Knowing about Lymphology·The first phase of big coffee gathered, focusing on the improvement of pathological technology, helping to accurately diagnose lymphoma

In order to further enhance the pathologist’s ability in the clinical differential diagnosis of common tissue diseases and lymphoma, and reduce the occurrence of missed lymphoma diagnosis, the "Knowledge of Lymphoma-Basic Lymphoma Diagnosis" series of interviews officially set sail, and Yimaitong will invite many people Experts in pathological diagnosis of lymphoma were interviewed to share the theories and practical experience in the differential diagnosis of common diseases and lymphomas in different tissues, so as to help pathologists to improve the comprehensive diagnosis ability of lymphoma
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In this issue of "Lin Li Zhi Zhi", Professor Zhang Yan from Peking University Third Hospital, Professor Meng Qingyang from Peking University Third Hospital and Professor Pan Huaxiong from Union Hospital of Tongji Medical College of Huazhong University of Science and Technology were invited to be interviewed to share clinical laboratory specimen processing technology and quality control Relevant experience
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Prof.
Zhang Yan: The classic quotations of pathology technology from obtaining materials to staining diagnosis: Do a good job in the quality control of the handover (error-prone) link, and achieve full responsibility to the person (the video is longer, it is recommended to watch under WiFi conditions) The sample processing of Yimaitong includes There are six processes of pretreatment, fixation, dehydration, embedding, slicing and dyeing.
Quality control is an important connection point between the processes.
Please talk about how to sort out the quality control within and between processes
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Professor Zhang Yan should strictly abide by the operating procedures and specifications for the internal quality control of the specimen processing process, and pay attention to the quality control between the processes: 1.
Pre-treatment and fixation of the organization: The vacuum sample transfer system can help solve the problem of difficulty in instant fixation at night ; In the fixation process, small specimens should be used by clinicians as far as possible to choose transparent bottles and soak them in the fixative
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2.
Dehydration: For gastrointestinal endoscopy specimens, a 6-7 hour dehydration process is very necessary.
If dehydration is only performed for 3 hours, it may be due to the loss of a part of the nucleic acid of the tissue due to excessive temperature and excessive pressure, which may cause some molecular damage.
Improper handling
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3.
Embedding: Since the organization is directly exposed and unlabeled, embedding has become the most vulnerable link in daily work.
Therefore, the operating specifications of embedding are very important.
Avoid tissue loss and prevent the loss of the organization. .

4.
Slicing: A single slice responsibility system is implemented, and each machine is equipped with a slide marking machine
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5.
Dyeing: dyeing process, liquid replacement and dyeing machine maintenance are all important links of dyeing
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Marking and sorting large and small specimens on the dyeing machine helps to improve work efficiency
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Yimaitong What do you think are the key points in the quality control of specimen processing? The key links of quality control by Professor Zhang Yan include handover links, irreversible links, human factors affecting technical quality links and record control links
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1.
In the handover link, modern technology should be used to reduce the handover errors of the eight handover and conversion links, so that full responsibility is given to each person
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2.
In the irreversible link, the maintenance of the dehydrator should follow the SOP combining process and experience, and deal with the details
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3.
Implement a single-person responsibility system for key quality control links in the links of human factors affecting technical quality and conduct daily random inspections to summarize problems and deal with them in a timely manner
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4.
Regarding the record control link, attention should be paid to regularly summarize and summarize into a monthly technical quality control report
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What do you think is included in the technical quality control of Yimaitong? Are there any links between them? Professor Zhang Yan technical quality control includes internal quality control, communicating with diagnosticians and conducting various inspections.
Quality control management is an interlocking process management.
It is necessary to clarify the importance and focus of each process of quality control, and clearly implement responsibilities.

