RELATIONSHIP BETWEEN FIXATION TIME AND THE PRESENCE OF ARTIFACTS RETRACTION THAT SIMULATE LYMPHOVASCULAR INVASSIONS IN TUMOR TISSUE
Retraction artifact. Lymphovascular invasion. Cancer. Histological fixation. Formaldehyde
Cancer is one of the leading causes of death worldwide and represents a major challenge for global public health. As important as understanding the molecular and biological mechanisms underlying the development and progression of tumors is assertive diagnosis for effective cancer management, directly impacting therapeutic choices, prognosis and patients’ quality of life. Lymphovascular invasion (LVI) is an important prognostic marker in the staging of malignant tumors, playing a critical role in assessing the aggressiveness and metastatic potential of cancer. The presence of tumor cells within lymphatic or blood vessels is considered a high-risk indicator for metastatic dissemination, directly influencing therapeutic decisions, such as the need for more intensive adjuvant treatments, including chemotherapy, radiotherapy and targeted therapies. Histological analysis of tumors using the paraffin technique with H&E staining is still the most widely used in pathology departments. Fixation is a critical step in the proper preparation of these samples to ensure the preservation of tissue morphology and diagnostic accuracy, conditions that also depend on the technical skills and experience of the pathologist. This study investigates the impact of chemical fixation times of 6, 48 and 72 hours with formaldehyde in breast, colonic and uterine tumor tissues, in order to identify whether there is any interference in the pathologists’ interpretation in differentiating lymphovascular invasions from retraction artifacts during the histopathological evaluation of tumors. After evaluation by 3 pathologists, the preliminary results indicate that, even with the presence of diffusely distributed retraction artifacts in all samples, fixation for 6 hours showed a lower percentage of doubts in differentiating between RA and ILV, which may indicate a fixation time with better potential for structural tissue preservation. The 48-hour and 72-hour fixations showed an increase in the presence of artifacts that could be mistaken for lymphovascular invasions. Complementary data from the other patients collected may reinforce or refute this pattern found in the evaluation observed so far.