Problem: Equivocal Color of Ink on Lumpectomy Margins upon Microscopy. Solution: Naked Eye Assessment of the Margin on the Corresponding Tissue Block.
Syed A Hoda, Laura Cervino, Joan G Jones. Weill Cornell Medical College, New York, NY
Background: Tumor removal and adequate margin clearance are major goals of breast lumpectomies. However, histological evaluation of margins can be problematic due to 2 main reasons: "trickling" of ink into tissue crevices and uncertainty regarding "true" color of ink. The latter problem has received minimal attention.
Design: All glass slides and selected corresponding tissue blocks from 50 randomly-selected archived breast lumpectomy specimens (all from 2010) were reviewed with particular attention to uncertainty regarding the true color of applied ink. In all cases, 6 colors (black, blue, green, yellow, orange and red) had been applied to fresh specimens. Davidson Marking System's ink (Bradley Products, Bloomington, MN) was used. Acetone was applied after application of ink. Lumpectomies were then formalin-fixed (> 6hours) and processed routinely. Tissue blocks were paraffin-embedded. Histological sections were cut at 5u, and stained with H&E.
Results: BLACK ink was not a problem per se in any case. BLUE ink was a problem when applied too thick, wherein it simulated black (in 9/50: 18% cases). Blue ink was also a problem when it abutted yellow-inked surface, turning green (in 9/50: 18% cases). GREEN ink was a problem when applied too thick, simulating blue or black (in 5/50:10% of cases). Blue ink was also a problem when it abutted yellow-inked surface, turning green (in 8/50: 16% cases). YELLOW ink was a problem when applied too thick, simulating orange (in 6/50: 12% cases). Yellow ink was also a problem when it abutted red-inked surface, turning orange (in 5/50: 10% cases). ORANGE ink was a problem when applied too thick, simulating red (in 5/50: 10% cases). RED ink was a problem when applied too thick, simulating black (in 3/50: 6% cases). Naked eye assessment of problematic margins in corresponding tissue block, with gross examination correlation, resolved the problem in all cases. Ink "trickling" into tissue crevices along the margin was not the focus of this work; however, "trickling" was present in 9/50 (18%) cases.
Conclusions: Assessment of true color at a margin in breast lumpectomies can be difficult when the ink is applied too thick. True color can also be difficult to determine at interfaces of yellow- and blue-inked surfaces, and yellow- and red-inked surfaces. Naked eye examination of the equivocal color of ink at margin on the corresponding tissue block provides a solution, as it appears that tissue blocks retain the color of originally applied ink significantly better than H&E-stained sections.
Monday, February 28, 2011 1:00 PM
Poster Session II # 34, Monday Afternoon