eastern health - source: susan bonnell volume 10 page 129...eastern health -source: susan bonnell 7...

Eastern Health - source: Susan Bonnell Volume 10 29CIHRT Exhibit P-0113 Page 1

Eastern Health - source: Susan Bonnell

HealthCareCorporation of St. 101m 's

Volume 10 Page 131

T O :

F?OI~ ,

S UBJECT:

DATE :

PATH OLOG!STS, HS C , S T . CLJ..P..2 ' S .l;.ND OUT OF TOT. ~ ..f!0 SPITJ.LS

DP. . G . EJECLLJ.r" P.L.THOLOGIST , ES C~/

Ep./ pP. I!1!/fL1NOEI S TOCEE!~ I C.L.L ST.n. I NS/ L- .

I~ay 2 , 2003

I am g l ad to i nfo r m you ~hat we hay: ~ecc if ied the diff icu l t ies ~e lated to L~e

~mrn~~os t2in o f ER/ Prt , t h e r e f o re , we can n ow r esume r egu lar reque s t f o r th; s e

ant ibody s tains .

y our attent i or..:

I wi ll , h owever , l i ke t o b ri ng t h e follo~ing i nforma t i o n to

1 . Re sul t s o f t h e immunos tain s may ~e af f e c t e d by :

(a) Delayed fiK2ti o n .

(b ) Over f i x a tion .

(c ) Un d e r f i.x ac Lon .

(0) Uneven f ixa t i on .

(e ) Inad equa t e t issue dehydra t ion.

(fl Ti s sue reproces s ing .

The op t i mal f i x a t i on time f or imm~nos~ains i s 18 24 hour s, in '0%

nF utYal b u ffered f o r mal in. I f you u se a different fixative , p l e a s e

specify t.hat when yo u send your r e q u es t. .

: t i s a d v is a bl e t o maint.a~n a =egula ~ c heck on the PH o f the buf :er e d

fo~malin eve~ if i t i s p =o c u r e a c omme=ciall y . ~egula = c hec k a~d

c hang e o f g =ace s ~f a ~ coho: i n ~ he T i ssue P=ocesso r wi ll e ~ imirra t e

i~ac~quate t issue a e hyd=a tic n .

General H ospital

Health Sc ience Centre, 300 Prince Philip Drive, S1. John's, Newfoundland, Canada AlB 3\'6 Tel. (709) 737- 630 0 Fax (709) 737-6400

Website: www.hccsj .nf.ca

. ..... ,. . :.. ;•.. _. .•.- r .... · ~.. • nr I f-,-,r.::rc .!-. ;,1,111:! ': ~ IH : ~

CIHRT Exhibit P-0113


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Volume 10 Page 132.

2 . ER/ PP. f a lse ~egaLiv= ~ e su l t s inc~ : a s e ~ n co r e ~iOp5 i ~ s . ~h~re f ore , wne r e

possibl e r e strict r~quesL ~o ex cision b iops i e s .

Chec k normal br ea s t ac ini in your sec[,i:::ms a s i n t e r n ;:;. l c on :.r o l s . Th i s is

a second l eve l c ont r o l . Nucl e a r sta ir- i ng in n o r ma l b r e a s t c~ssue i s

he te r ogeneous and v a ries with menst r ua l cyc l e .

4 . I n c a r c i n oma or t he breast , mos t P?'+ ~umors a r E also E?+. howe v e r , 1 0 % o f

PR+ tumor s a re ER- .

Pa t ients with PR+ tumo~s have s ignificantly l onger dise a s e r r e e s u r v i v a l

than pa t i e n t s who a r e PR- .

s . Report ing o f ER/PR :

Se v e r a l f ormula e are i n t h e l i te~ature.

FOR POSITIVE EESULTS :

Ert+ grea t e r o r equal t o 5% nuclear sta ining.

ER+ 2 0% o f t umor s t aining .

2R+ 1 % - showTI t o bene f i t f r om e nd o c r i n e ~rea~m=~L .

Cons e n s us Statemen t on Adju~an t The r apy o f Breas t Ca n c e r, Nove mber 1 - 3 ,

200 0, Nat i ona l I~st i tut e of He a l t h . " Any po s i tive nu c lea r E?

immu~os t ain ing is c ons ide red to b e a p~s i t ive result and s h o uld b e a

def i n i t ive r eason f or i ns t ituting a n t i es t rog e n t h e !:"apy f o r a pa t i ent . "

The medi ca l onco~ogis t may r e qui r e pe r c e n t ag e o f tum~r posi t i Vity .

