Correcting the Shrinkage Effects of Formalin Fixation and Tissue Processing for Renal Tumors: toward Standardization of Pathological Reporting of Tumor Size

Thu Tran, Chandru P Sundaram, Clinton D Bahler, John N Eble, David J Grignon, M Francesca Monn, Novae B Simper, Liang Cheng, Thu Tran, Chandru P Sundaram, Clinton D Bahler, John N Eble, David J Grignon, M Francesca Monn, Novae B Simper, Liang Cheng

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.

Keywords: Kidney; pathologic staging; radiographic size; renal cell carcinoma; tissue processing shrinkage; tumor size measurement.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Pictorial representation of the sequential outcomes of renal tumor fixation and processing. A: The transversally sectioned renal tumor specimen immediately after resection; B: The corresponding transversally sectioned renal tumor specimen after fixation in 10% formalin; and C: Microscopic section of the renal tumor specimen on a whole mount hematoxylin and eosin glass slide
Figure 2
Figure 2
Average linear shrinkage in tumor diameter from radiologic imaging to final processed state. Tumor size relative to postresection (fresh) diameter is illustrated here. Fresh tumors (orange) are considered the gold standard in terms of size and are represented as 100% of the diameter. Mean radiologic (green), postfixation (blue), and microscopic glass slide (gray) measurements are represented as percentage differences from the gold standard. Standard error bars and P values between each group pairing are provided. Y axis represents tumor size relative to postresection diameter.

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