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Floaters Embedded in Paraffin Block

July 2013

Requested by Maria M. Picken, MD, PhD, FASN
Total # of respondents: 13

What do surgical pathologists do when a benign floater is embedded in the paraffin block?

1.   Write a comment that there is extraneous tissue, apparently a benign floater, and that this was discussed with the clinician?

  • If there is a “significance,” mention in a note that this fragment likely represents a “carry over” artifact (x1)
  • Floaters are only documented in pathology reports when they could clearly cause diagnostic confusion (x1); there is a clinical need for the documentation (x1)
  • If there is NO diagnostic significance for the patient, the floater is considered within the “ignorable range;” not mentioned in the report (x10). 

2Review the slide(s) at the departmental consensus conference and, with the group's agreement, remove the floater from the block without commenting on its existence?

  • If tissue is in block and its presence could create confusion or management problems for the patient’s care, we dig out and recut for file, saving original for QA (x1)
  • If the extraneous piece came from another case and is important to the other case, we might move it to the correct block, but otherwise, just leave it where it is (x1).  
  • If tissue is in block and its presence could be problematic and we have doubt about origin, we DNA test for identity (x1)  
  • In the past, we would dig the floater out of the block.  We do not do that anymore (x1). 
  • If tissue is in block and of no confounding significance, we ignore (x3). 
  • Floaters are not routinely/normally removed from affected blocks (x5). 

    3.   Other?

  • Basically ignore (x2)
  • It is up to the pathologist whether they want to write "FLOATER" on the glass slide (x1)
  • Circle or otherwise tag as floater on slide (x6)  
  • Circle the floater on the slide and write “floater” if there is NO significance (x1)                                          
  • Floaters are tracked and evaluated as part of our QA program/form filled out (x2)                                     
  • If it is tissue that might cause diagnostic confusion, we try to determine its source from possible cases with similar appearances grossed or embedded on the same day (needle in the haystack); perform a tissue identification protocol (molecular testing) (x2); actions are documented in the LIS (x1)                                                                                                             
  • investigate the cause of the floater (grossing, embedding station, water bath...) and try to fix that problem: educate/inform/involve people in the lab/residents for all cases (x1) or just for those floaters which are important (x1)