RELATIONSHIP BETWEEN FIXATION TIME AND THE PRESENCE OF RETRACTION ARTIFACTS SIMULATING LYMPHOVASCULAR INVASION IN MALIGNANT NEOPLASMS
Artifacts. Lymphatic Metastasis. Malignant Neoplasm. Tissue Fixation.
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 disease 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 consequent diagnostic accuracy, a condition that also depends on the technical ability and experience of the pathologist who will be evaluating them. This study investigates the impact of 6-, 48- and 72-hour formaldehyde chemical fixation times on breast, colonic and uterine tumor tissues, with the aim of identifying whether there is any interference in pathologists' interpretation in differentiating lymphovascular invasion from retraction artifacts during the histopathological evaluation of tumors. After evaluation by 3 pathologists, the results indicate that fixation for 6 hours showed a lower percentage of doubts in differentiating between retraction artifacts and lymphovascular invasions, which may indicate a fixation time with better potential for structural tissue preservation. Fixation at 48 and 72 hours showed an increase of more than 50% in confusion when evaluating these artifacts with lymphovascular invasions.