Skip to main content

Immunohistochemistry Quality Management and Regulation

  • Chapter
  • First Online:
Handbook of Practical Immunohistochemistry
  • 4743 Accesses

Abstract

Immunohistochemistry testing is highly complex with multiple steps. Assuring the optimum performance of your immunohistochemistry laboratory requires attention to numerous quality monitors. For testing performed on patient specimens, there are also additional regulatory requirements. This chapter answers questions about best practices in quality management in preanalytic, analytic, and postanalytic phases of the total immunohistochemistry test providing examples of possible quality improvement opportunities. It also provides information related to CLIA and FDA regulatory oversight medical devices, in vitro diagnostics (IVD), and analyte-specific reagents (ASR). With regard to immunohistochemistry laboratory accreditation, the final portion of this chapter draws attention to current best practice guidelines of the College of American Pathologists (CAP) relating to immunohistochemistry to prepare for inspection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Taylor CR, Cote RJ. Immunomicroscopy, a diagnostic tool for the surgical pathologist. 3rd ed. Philadelphia, PA: Elsevier; 2006.

    Google Scholar 

  2. Dabbs DJ. Diagnostic immunohistochemistry. New York, NY: Churchill Livingstone; 2002.

    Google Scholar 

  3. Leong AS-Y, Cooper K, Leong FJW-M. Manual of diagnostic antibodies for immunohistology. 2nd ed. London: Greenwich Medical Media; 2003.

    Google Scholar 

  4. Brown RW. Quality management in immunohistochemistry. In: Nakleh RE, Fitzgibbons PL, editors. Quality management in anatomic pathology: promoting patient safety through systems improvement and error reduction. Northfield, IL: CAP; 2005. p. 93–110.

    Google Scholar 

  5. Taylor CR. The total test approach to standardization of immunohistochemistry. Arch Pathol Lab Med. 2000;124(7):945–51.

    CAS  PubMed  Google Scholar 

  6. National Committee on Clinical Laboratory Standards (NCCLS) MM4-A. Quality assurance for immunocytochemistry; approved guideline. Wayne, PA: National Committee on Clinical and Laboratory Standards; 1999.

    Google Scholar 

  7. O’Leary TJ. Standardization in immunohistochemistry. Appl Immunohistochem Mol Morphol. 2001;9(1):3–8.

    PubMed  Google Scholar 

  8. Laboratory Accreditation Program. College of American Pathologists. Northfield, IL.

    Google Scholar 

  9. Novis DA. Detecting and preventing the occurrence of errors in the practices of laboratory medicine and anatomic pathology: 15 years’ experience with the College of American Pathologists’ Q-PROBES and Q-TRACKS programs. Clin Lab Med. 2004;24(4):965–78.

    Article  PubMed  Google Scholar 

  10. Condel JL, Sharbaugh DT, Raab SS. Error-free pathology: applying lean production methods to anatomic pathology. Clin Lab Med. 2004;24(4):865–99. Review.

    Article  PubMed  Google Scholar 

  11. Muirhead D, Aoun P, Powell M, Juncker F, Mollerup J. Pathology economic model tool: a novel approach to workflow and budget cost analysis in an anatomic pathology laboratory. Arch Pathol Lab Med. 2010;134(8):1164–9.

    PubMed  Google Scholar 

  12. Zarbo RJ, Tuthill JM, D’Angelo R, et al. The Henry Ford production system: reduction of surgical pathology in-process misidentification defects by bar code-specified work process standardization. Am J Clin Pathol. 2009;131(4):468–77.

    Article  PubMed  Google Scholar 

  13. Valenstein PN, Sirota RL. Identification errors in pathology and laboratory medicine. Clin Lab Med. 2004;24(4):979–96. vii.

    Article  PubMed  Google Scholar 

  14. Makary MA, Epstein J, Pronovost PJ, Millman EA, Hartmann EC, Freischlag JA. Surgical specimen identification errors: a new measure of quality in surgical care. Surgery. 2007;141(4):450–5.

    Article  PubMed  Google Scholar 

  15. Nakhleh RE, Zarbo RJ. Surgical pathology specimen identification and accessioning: a College of American Pathologists Q-probes study of 1 004 115 cases from 417 institutions. Arch Pathol Lab Med. 1996;120(3):227–33.

    CAS  PubMed  Google Scholar 

  16. Nakhleh RE, Zarbo RJ. Amended reports in surgical pathology and implications for diagnostic error detection and avoidance: a College of American Pathologists Q-probes study of 1,667,547 accessioned cases in 359 laboratories. Arch Pathol Lab Med. 1998;122(4): 303–9.

