Developments in IHC
The past eight decades have witnessed the development of direct detection techniques using fluorescein isothiocyanate (FITC)-labelled antibodies [2,3], and the subsequent introduction of indirect techniques resulted in the use of peroxidase–anti-peroxidase [4,5] and, later, streptavidin–biotin complex . The latter methods were developed to label antibodies applied to tissue sections to detect the presence of an increasing range of cellular elements. This has led to the current application of IHC and in situ hybridization (ISH) methods as vital diagnostic tools to detect the presence of diagnostically important cellular features.
The arrival of automated technologies led to the introduction of the first compact systems (BOND-III and BOND-MAX IHC/ISH systems, Leica Biosystems) able to provide fast, flexible and efficient delivery of quality IHC staining [7,8]. Further innovation this year saw the arrival of a technologically enhanced, next-generation staining solution (BOND-PRIME IHC/ISH System, Leica Biosystems).
What a customer wants
A study among pathologists and cellular pathology laboratory managers was carried out to understand how today’s pathologists perceive staining quality, and what quality means to them, as well as its effect on their working day or even their personal time. Moreover, there is the wider impact of poor quality, for example, in terms of overall laboratory costs of increased pathologist time.
The study noted the impact on service delivery when faced with poor-quality slides. This would increase the time it took to complete a case, whether from spending more time at the microscope
to arrive at a diagnosis or from the need to repeat staining.
While automation solutions replaced early, labour-intensive manual IHC methods that required careful, time-consuming technique, that same attention to detail can now be seen through the lens of delivering consistent and reproducible quality. The study noted that when an automated staining solution delivered consistently high quality, this built confidence in its performance. This was not only in terms of personal success, but it was noticeable how highly pathologists valued their institutions for investing in the means to deliver quality slides as standard. This was echoed by the repeated view that quality on one slide alone was insufficient; it required reliance on reproducibility as standard of that quality. This was judged equally important.
What was also interesting was the degree of personal pride expressed as “emotional and visual pleasure” that pathologists experienced from high-quality slides. This personal aspect was reflected when evaluating new systems, with pathologists seeking out colleagues for word-of-mouth endorsement. This was shown to have far greater influence than simply relying on manufacturer brochures and publications.
Never compromising on quality or productivity
As well as maintaining or enhancing the quality of immunostaining, pathologists and cellular pathology staff need a system with the flexibility to adapt rapidly to changing workflow requirements. This type of technological agility means a system that can handle any slide, in any combination, at any time and using any reagent. While several manufacturers can offer aspects of universal access (UA), only the new platform has the flexibility to deliver all four steps. For the laboratory staff this means time is saved by being able to:
• load any slide: any staining protocol, chromogen or technology;
• in any combination: load single slides, complete cases or full batches;
• with any reagent: add markers or detection at any time with 70 reagent positions; and
• at any time: preload and unload drawers let the user load and unload slides according to their schedule, not the instrument’s schedule.
In terms of productivity, they can expect an instrument delivering UA to provide touch time of less than 6 minutes for an operator when processing 96 slides, while loading and unloading 24 slides from the rack can take a fraction over 80 seconds.
Scheduled maintenance tasks are vital to ensure that quality is maintained and any equipment is running optimally. In line with the demands of the diagnostics healthcare sector, the claimed yearly user resource time of less than 6 hours means that laboratory productivity is increased as a result of the reduced time spent maintaining the system, thereby allowing staff to perform other critical laboratory tasks and activities.