Correcting the shrinkage effects of formalin fixation and tissue processing for renal tumors

Toward standardization of pathological reporting of tumor size

Thu Tran, Chandru Sundaram, Clinton Bahler, John Eble, David Grignon, M. Francesca Monn, Novae B. Simper, Liang Cheng

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Given the importance of correctly staging renal cell carcinomas, specific guidelines should be in place for tumor size measurement. While a standard means of renal tumor measurement has not been established, intuitively, tumor size should be based on fresh measurements. We sought to assess the accuracy of postfixation and microscopic measurements of renal tumor size, as compared to fresh measurements and radiographic size. Thirty-four nephrectomy cases performed by a single surgeon were prospectively measured at different time points. The study cases included 23 clear cell renal cell carcinomas, 6 papillary renal cell carcinomas, and 5 other renal tumors. Radiologic tumors were 12.1% larger in diameter than fresh tumors (P <0.01). Furthermore, fresh specimens were 4.6% larger than formalin-fixed specimens (P <0.01), and postfixation measurements were 7.1% greater than microscopic measurements (P <0.01). The overall mean percentage of shrinkage between fresh and histological specimens was 11.4% (P <0.01). Histological processing would cause a tumor stage shift from pT1b to pT1a for two tumors in this study. The shrinkage effects of formalin fixation and histological processing may result in understaging of renal cell carcinomas. The shrinkage factor should be considered when reporting tumor size.

Original languageEnglish (US)
Pages (from-to)759-766
Number of pages8
JournalJournal of Cancer
Volume6
Issue number8
DOIs
StatePublished - 2015

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Tissue Fixation
Formaldehyde
Kidney
Neoplasms
Renal Cell Carcinoma
Nephrectomy
Guidelines

Keywords

  • Kidney
  • Pathologic staging
  • Radiographic size
  • Renal cell carcinoma
  • Tissue processing shrinkage
  • Tumor size measurement

ASJC Scopus subject areas

  • Oncology

Cite this

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title = "Correcting the shrinkage effects of formalin fixation and tissue processing for renal tumors: Toward standardization of pathological reporting of tumor size",
abstract = "Given the importance of correctly staging renal cell carcinomas, specific guidelines should be in place for tumor size measurement. While a standard means of renal tumor measurement has not been established, intuitively, tumor size should be based on fresh measurements. We sought to assess the accuracy of postfixation and microscopic measurements of renal tumor size, as compared to fresh measurements and radiographic size. Thirty-four nephrectomy cases performed by a single surgeon were prospectively measured at different time points. The study cases included 23 clear cell renal cell carcinomas, 6 papillary renal cell carcinomas, and 5 other renal tumors. Radiologic tumors were 12.1{\%} larger in diameter than fresh tumors (P <0.01). Furthermore, fresh specimens were 4.6{\%} larger than formalin-fixed specimens (P <0.01), and postfixation measurements were 7.1{\%} greater than microscopic measurements (P <0.01). The overall mean percentage of shrinkage between fresh and histological specimens was 11.4{\%} (P <0.01). Histological processing would cause a tumor stage shift from pT1b to pT1a for two tumors in this study. The shrinkage effects of formalin fixation and histological processing may result in understaging of renal cell carcinomas. The shrinkage factor should be considered when reporting tumor size.",
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AU - Grignon, David

AU - Francesca Monn, M.

AU - Simper, Novae B.

AU - Cheng, Liang

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