Table 1 Recommendations for biopsy/cytology specimen acquisition and processing. These should be discussed in each institution and modified by the pathology according to current practices. Lindeman et al. 2018a; Roy-Chowdhuri et al. 2020; Aisner 2018
Recommendation | Comment | |
|---|---|---|
Needle | • 14-20G for core needle biopsies • 20-25G for FNA • 19–20-21G for EBUS | |
Number of fragments/passes | • 3 core needle biopsies minimum • EBUS – 3 to 5 passes • Multiple passes for transthoracic FNA | ROSE can be performed if the pathologist and clinical team have established protocols. If not, tissue should be maximized in cell block preparations |
Time to fixation | Cold ischemia of less than 1 h | |
Fixative | 10% neutral buffered formalin | EDTA decalcification protocols may be used if necessary. Decalcification with acids is not recommended |
Fixation | 6-48h | Time of the sample in formalin should be informed in the requisition |
Tissue blocks | Samples should be ideally separated in more than 1 block for processing and cutting | |
Tissue selection for molecular and IHC analyses | Pathologists should choose the block with maximal amount of tumor % and register in the report | Tissue % can be enriched by macro or microdissection |