    CAS  PubMed  Google Scholar 

  17. Nakhleh RE, Gephardt G, Zarbo RJ. Necessity of clinical information in surgical. Arch Pathol Lab Med. 1999;123(7):615–9.

    CAS  PubMed  Google Scholar 

  18. Barnes RO, Parisien M, Murphy LC, Watson PH. Influence of evolution in tumor biobanking on the interpretation of translational research. Cancer Epidemiol Biomarkers Prev. 2008;17(12): 3344–50.

    Article  CAS  PubMed  Google Scholar 

  19. Mazumder A, Wang Y. Gene-expression signatures in oncology diagnostics. Pharmacogenomics. 2006;7(8):1167–73.

    Article  CAS  PubMed  Google Scholar 

  20. De Cecco L, Musella V, Veneroni S, et al. Impact of biospecimens handling on biomarker research in breast cancer. BMC Cancer. 2009;9:409.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Dumur CI, Sana S, Ladd AC, et al. Assessing the impact of tissue devitalization time on genome-wide gene expression analysis in ovarian tumor samples. Diagn Mol Pathol. 2008;17(4):200–6.

    Article  CAS  PubMed  Google Scholar 

  22. Hopwood D. Fixatives and fixation: a review. Histochem J. 1969;1(4):323–60.

    Article  CAS  PubMed  Google Scholar 

  23. Mason JT, O’Leary TJ. Effects of formaldehyde fixation on protein secondary structure: a calorimetric and infrared spectroscopic investigation. J Histochem Cytochem. 1991;39(2):225–9.

    Article  CAS  PubMed  Google Scholar 

  24. Medawar PB. The rate of penetration of fixatives. J R Microsc Soc. 1941;61:46–57.

    Article  Google Scholar 

  25. Ostrowski K, Komender J, Kwarecki K. Quantitative investigations on the solubility of proteins extracted from tissues fixed by different chemical and physical methods. Ann Histochim. 1961;6:501–6.

    CAS  PubMed  Google Scholar 

  26. Petsko GA, Ringe D. Protein structure and function. Sunderland, MA: Sinauer; 2004.

    Google Scholar 

  27. Burnett MG. The mechanism of the formaldehyde clock reaction: methylene glycol dehydration. J Chem Educ. 1982;59(2):160.

    Article  CAS  Google Scholar 

  28. Fox CH, Johnson FB, Whiting J, Roller PP. Formaldehyde fixation. J Histochem Cytochem. 1985;33(8):845–53.

    Article  CAS  PubMed  Google Scholar 

  29. Goldstein NS, Ferkowicz M, Odish E, Mani A, Hastah F. Minimum formalin fixation time for consistent estrogen receptor immunohistochemical staining of invasive breast carcinoma. Am J Clin Pathol. 2003;120(1):86–92.

    Article  PubMed  Google Scholar 

  30. Gown AM. Unmasking the mysteries of antigen or epitope retrieval and formalin fixation. Am J Clin Pathol. 2004;121(2):172–4.

    Article  PubMed  Google Scholar 

  31. Helander KG. Kinetic studies of formaldehyde binding in tissue. Biotech Histochem. 1994;69(3):177–9.

    Article  CAS  PubMed  Google Scholar 

  32. Helander KG. Formaldehyde binding in brain and kidney: a kinetic study of fixation. J Histotechnol. 1999;22(4):317–8.

    Article  Google Scholar 

  33. Hewlett BR. Penetration rates of formaldehyde. Microsc Today. 2002;10(6):30.

    Google Scholar 

  34. National Committee on Clinical Laboratory Standards MM7-A. Fluorescence in situ hybridization (FISH) methods for medical genetics; approved guideline. Wayne, PA: National Committee on Clinical and Laboratory Standards; 2004.

    Google Scholar 

  35. Williams JH, Mepham BL, Wright DH. Tissue preparation for immunocytochemistry. J Clin Pathol. 1997;50(5):422–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Yaziji H, Taylor CR. Begin at the beginning, with the tissue! The key message underlying the ASCO/CAP task-force guideline recommendations for HER2 testing. Appl Immunohistochem Mol Morphol. 2007;15(3):239–41.

    Article  PubMed  Google Scholar 

  37. Leake R, Barnes D, Pinder S, et al. Immunohistochemical detection of steroid receptors in breast cancer: a working protocol. UK Receptor Group, UK NEQAS, The Scottish Breast Cancer Pathology Group, and The Receptor and Biomarker Study Group of the EORTC. J Clin Pathol. 2000;53(8):634–45.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med. 2007;131(1):18–43.

    CAS  PubMed  Google Scholar 

  39. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med. 2010;134(6):907–22.

