124 A Rapid Triage Protocol to Optimize Cold Ischemic Time for Breast Resection Specimens. (11th January 2018) - East, Ellen
Abstract: Context: Prolonged cold ischemic time (CIT), or time from tissue removal until adequate formalin exposure, negatively impacts estrogen receptor (ER), progesterone receptor (PR), and Her2 studies routinely performed on breast specimens. The College of American Pathologists and American Society of Clinical Oncology recommend CIT ≤1 hour. Since formalin does not rapidly penetrate resections, optimal formalin exposure does not occur unless the specimen is incised. Methods: We developed a triage protocol for breast (excisional biopsy [EB], lumpectomy, and mastectomy) resections to optimize CIT and allow later comprehensive grossing. Triage consisted of weighing, measuring, inking, and incising the specimen. Keyword searches identified cases (2014–2016). Clinicopathologic features including age; general diagnostic category (benign, atypia, or malignant); availability of, absolute, and approximate (≤1 hr, >1 but <4 hr, and ≥4 hr) CIT; performance of ER, PR, and/or Her2, and missing data (excision time and/or time in formalin), were recorded. Results: Partial analysis (~50% of data) included 1, 342 cases, 320 (23.9%) EB, 600 (44.7%) lumpectomy, and 422 (31.4%) mastectomy specimens. Mean age was 54.4 years (range 11–91), and 99.7% were female patients. A total of 472 (35.2%) were benign, 93 (6.9%) atypia, and 777 (57.9%) malignant. Malignant diagnoses were more frequent for lumpectomy (509/600; 84.8%) vs mastectomy (223/422; 52.8%) and EB (44/320; 13.8%). CIT was available for 84.4%, most frequently for mastectomy (385/422; 91.2%) vs lumpectomy (526/600; 87.7%) and EB (221/320; 69.1%). CIT was ≤1 hr and ≤4 hr for 872/1, 132 (77.0%) and 1, 118/1, 132 (98.8%), respectively. ER, PR, and/or Her2 were performed in 265 (19.7%), most frequently for Her2 alone (146/265; 55.1%) and on lumpectomies (156/265; 58.9%). Of 210 cases without CIT, excision time and time in formalin were missing for 111 (52.9%) and 167 (79.5%), respectively. Conclusions: Our rapid triage protocol allows for optimal CIT for the majority of breast resections; this is of growing importance as ancillary studies are increasingly recommended to be performed on these specimens.