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(For more details, please refer to the interview video in this issue) Professor Meng Qingyang: Conventional production process and precautions Diagnostic classic quotes: interlocking, every link needs attention (the video is longer, it is recommended to watch under WiFi conditions) Medical Pulse Through embedding, the tissue can obtain a certain degree of hardness and toughness, which is convenient for sectioning.
It is an important part of specimen processing.
Could you please talk about the precautions for embedding? Professor Meng Qingyang's "four preventions" are 4 areas that need to be paid attention to during the embedding process: prevention of "pollution": the table must be kept clean and tidy during the embedding process; tweezers must be burned with an alcohol lamp after each wax block is embedded
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Avoid "splashing": When using tweezers to unpack, be careful about small tissues, punctured tissues and other tissues that are easy to pop out
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Anti-"lost": When opening the box cover, pay attention to whether there is tissue adhesion on the box cover, and observe whether the number of tissues is consistent with the mark on the box
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Prevent “sweeping the crown and wearing the crown”: Do not open multiple cassettes at once, open one to embed one
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Secondly, for the choice of embedding direction, the cut surface of the tissue/pathological position should be embedded downward; for special tissues (such as gastrointestinal, skin, lumen and other tissues that require observation levels), vertical embedding should be selected; in the choice of location , The tissue should be placed in the center of the mold, and multiple small/long tissues should be placed neatly and concentratedly and flat
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Yimaitong slice is the process of making slices with a slicer after the tissue blocks are taken, fixed, dehydrated and embedded.
Can you talk about the precautions for slices based on your daily work experience
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Professor Meng Qingyang’s slicing process needs to focus on the “three preventions” (as shown in the picture above), followed by the “six preventions”, the prevention of “folds”, the prevention of “overlaps”, the prevention of “chatter marks”, and the prevention of “knife marks”.
Prevent "cracks" and "incomplete cuts"
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Yimaitong dyeing allows specimens to be directly observed under an optical microscope, which is one of the key links in the routine film production process.
Could you please talk about the details that need to be paid attention to in the dyeing process
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Professor Meng Qingyang’s staining is a process in which dyes are combined with cell tissues.
In the process of dehydration and transparency, poor transparency leads to blurred tissue structure, prompting a change of fluid
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After the machine is used for dyeing, it will be taken out under a microscope for quality control to observe the contrast of red and blue, so as to adjust the hematoxylin and eosin in time to ensure that the nucleoplasmic dyeing contrast is sharp
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Pay attention to adjusting the amount of glue when sealing the film; when the glue is small, it is easy to cause air bubbles.
It should be noted that the glue needle should be soaked in xylene in time after the film is sealed, and the previous glue liquid should be shot out before the film is sealed
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The specimen processing process should be operated in accordance with the standardized process.
When each step is carried out, think about one more step, and consider whether it will affect the next step
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The links are interlocked, and every link needs to be paid attention to .

Prof.
Huaxiong Pan: Immunohistochemistry and chromosome quality control-the role of pathologists.
Diagnosis classic quotes: The improvement of doctors' immunohistochemistry technology can help improve the accuracy of diagnosis (the video is longer, and it is recommended to watch under WiFi conditions) Yimaitong technician , Reagent manufacturers, quality control centers and pathologists are all participants in quality control.
Could you please talk about their role in quality control? Prof.
Pan Huaxiong Technician: It can monitor the external control and find high background and uneven staining, but it cannot detect the staining failure of the internal control, nor can it monitor all the indicators.
It is still unable to solve the subtle problems such as false negatives and antigen loss
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Reagent manufacturers: Under the standard process, the compatibility of the primary antibody and the secondary antibody is recommended to choose a closed platform and bind the two; automated stains can help solve the problem of the standardization process of staining
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However, the timeliness of solving the problem is poor, and it is impossible to detect the failure of the internal control staining
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There may be qualitative differences in the quality of different reagent manufacturers .

Quality Control Center: It is helpful to find quality control problems, but the quality control indicators are limited and timeliness is poor
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Pathologist: Can monitor all indicators, solve timeliness issues, and be familiar with the expression profiles of various antibodies, but because of unfamiliarity with the technology, they cannot propose quality control-related solutions
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Quality control is a systematic project that requires the coordination of clinicians, technicians, reagent manufacturers, and doctors.
As it involves professional diagnostic capabilities, the choice of quality control personnel is recommended to the director of the pathology department or senior diagnostician
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The quality of Yimaitong immunohistochemistry plays an important role in the diagnosis of lymphoma.
Could you please talk about the possible problems in the section processing process
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Professor Pan Huaxiong needs to go through the dehydration and slice staining process of the operating room, the sampling room and the pathology department from the operating room to the pathological slice presented at the table of the pathologist
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Yimaitong pathologists play an important role in the quality control of immunohistochemistry.
What do you think are their responsibilities? Prof.
Pan Huaxiong understands technical pathologists to help solve the quality control problems of the whole process.
The role of pathologists is to identify technical problems through slice observation, listen to the analysis of technicians, jointly formulate solutions, and complete the verification and improvement of the solutions.

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During the interview, Professor Pan analyzed the reasons for the problems of common HE slices through sharing 7 actual cases, and put forward solutions based on his own years of clinical experience
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(For more actual case sharing, please refer to the interview video in this issue) Yimaitong dyeing intensity is an important factor in determining the dyeing effect.
Could you please talk about what is the ideal dyeing intensity and its determining factors? Professor Pan Huaxiong's different cells will have different staining intensities for the same antibody.
Without staining intensity, there will be no staining levels.
The ideal staining intensity includes brown (yellow through black), accurate and complete membrane positioning, and complete coverage of the nucleus
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The factors that determine the intensity of staining are shown in the figure below.
The doctor's understanding of antibodies determines the final staining effect
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For the repair time, it is recommended that the standard time of the water bath is ≥40 minutes, the pressure cooker is 1-4 minutes (to know the specific test), and the recommended pH value of the repair liquid is 9.
0
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The next issue of the preview of lymphatics The basic differential diagnosis of lymphoma-theory If you want to view the expert interview video of this issue, please