Updated: Sep 29, 2020
“It’s brown it’s worked” How many of us have heard something like this during our careers? An alarmingly high number I expect. The “its brown it’s worked” concept absolutely infuriates me, not just because it’s not true but plainly because it’s dangerous. Now, this isn’t meant to be a patronising blog post, but more an acknowledgment of how vital our role as immunohistchemists is, in ensuring that the slides that leave our laboratories are appropriately immunostained and our patients are managed correctly as a result.
Most laboratories use same slide controls, that is; a control piece of tissue is added to the same slide as the test tissue, this gives some assurance that if the reagents have made it to your control tissue then your test tissue should have also been sufficiently dowsed too. Using same slide controls with a piece of or multiple pieces of tissue with an array of expression patterns is generally considered good practice. When an IHC slide meets with the quality control (QC) department the excellent choice of control should make the QC part a little easier. The QC checker’s main priority is to ensure the test has worked correctly, that the test is not a false negative or false positive or somewhere in between where it looks like it has kind of worked, sounds simple enough doesn’t it? But, I hope we are all in agreement that QC checking isn’t an easy task. The QC checker is required to have a sound knowledge of protein localisation, protein expression patterns as well as knowing whether they are looking for a positive or negative reaction. Ok, so you have some brown staining, but what if the brown staining isn’t in the places it should be, what if there is too much brown staining or not enough? We are well aware that our finely controlled laboratory process, brilliant automated platforms and an array of QC checks will ensure and repeat testing is kept to a minimum. But what about what we cannot control? We can’t always be certain that the person making up a diluted antibody from concentrate got the maths right, or the right antibody was poured into the right vial, human error is a thing, we all make mistakes. We know our platforms are robust but are they always perfect? No. So we have acceptance criteria in place, huge documents that would have taken the laboratory IHC team hours of commitment to put together, and we use these when we QC check. But when the patient is in clinic and a result is needed urgently, we rely on our knowledge and experience as an efficient way to QC.
Thankfully, in recent years training schemes like the IBMS Specialist portfolio have an increased focus on IHC, including structured learning and objectives the trainees are required to meet in order to be deemed competent, but ultimately it’s up to the diagnostic laboratory to have a robust training schedule in place which includes not only learning the practical techniques associated with IHC but also the theory and extensive microscopy work. Easier said than done though, we do not always have ample time to make this our focus.
How can we utilise the huge range of expertise and knowledge within The IHC Network to facilitate training our future scientists? I’m hoping that together we can build a collection of images with referenced explanations that can be used as an educational tool. Can we make training videos? There is so much potential with the website and this wonderful community, lets grab the opportunity with both hands.
We all have a part to play in training the future workforce, we all have a duty to vanish the myth, we owe it to them, but most importantly, we owe it to our patients. So the next time you hear someone say “Its brown it’s worked” point them to www.TheIHCNetwork.com
Keeley Thwaites
The IHC Network Founder. Contact at info@TheIHCNetwork.com