    PubMed Central  PubMed  Google Scholar 

  40. Enterline HT. Pathologist and histotechnologist: a marriage in need of counseling. Pathol Annu. 1975;10:205–11.

    CAS  PubMed  Google Scholar 

  41. Buesa RJ. Histology aging workforce and what to do about it. Ann Diagn Pathol. 2009;13(3):176–84.

    Article  PubMed  Google Scholar 

  42. Buesa RJ. Staffing benchmarks for histology laboratories. Ann Diagn Pathol. 2010;14(3):182–93.

    Article  PubMed  Google Scholar 

  43. Buesa RJ. Productivity standards for histology laboratories. Ann Diagn Pathol. 2010;14(2):107–24.

    Article  PubMed  Google Scholar 

  44. Hsi ED. A practical approach for evaluating new antibodies in the clinical immunohistochemistry laboratory. Arch Pathol Lab Med. 2001;125(2):289–94.

    CAS  PubMed  Google Scholar 

  45. College of American Pathologists. 2010 CAP LAP audioconference: test validation: a brave new world for anatomic pathology. May 19, 2010.

    Google Scholar 

  46. Brown RW, Sharkey FE. Standards and guidelines for clinical genetics laboratories. 2nd ed. Bethesda, MD: American College of Medical Genetics; 1999.

    Google Scholar 

  47. Graziano C. Disclaimer now needed for analyte-specific reagents. CAP Today. 1998;12(11):5–11.

    Google Scholar 

  48. U.S. Department of Health and Human Services, Food and Drug Administration. Guidance for industry and fda staff – commercially distributed analyte specific reagents (ASRs): frequently asked questions. 2007. http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm078423.htm. Accessed 30 Apr 2014.

  49. Clinical and Laboratory Standards Institute (CLSI) GP2-A5. Laboratory documents: development and control; approved guideline. 5th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2006.

    Google Scholar 

  50. Rhodes A, Jasani B, Balaton AJ, et al. Study of interlaboratory reliability and reproducibility of estrogen and progesterone receptor assays in Europe. Documentation of poor reliability and identification of insufficient microwave antigen retrieval time as a major contributory element of unreliable assays. Am J Clin Pathol. 2001;115(1):44–58.

    Article  CAS  PubMed  Google Scholar 

  51. Larsson LI. Section pre-treatment, epitope demasking, and methods for dealing with unwanted staining. In: Larson LI, editor. Immunocytochemistry: theory and practice. Boca Raton, FL: CRC; 1988. p. 147–70.

    Google Scholar 

  52. Shi SR, Gu J, Taylor CR, editors. Antigen retrieval techniques: immunohistochemistry and molecular morphology. Natick, MA: Eaton; 2000.

    Google Scholar 

  53. Sompuram SR, Vani K, Messana E, Bogen SA. A molecular mechanism of formalin fixation and antigen retrieval. Am J Clin Pathol. 2004;121(2):190–9.

    Article  CAS  PubMed  Google Scholar 

  54. Werner M, Chott A, Fabiano A, Battifora H. Effect of formalin fixation and processing on immunohistochemistry. Am J Surg Pathol. 2000;24(7):1016–9.

    Article  CAS  PubMed  Google Scholar 

  55. Hardy LB, Fitzgibbons PL, Goldsmith JD, et al. Immunohistochemistry validation procedures and practices: a College of American Pathologists survey of 727 laboratories. Arch Pathol Lab Med. 2013;137(1):19–25.

    Article  PubMed  Google Scholar 

  56. Fitzgibbons PL, Murphy DA, Hammond ME, Allred DC, Valenstein PN. Recommendations for validating estrogen and progesterone receptor immunohistochemistry assays. Arch Pathol Lab Med. 2010;134(6):930–5.

    CAS  PubMed  Google Scholar 

  57. Miller RT, Groothuis CL. Multitumor “sausage” blocks in immunohistochemistry. Simplified method of preparation, practical uses, and roles in quality assurance. Am J Clin Pathol. 1991;96(2):228–32.

    CAS  PubMed  Google Scholar 

  58. Chan JK, Wong CS, Ku WT, Kwan MY. Reflections on the use of controls in immunohistochemistry and proposal for application of a multitissue spring-roll control block. Ann Diagn Pathol. 2000; 4(5):329–36.

    Article  CAS  PubMed  Google Scholar 

  59. Burry RW. Specificity controls for immunocytochemical methods. J Histochem Cytochem. 2000;48(2):163–6.

    Article  CAS  PubMed  Google Scholar 

  60. Torlakovic EE, Francis G, Garratt J, et al. Standardization of negative controls in diagnostic immunohistochemistry: recommendations from the international ad hoc expert panel. Appl Immunohistochem Mol Morphol. 2014;22(4):241–52.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Weirauch M. Multitissue control block for immunohistochemistry. Lab Med. 1999;30(7):448–9.