6. Hi g h e r staining i~ tensity d o es not r eflect bet ter ~esu~ t s . Th i s i s a

fun c t i o~ o f sta:'n:' ng p=oc ed~r e a n d ma y a l ~er.

E? a n d ?P. - mmunos t a-.n a r e :' 0 b e c ons i.de r ed as n:ga::~·-:e .



7 . ER~ve t umo r s :

Tubular .

!'1ucinous .

Papi l l a r y .

Du c t a l (low nucl ea r grade )

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Volume 10 Page 133.

8 . Low n ucl e a r grade ~umors are u sua l l y positiv e fo r E? / PP. and nega~iJe =o r

Eer2Neu whi l e high gr ade t.umors t e nd e.o be pos i t ive for HEr1Neu and

n egat i ve f or ER/PR .

We a re wo rking on t h e r ema inin g antibodi e s and hopefu l ~y al l n ormal

irnm~~os ta ins will resume s oon .

Dr _

c c : ESC and s~ . Cla r e 's

on ! mmQDo h isto c h emi s cry



~

HealthCareCorporation of St. John's

Volume 10 Page 134

TO :

FROM,

S UBJ ECT ,

DATE :

TERRY Gur~LIVER ~

Dr . G . EJECK.D..MU\V....

IMf~OH!STOCHEMICFL STAINS AT H~~TH SCIENCE CENTRE

J UNE 1 9, 2003

Following persistent erratic results o f imm~~os t2 ins in our lab o r a t ory , I

accepted to work closely with t he cec~~ical s taf f in order to rectify this

problem . Despite the fac t tha t t h e problem seems to have been arr e s t e d , the

state of im muno stain at the Gene r a l Hosp ita l Dep a r t me n t o f Labora t ory

Medi c ine and Pathology i s still unsatisfactory .

~ . The p hysical loca t ion o f t h is f a c i lity i s ~~sat i s factory.

Immunohi s tochemica l s tains n e e d to be h ou s e d in a s eparat e room with

prop er humidity contr ol . This i s l a cki ng in the co r ner of an open

l aboratory wh e r e t h e procedu res are c a r r i e d ou t a~ the mome n t .

2 . ImmQ~ohistochemical stain is not just anothe r special s t ain . I t is

a ffected by f ar more nume r ous factors t han may a p p l y in o ther s p e c i a l

s't.ains . I t is an extremely sensitive p rocedure, therefore, a haphazard

and lass ie affair a p p r oac h t o it is n~t the way t o go.

3. The s ta f f arrangement a s i t stands now is grossly inadequate and

una c c eptable f or prob l e m f r e e or mi n i ma l prob~em operations .

There has t o b e a d edi c ated s t a f f =0 t a t e ove r thi s s pecial proc edur e .

Th e staff is expected to read w~de on the subject and =0 u nderstand t h e

t h e o r y and practica l aspec ts o f the ~mmunoh i s t ochemi s t ry . The s t. a ff

Gene ra l Hospita l

Health Science Centre, 300 Prince Philip Drive, St. John's. Newfoundland, Canada AlB 3\'6 Tel. (709) 737-6300 Fax (709) 737-6400V·...ebsite: www.h ccsj .nf.ca

Janewav C~! !C n~2. 1± Centre/Children's Rehabi litation Centre 0 Dr. Leonard .L• . lvirller Ceuu c



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Volume 10 Page 135,

s hould be a probl e m shoo t e r and t ha t c a n o n l y ma t e r ial i z e t h rou g h thoro ugh

u n d ers tanding o f the subject . Be side s the d es ignated staff t h e r e should

b e a n eed f o r a stand -by s taf f in c a s e o f hol i d a y s or illnes s of the

designa t ed s t a f f . Th e d e d icated staff s houl d c u t a n d stain al l cas es

whi le the as s i stant /standby staf f d o es tha t : wice a week. Th e de s ign~t e d

sta ff us e s thi s v a luabl e t i me fo r hous e k e eping j ob s in immuno . Thi s wi ll

i ncl u de d e a l ing with o rde r i ng a nd t itra ting n e w a n t i b o d i e s _ This e nsures

tha t the s t and-by s t a f f is in tQ;e with ~he p rocedure and c an p r o d uce

acceptable res u lts when t h e nee d ari ses .

