Vol. 18 • Issue 10
• Page 78
Case Study
The Immunopathology Laboratory at Duke University Medical Center in Durham, NC, is a clinical laboratory that produces 80,000 immunohistochemical slides per year for the Duke University Health Systems (DUHS) network, Durham Veterans Administration and other outside consultants. Over the years, as our workload has grown, so has the need for automation.
Immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded tissue was initiated in 1979. Our first automated IHC slide stainer was the Code-On capillary gap stainer, developed by Dr. David Brigati. This was prior to the discovery of heat-induced epitope retrieval (HIER) techniques. While the "cap gap" stainer was a good platform for processing slides requiring no pretreatment or pretreatment with proteolytic enzyme, it was not suitable for processing slides that received HIER pretreatment, due to inherent HIER problems associated with tissue detachment. Detachment or lifting of tissue restricted flow of reagents by capillary action.
The increasing slide volume and implementation of HIER techniques necessitated a better automated staining platform. We selected the Autostainer from Dako. Based on the open system, our expenditures and a long-standing relationship with Dako, the autostainer was the right fit for our laboratory, using the reagent acquisition plan.
Saving Time
Older autostainer models are being replaced with newer Link 48 models that have a narrower footprint to save counter space. With the Link 48 stainers, we are able to track workload processes and incorporate data into quality indicator reports.
The pretreatment module standardizes target retrieval, and color-coded retrieval helps prevent placement of slides in the wrong solution. The laboratory information system, local area network and integration of specimen tracking connectivity allow us to maintain patient identification and reduce the number of times accession numbers and patient demographics need to be entered into the system.
Having been a user of concentrate antibodies for years, I also find the ready-to-use antibodies available in the Flex models a time saver. Optimized for the detection system and preprogrammed for added convenience, the signal generated is the expected quality. Participating in the price per slide with the Dako Flex detection system allows us to use Dako as our warehouse. Placing orders for replacement antibodies and support reagents requires a simple telephone call to Dako rather than a more time-consuming purchasing process.
Added Features
The openness of the Link software and staining platform allows me to perform clinical, developmental and research IHC. I am able to continue certain tests (e.g., double label staining) in the manner I am accustomed to, which also is a time saver for me. As our test volume grows, I see the Dako Link to be a valuable tool at my disposal for providing quality IHC results in contributing to patient care.
Technical Support
Dako's in-house training and technical support for set-up is stellar. Trips to their training facilities in Carpinteria, CA, have gone superbly, and the company's Southern California hospitality is a welcome break. Training personnel are patient and thoroughly explain all aspects of the Link operating system software, making sure the material is comprehended before trainees return to their places of employment.
Jim Burchette is an analytical specialist in the Department of Pathology, Clinical Laboratories, Molecular Pathology, Duke University Medical Center, Durham, NC.
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