    Google Scholar 

  62. Clinical Laboratory Standards Institute GP28-A. Microwave device use in the histology laboratory; approved guideline. Wayne, PA: Clinical and Laboratory Standards Institute; 2005.

    Google Scholar 

  63. Vyberg M, Torlakovic E, Seidal T, Risberg B, Helin H, Nielsen S. Nordic immunohistochemical quality control. Croat Med J. 2005;46(3):368–71.

    PubMed  Google Scholar 

  64. United Kingdom National External Quality Assessment Service. http://www.ukneqas.org.uk/content/Pageserver.asp. Accessed 30 Apr 2014.

  65. Nordic Immunohistochemistry Quality Control. http://www.nordiqc.org/. Accessed 30 Apr 2014.

  66. Joint Commission on Accreditation of Healthcare Organizations. Accreditation manual for pathology and clinical laboratory services. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations (JCAHO); 1996.

    Google Scholar 

  67. Goris JA, Ang S, Navarro C. Minimizing the toxic effects of formaldehyde. Lab Med. 1997;29(1):39–42.

    Google Scholar 

  68. Clinical Laboratory Improvement Amendments (CLIA). http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/IVDRegulatoryAssistance/ucm124105.htm. Accessed 30 Apr 2014.

  69. Sliva CA. FDA’s CLIA complexity process. IVD roundtable 510(k) workshop. 2002. http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/IVDRegulatoryAssistance/ucm124269.htm. Accessed 30 Apr 2014.

  70. U.S. Department of Health and Human Services, U.S. Food and Drug Administration. Overview of IVD regulation. http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/IVDRegulatoryAssistance/ucm123682.htm. Accessed 30 Apr 2014.

  71. U.S. Department of Health and Human Services, U.S. Food and Drug Administration. Medical device databases. http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Databases/default.htm. Accessed 30 Apr 2014.

  72. Philip R, Carrington L, Chan M. US FDA perspective on challenges in co-developing in vitro companion diagnostics and targeted cancer therapeutics. Bioanalysis. 2011;3(4):383–9.

    Article  CAS  PubMed  Google Scholar 

  73. U.S. Department of Health and Human Services. Medicare, Medicaid and CLIA programs: regulations implementing the clinical laboratory improvement amendments of 1988 (CLIA ’88). Final rule. Federal Reg. 1992;57:7002–186.

    Google Scholar 

  74. COLA. COLA laboratory accreditation manual. Columbia, MD: Commission on Office Laboratory Accreditation; 1996.

    Google Scholar 

  75. National Committee on Clinical Laboratory Standards GP2-A3. Clinical laboratory technical procedure manuals – approved guideline. 3rd ed. Wayne, PA: National Committee on Clinical and Laboratory Standards; 1996.

    Google Scholar 

  76. CAP accreditation and laboratory improvement: about the CAP accreditation program. http://www.cap.org/. Accessed 30 Apr 2014.

  77. Arber DA. Effect of prolonged formalin fixation on the immunohistochemical reactivity of breast markers. Appl Immunohistochem Mol Morphol. 2002;10(2):183–6.

    PubMed  Google Scholar 

  78. U.S. Department of Labor, Occupational Safety and Health Administration. 29CFR part 19 standards 10.1048 and 10.1450, revised 1 Jul 1998.

    Google Scholar 

  79. National Committee on Clinical Laboratory Standards C24A2. Statistical quality control for quantitative measurements: principles and definitions; approved guideline. 2nd ed. Wayne, PA: National Committee on Clinical and Laboratory Standards; 1998.

    Google Scholar 

  80. Miller RT, Swanson PE, Wick MR. Fixation and epitope retrieval in diagnostic immunohistochemistry: a concise review with practical considerations. Appl Immunohistochem Mol Morphol. 2000;8(3):228–35.

    CAS  PubMed  Google Scholar 

  81. Miller RT, Kubier P, Reynolds B, Henry T. Blocking of endogenous avidin-binding activity in immunohistochemistry: the use of skim milk as an economical and effective substitute for commercial biotin solutions. Appl Immunohistochem Mol Morphol. 1999;7(1):63–5.

    Google Scholar 

  82. College of American Pathologists. Retention of laboratory records and materials. http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=policies%2Fpolicy_appPP.html&_state=maximized&_pageLabel=cntvwr. Accessed 30 Apr 2014.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey Prichard DO .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Prichard, J. (2015). Immunohistochemistry Quality Management and Regulation. In: Lin, F., Prichard, J. (eds) Handbook of Practical Immunohistochemistry. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1578-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1578-1_1

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1577-4

  • Online ISBN: 978-1-4939-1578-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics