCC, Bengaluru, Karnataka, India
,
Ujwala Joshi
1   Department of Pathology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
,
Veena Ramaswamy
14   Department of Histopathology, Triesta Reference Lab, A Unit of HCG Hospital, Bengaluru, Karnataka, India
,
Veeraiah Koppula
15   Department of Radiology, Basavatarakam Indo-American Cancer Institute and Research Center, Hyderabad, Telangana, India
,
Sudeep Gupta
2   Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
9   Department of Medical Oncology, Tata Memorial Hospital (TMC), Mumbai, Maharashtra, India
16   Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Center (TMC), Mumbai, Maharashtra, India
› Author Affiliations Funding This work was supported by AstraZeneca, India.
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Abstract

Molecular analysis of biospecimens is the key to diagnostic and therapeutic decisions in clinical practice. However, there is a lack of consolidated guidelines for biospecimen collection, tissue handling, and storage in India. Therefore, this study aims to generate expert recommendations for the optimization of tissue handling and processing practices in India in the era of precision medicine. This study aimed to evaluate the clinical gaps related to tissue handling for molecular analysis and develop expert recommendations to mitigate preanalytical issues associated with biospecimen processing. These expert recommendations will help in increasing the diagnostic yield and accuracy of biomarker testing in clinical practice. A virtual advisory board meeting was convened with 19 experts, including pathologists, molecular biologists, medical oncologists, surgical oncologists, interventional radiologists, and a senior histology technician from 10 hospitals in India, along with an accreditation officer for testing and calibration of laboratory procedures. The scientific coordinators developed specific questions to address the salient issues associated with the preanalytic phase of tissue specimen preparation. The experts discussed each question until a complete set of recommendations was obtained. The expert panel provided recommendations for tissue collection, processing, fixation, and block preparation to ensure high-quality biospecimens. As per the expert panel recommendations, tissue sampling can be performed from any easily accessible site, regardless of the primary or metastatic locations. In addition, the cold ischemia time should be <1 hour, 10% neutral-buffered formalin should be used as the fixative, isopropyl alcohol should be used as the dehydrating agent, the volume of tissue to fixative ratio should be 1:10, and all the paraffin blocks should be archived in dry, pest-free conditions at room temperature. The experts suggested that the formalin used for fixation should be freshly prepared and its pH should be checked daily; moreover, the pH and date of formalin preparation should be mentioned on the containers. The experts highlighted the need to educate multidisciplinary teams on the optimization of tissue handling practices and emphasized that a pathologist should always check the tissue for adequate quality and quantity for biomarker testing. The existing routine clinical procedures for collecting and handling biospecimens adversely affect their quality. The expert recommendations for preanalytical quality control would ensure high-quality biospecimens for molecular analysis and precision medicine.

Keywords

biospecimens - cold ischemia time - fixation - tissue processing - paraffin blocks

Patient Consent

 


Authors' Contribution

All authors have contributed equally toward the conception, design, manuscript preparation, manuscript editing, review, and finalization of the manuscript.


Supplementary Material



Publication History

Article published online:
27 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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