By Linda St. Germain MT(ASCP)

CytoLogix Artisan Staining System Although automation is commonplace in many laboratory procedures, until recently it has had little impact on the preparation of special stains and immunohistochemistry.

No instrument could successfully handle the complex array of steps needed to produce consistently good histology stains. Different stains require different temperatures. Complex multistep procedures must be customized to suit each laboratory’s needs.

However, the recently developed CytoLogix Artisan Staining System is showing that automation can yield high quality stains consistently.

Labs that have incorporated the Artisan find that it contributes to better patient care. Pathologists at these labs have greater confidence in their diagnoses, and lab technicians have seen their skills enhanced. Some managers report that the Artisan has even contributed to the financial health of their laboratories.

Automation can handle special stains
The notion that automation could handle special stains was not easily accepted. Skepticism ran deeply among pathology laboratory professionals, even among those who suffered from the many problems engendered by manual staining. Histotechnologists and pathologists had serious doubts that an automated system could hold its own against manual staining.

Bonnie McMahill, supervisor of the histology departments at Pathology Associates, Inc., P.S., and Sacred Heart Medical Center in Spokane, Wash., was one such doubter.

McMahill, who ultimately spearheaded the purchase of an Artisan for Pathology Associates noted, “Manual stains take a lot of effort, but even with all its problems, manual staining gives you control over every step. It gives the opportunity to monitor each step under the microscope.”

McMahill was highly skeptical that an automated system that you could just set and walk away from could deliver the slides her pathologists require.

However, McMahill changed her mind when she saw the Artisan demonstrated at a National Society of Histotechnology meeting in 2000. She now counts herself among the growing number of laboratorians acknowledging the superiority of automated staining.

Dana Dittus, anatomic pathology manager at Abington Memorial Hospital in Abington, Pa., is another convert. “[When manual techniques are used] sometimes the stains are too dark,” Dittus said. “Sometimes they turn out too light. There are many occasions where the stain is very pretty and technically correct, but not what the pathologist wanted to see. The result of this is a continuing, costly and time-consuming need to do repeat stains.

“The Artisan did away with that,” she noted. “The quality of stains is exceptional. The silvers, which are the most difficult, are the best I have seen. And because this is an automated system, the slides are consistently of high quality, use a predictable amount of reagents and can be adjusted to the specific demands of each pathologist.”

Others say that the Artisan has made their labs more efficient.

“Ultimately, we saw that the benefits of the Artisan affected everyone,” said Debbie Cobb, former clinical specialist in histology at Providence Saint Joseph Medical Center, in Burbank, Calif. Cobb is currently assistant lab manager at a large southern California HMO.

“The turnaround time for getting the slides to the pathologist was shortened,” Cobb said. “The need to do repeats dropped below 1 percent. The pathologists’ reports were getting to the floor faster.” Those results translate into better patient outcomes.

Artisan uses a silver stain that turns
H. pylori black against a yellow/brown background
The Artisan, McMahill explained, uses a silver stain that turns the ulcer-causing Helicobacter pylori bacterium black and casts it against a yellow-to-brown background. That, McMahill said, makes it much easier for the pathologist to spot the bacterium, even when it is present in small amounts.

stainWarthin-Starry stain demonstrating H. pylori performed by Artisan.

“Patients who might not have gotten antibiotics, because manually prepared slides did not show signs of the bacterium, now are treated,” McMahill added. “And because we can do stains around the clock, ulcer patients now get started on therapy sooner.”

Particularly encouraging to the people who run and work in pathology labs is that Artisan helps them turn out higher quality work, despite a nationwide histotechnologist shortage — and often despite absences due to vacations, illnesses and personal emergencies.

Processes up to 48 slides on a single run
“With the automated Artisan, we can process up to 48 slides on a single run and do special and immunohistochemistry stains simultaneously. It has eased the problems engendered by chronic labor shortages,” McMahill said.

Any one of our lab’s nine technicians can start a staining run by loading barcoded slides and clicking on the Begin Staining icon on the computer screen. “It’s not that technicians have more time on their hands, they’re allowed time to expand their skills,” McMahill said.

“Technicians are increasingly being asked to participate in molecular work, immunohistochemistry and in situ hybridization, said Dittus.

“And our technicians want to increase their abilities and skill sets in these areas. Because we have the Artisan, we don’t have to devote staff to babysitting stains. Now our technicians can attend to the molecular studies and meet more advanced demands.”

Artisan saves the lab $18,000 a year in labor costs
Laboratory administrators have not overlooked the Artisan’s contribution to the bottom line.

After Pathology Associates purchased its Artisan, technicians spent three-and-a-half hours a day less on special stains, saving the lab $18,000 a year in labor costs.

“The Artisan produces high-quality stains, and it is helping us cope with a severe personnel shortage,” McMahill said. “It is helping us be more productive. It is saving us money. It is helping our pathologists help clinicians deliver better care to patients.

“I can’t imagine life without it anymore.”

Linda St. Germain is marketing director for CytoLogix Corp. in Cambridge, Mass.

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