15/09/2016 07:25A Cure-All For Block Management Woes?

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ManagementManagement

Woes?Woes?

Automated paraffin block

storage systems can

increase traceability and

security while reducing the

time and effort needed to

sort and store

By Valérie Costes Martineau, Laure Dumas andNicolas Leventoux

About thisArticlePublished inIssue #0116

Welcome to theJanuary issue. OurUpfront topicsinclude disease-predictingproteins, theongoing debateover cancerscreening, and theworldwide agarshortage. OurFeature profilesManuel Sobrinho-Simões, Portugal’sleadingpathologist and asignificantproponent ofmolecular biology

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At a GlanceThe volume of paraffin blocks inuse has seen a dramatic increase –but our storage space hasn’tComplicated, non-standardizedblock storage systems can lead toerrors and losses, which in turncan delay vital patient careA fully automated paraffin blockstorage system reduces both thetime and space needed to sort andfile large numbers of blocksThe system can also improvesecurity by limiting access tostorage areas and tracing eachindividual block’s whereabouts

In an era of increasing digitization, it’s rare tohave a conversation about physical storage.But it’s an area that needs our attention – thevolume of paraffin blocks needing storage hasincreased dramatically over the last 10 yearsand is continuing to rise. The population isgrowing, patients are aging, cancer incidenceis rising, and standards of care are improving –all things that lead to an increase in tissuesampling. But with tighter legal frameworks,more exacting standards for laboratoryaccreditation, and the increase in blockscirculating for second opinions or advancedanalysis, there’s a desperate need to manageparaffin block storage and access. Especiallygiven the current shortages of technicians andresources, there’s a real risk of mislabeling or

with somecontroversialopinions on thedigital revolution.In Practicefeaturesautomatedparaffin blockstorage, and inNextGen we lookat an inexpensiveprototype 3D-printed in vivomicroscope. InProfession, we seethe power of the#PathArt hashtagand onlinecommunity-building, and weSit Down WithFred Bosman,Professor Emeritusat the UniversityInstitute ofPathology,University MedicalCenter ofLausanne,Switzerland.

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misplacing blocks – and, because they’re theones that most often change hands, it seemsthat it’s always the most precious blocks thatgo missing.

Each error or loss of a paraffin block risksdelaying key diagnoses and treatments. Thispressing need, and the lack of an establishedmanagement system, led to a collaborationbetween the medical device department atCHRU Montpellier and Dreampath Diagnosticsto develop FINA, the first fully automatedparaffin block management system. Our twogroups cooperated to determine the necessaryspecifications and to test each prototype. Thefinal version of FINA, which we’ve beenrunning routinely in our lab since June of 2014,consists of a block scanner and accompanyingmanagement software.

Manual managementCHRU Montpellier is a university laboratorythat handles about 30,000 biopsies andsurgical samples each year and produces about100,000 blocks per year. In the last 12 months,we have retrieved 19,712 blocks from storage –mainly for daily routine techniques (91percent), but also for targeted therapy (4percent), research or clinical trials (3 percent),and access to our expert network or secondopinions (2 percent). Before the advent ofFINA, these blocks were sorted by numericalorder in metal drawers, a system that requireda lot of time and space. Anytime a large series –like an autopsy, fetal pathology, or set of bonespecimens – came in late, we had to move alarge number of blocks. Once a week, wetransferred blocks from the drawers into aseparate set of cardboard drawers for long-

+offer insights andadvice on bestpractice, techniques, toolsand technologies. In practice articlesreport valuableinsights frompathologists andlaboratorymanagers; offeringinsights andadvice on bestpractice fromleading experts,and examining theimpact of newtechnologies,materials andtechniques onpathologists’ dailypractice.

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term storage in the basement. The system wasdifficult to use; there was no security, we onlyused a block register when we knew sampleswould be out of the lab for a long time, and ourtechnicians lost a lot of time looking for blocksthat had been misplaced or removed and thenre-archiving them after use. Just managing ourblocks required the equivalent of nearly oneand a half full-time jobs!

Figure 1. a. The FINA paraffin block storage system. b.Blocks randomly placed in a storage tray. c. Acomplete storage tray entering the scanner. d. Usingthe PDA to remove a block from storage. e. Ourlaboratory’s block storage cabinets.

Automated managementTo gain more control over our blocks, weturned to automated management. The FINAsystem consists of a scanner, a computer with aPDA, a label printer, and a set of cabinets(Figure 1a). With this system, the blocks arestored in a special tray at the cutting station; itholds 240 blocks, but they can be placed in

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random order to save time (Figure 1b). Oncethe technicians have finished cutting, theyscan the tray (Figure 1c) to enter it into thespecialized software, which requires a userpassword to ensure access security andgenerates reports to improve traceability.Scanning time varies from two to six minutesbased on the number of blocks, quality ofprinting and cleanliness of the paraffin block.The percentage of unread blocks is very low (inour case, 242 of 26,400, or 0.9 percent), andchiefly occurs as a result of paraffin depositionon the barcode of the label. If a barcode isdamaged or unreadable, we also have theoption of taking a photograph and entering itmanually into the software.

To “check out” a block, the user creates a picklist and exports it to the PDA (Figure 1d). Foreach block, the system asks the user’s name,reason for removing the block, and expectedduration of use. The PDA shares thisinformation with the main system computer;then, if the blocks aren’t returned on time,alerts and reports help us to follow up withusers and ensure the samples don’t go missing.We also have FINA connected to our laboratoryinformation system (LIS), so that we canautomate our requests directly from the LIS.We store each tray in a cabinet in thelaboratory for two years (Figure 1e) beforetransferring it to long-term storage – at whichpoint, the FINA software records its newposition.

Using a fully automated system not only savesus the space needed to sort blocks, it alsoallows us to ensure good traceability byrecording who checks out each block, when,and why. It minimizes the risk of loss, as we

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can now better manage the blocks as theymove within and outside the lab. The use ofpasswords and reports improve security, asonly authorized people have access to theblocks and the system records all activity. Butalthough all of these are useful functions, theone we’ve found most useful in our lab is thatone entire person’s worth of workload has beentaken off our hands, letting us devote our mostvaluable resource – time – to our work.

Valérie Costes Martineau is head of thedepartment of anatomic and cytologic pathologyat CHRU Montpellier, France.

Laure Dumas and Nicolas Leventoux aretechnicians in the department.

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