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. 2021 May 27:11:e2021291.
doi: 10.4322/acr.2021.291. eCollection 2021.

Formalin pre-fixation improves autopsy histology

Jennifer Vazzano  1 , William Sinclair  1 , Bradley Zehr  1 , Patricia Allenby  1
Affiliations

Formalin pre-fixation improves autopsy histology

Jennifer Vazzano et al. Autops Case Rep. .

Abstract

Microscopic findings in key tissues are often critical to determine the cause of death in medical autopsies. The overall quality of histologic sections depends on numerous pre-analytic factors, among which are tissue section size and thickness. We designed a prospective quality improvement study to determine whether a simple intervention of formalin pre-fixation of myocardium, liver, and kidney tissues could improve the ease of cutting and quality of autopsy histologic sections as assessed by histotechnicians and pathologists. Of 46 autopsies included in the study, 21 were randomly assigned to formalin pre-fixation, and 25 underwent routine sectioning without formalin pre-fixation. A significant improvement in overall quality score by histotechnicians was detected in the sections from pre-fixed autopsy tissues compared to the control group (p=0.0327). There was no significant difference in quality score between the two groups as assessed by pathologists. Our autopsy quality improvement study demonstrates that a simple, low-cost intervention of formalin pre-fixation of fresh autopsy tissues for 90 minutes could significantly improve the overall quality of sections submitted for histologic processing.

Keywords: Autopsy; Histology; Pathology; Quality Improvement; Tissue Fixation.

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Conflict of interest statement

Conflict of interest: All authors have no conflicts of interest.

Figures

Figure 1
Figure 1. Histologists and Pathologists questionnaires. A – The questionnaire sent to histotechnicians to score the thickness, size, and the ease of cutting of the tissue on a 1-5 scale (1 being poor and 5 being best; B – The questionnaire sent to pathologists to assess the histologic sections for cutting artifacts, thickness of the section, and depth of the section on a 1-5 scale (1 being poor and 5 being best).
Figure 2
Figure 2. Comparison of control tissue and formalin pre-fixed tissue. A – Histology of a tissue section taken from the right heart ventricle demonstrating artifacts; tissue was sectioned fresh without formalin pre-fixation (control); B – Improved histology of a tissue section taken from the right heart ventricle after formalin pre-fixation and subsequent tissue sectioning.
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