To do les s will simp ly b ecome a gamble wh e r e you may w~n or los e .

Th is ~bviously w~ l l spell disaster.

4 . The volume o f immunohi s t ochemical procedu~e s cont i nue s t o i n crease. Eve~y

day mor e d iagnostic ant i b o d i es a r e adde d to ~he armamentar i um of

immunOhi s tochemi s try . Each new ~~tibody po s e s i t s own s p e c i a l prob l e m

tha t n e eds to b e ma stere d a n d s olved b e fo r e re l i a b l e , reproduc i~le a n d

c ~ns istent =e s ults can b e obtaine d. Sin c e this is t h e o n l y cent r e in t he

prov i n ce t h at p e r f o rms c h i s te s t t h e r e i s enough case to be made for

iden t ify ing this activ i t y as spe c ia l and uniqu e , therefo~e, requi r e s

f i n a n c i n g a n d s t a f f i n g .

5 . The pr ~sent staff perfo~ming t h i s procedure are d o i ng the b e st t h e y caD

b u t wi th myriads of o t her d uties tha t take t hem a wa y f rom the ~~~uno st a i n

f ai r l y r e g u l a r l y it i s v irtually i mpos sib l e f o r t hem t o d evote the t ime

r~quired to master the int r i cacies o f this p rocedure.

Th e f a i r ly good stai n we have now is a cre d it t o t he m bu t they do not h ave



enoug h t i me t o s p a r e .

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Volume 10 Page 136,

I t i s my unde rstan~ing t o o. that some o f them hav e les s t ha t two or three

yea r s i n t he e s tab l i s hme n: a n d thei r exit will crea t e a v acu um and a n o ther

pe r i od o f un certai~ty r or i mmunohi s t o ch e mistry .

6 . F i nall y it i s p ert i n ent t o mention tha t results of immun o stains are

ext~eme ly importan t i n h i stop a t ho logic d i a g n o s is , esp e cia l l y wh e re

c l a s si f i c a t i on of lymphoma s and d etermination of b e nig n o r mal ignancy o f

c ertain les i ons , for e x amp l e , i n t h e p r-os t.at. e biopsies depend on c ri s p ,

r e lia b l e and repr o ducib l e s t a i n ing ~esults .

Diagnosi s bas ed on inappropriate immlli~o s tain wil l sure ly j eopardize

p a t i en t care ~~d may ev~~ expos e t h e HCCSJ to l i ~ iga t i on .

Therefo re , i L wil l b e i ll advised ~o op era Le ~, lli,rel iable and errat i c

immu~ohistochemic21 p r ocedures i n our labo~aLo~y _

I , t herefore , advise Lh a t y o u k indl y take a ha~d l o o k a t the a b ove a nd then

commi t t h e n e c e s s ary res o u r c e s , h uman and financi al to t h i s speci a l , al l

impo rta n t and on ly s erv i c e in the Provinc e o f Newfo~~dland .

c c: Dr. Desmond Ro b b, Agl . Chai r ma n , Di s cipl i n e o f La b o r a t o r y I~ e di c ine

Dr. D. Cook , Clini cal Chi e f and S i ~e Chi ef , St . Cl ar e 'sDr. S . Parai , Site Chi e f , HSCB a ~ ry Dye r , l~anager, Hi s t opath o logy


Eastern Health - so urce : Susa n Bonnell Volume 10 Page 137.

SURGICAL PATHOLOGY REVIE\V COMMITTEE (SPRC)HEALTH SCIEN CE CENTRE, HCCSJ

MINUTES OF MEETING, SEPTEMBER 23, 2003

PRESENT: Dr. G. Ejeckam, ChairmanDr. r.SiddiquiDr. M. ParaiDr. D. TennentMary Connors , Secretary

APOLOGIES: Dr. L. DawsonDr. S. Battcock

1. CALL TO ORDER

Dr. G. Ejeckam, Chairman called the meeting to order at 2:05 p.m. on September 23,2003 in Room 2864 . HSC. Dr. Ejeckarn asked if there was anything that needed to bechanged in the previous minutes. Dr. Siddiqui moved to accept the minutes, secondby Dr. M. Parai.

2. BUSINESS ARISING

2.1 EstroQen and ProQesterone Status

Dr. Ejeckarn stated that the technical problem with staining for ER and PRstains has been solved.


eastern health - source: susan bonnell volume 10 page 129...eastern health -source: susan bonnell 7...

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