A Cure-All For Block Management Woes?

In an era of increasing digitization, it’s rare to have a conversation about physical storage. But it’s an area that needs our attention – the volume of paraffin blocks needing storage has increased dramatically over the last 10 years and is continuing to rise. The population is growing, patients are aging, cancer incidence is rising, and standards of care are improving – all things that lead to an increase in tissue sampling. But with tighter legal frameworks, more exacting standards for laboratory accreditation, and the increase in blocks circulating for second opinions or advanced analysis, there’s a desperate need to manage paraffin block storage and access. Especially given the current shortages of technicians and resources, there’s a real risk of mislabeling or misplacing blocks – and, because they’re the ones that most often change hands, it seems that it’s always the most precious blocks that go missing.

Each error or loss of a paraffin block risks delaying key diagnoses and treatments. This pressing need, and the lack of an established management system, led to a collaboration between the medical device department at CHRU Montpellier and Dreampath Diagnostics to develop FINA, the first fully automated paraffin block management system. Our two groups cooperated to determine the necessary specifications and to test each prototype. The final version of FINA, which we’ve been running routinely in our lab since June of 2014, consists of a block scanner and accompanying management software.

Manual management

CHRU Montpellier is a university laboratory that handles about 30,000 biopsies and surgical samples each year and produces about 100,000 blocks per year. In the last 12 months, we have retrieved 19,712 blocks from storage – mainly for daily routine techniques (91 percent), but also for targeted therapy (4 percent), research or clinical trials (3 percent), and access to our expert network or second opinions (2 percent). Before the advent of FINA, these blocks were sorted by numerical order in metal drawers, a system that required a lot of time and space. Anytime a large series – like an autopsy, fetal pathology, or set of bone specimens – came in late, we had to move a large number of blocks. Once a week, we transferred blocks from the drawers into a separate set of cardboard drawers for long-term storage in the basement. The system was difficult to use; there was no security, we only used a block register when we knew samples would be out of the lab for a long time, and our technicians lost a lot of time looking for blocks that had been misplaced or removed and then re-archiving them after use. Just managing our blocks required the equivalent of nearly one and a half full-time jobs!

Automated management

To gain more control over our blocks, we turned to automated management. The FINA system consists of a scanner, a computer with a PDA, a label printer, and a set of cabinets (Figure 1a). With this system, the blocks are stored in a special tray at the cutting station; it holds 240 blocks, but they can be placed in random order to save time (Figure 1b). Once the technicians have finished cutting, they scan the tray (Figure 1c) to enter it into the specialized software, which requires a user password to ensure access security and generates reports to improve traceability. Scanning time varies from two to six minutes based on the number of blocks, quality of printing and cleanliness of the paraffin block. The percentage of unread blocks is very low (in our case, 242 of 26,400, or 0.9 percent), and chiefly occurs as a result of paraffin deposition on the barcode of the label. If a barcode is damaged or unreadable, we also have the option of taking a photograph and entering it manually into the software.

To “check out” a block, the user creates a pick list and exports it to the PDA (Figure 1d). For each block, the system asks the user’s name, reason for removing the block, and expected duration of use. The PDA shares this information with the main system computer; then, if the blocks aren’t returned on time, alerts and reports help us to follow up with users and ensure the samples don’t go missing. We also have FINA connected to our laboratory information system (LIS), so that we can automate our requests directly from the LIS. We store each tray in a cabinet in the laboratory for two years (Figure 1e) before transferring it to long-term storage – at which point, the FINA software records its new position.

Using a fully automated system not only saves us the space needed to sort blocks, it also allows us to ensure good traceability by recording who checks out each block, when, and why. It minimizes the risk of loss, as we can now better manage the blocks as they move within and outside the lab. The use of passwords and reports improve security, as only authorized people have access to the blocks and the system records all activity. But although all of these are useful functions, the one we’ve found most useful in our lab is that one entire person’s worth of workload has been taken off our hands, letting us devote our most valuable resource – time – to our work.

Valérie Costes Martineau is head of the department of anatomic and cytologic pathology at CHRU Montpellier, France.

Laure Dumas and Nicolas Leventoux are technicians in the department.