Transcript Intraop Smear and Touch Prep

Making an Intraop
Neuropathology preparation
Starring Ed Plowey
Surgeon obtains specimen
• Tissue within needle is gently teased onto
saline MOISTENED (not soaked) Telfa
Set up
• Instruments: Clean surface, Scalpel, Fine
forceps, labeled slides, OPEN Fixative jar
Specimen arrival
• Labeling slides
Touch Prep
• Either:
– Turn slide frosted side down and touch to entire
specimen
Or if specimen firm (e.g. meningioma)
– Pick up with forceps and dab twice to slide
• DO NOT SLIDE OR SWIRL
• FIX IMMEDIATELY
– i.e. ASAP
– i.e. in less than 1 second
Touch Prep
Turn slide frosted side
down and touch
entire specimen
• FIX IMMEDIATELY
i.e. ASAP
i.e. < 1 second
Touch Prep Video
• http://www.youtube.com/watch?v=Koxv1L5gy
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Pituitary adenoma TP
Slide overview of Adenoma TP
20X of adenoma
Pituitary adenomas are diagnosed intra-operatively by Touch Prep ONLY
Preparing to
do smear
Smearing: Specimen size
Smearing
specimen size
• No Larger than tip
of pencil
• 0.5mm3
Smearing
• Slides can be held
parallel or
perpendicular (as
shown here)
Smearing Video
• http://www.youtube.com/watch?v=7BFWS6Iz
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Examples of good smears
Useable area
2 parts of specimen
on one slide
Superb Smear
Summary: Set up: Key features
• Slides labeled
• Specimen on moist Telfa pad
– Not Dry: Not immersed in saline
• IF specimen uniform
– Cut off piece up to (but not exceeding) size of tip
of pencil (<0.5mm3)
• IF specimen is biphasic
– Make two slides or
– Place small piece on opposite sides of slide
Common problems / solutions
• Too much tissue on slide
– Use less
• Air drying
– Be sure fixative jar (95% ethanol) is open and
adjacent to prep site
– Drop slide into jar for fastest fixation
• No tissue touches off or smears
– Move on to frozen section
TEST
What is wrong with this smear?
Smear problems: Too much tissue
• Solution: Obviously use less
What is wrong with this prep?
TP/Smear Problems: Air dried
• Solution: Have fixative jar open and closer
before starting prep
What is wrong with this smear?
Not enough material
all at bottom of slide
• Solution: Start by placing specimen ½” from
frosted end of slide
What is wrong with this TP?
Specimen not touching off
• Try smear and if that doesn’t work go to
frozen
What is wrong with this picture?
No Gloves !