Smoothing the flow

Cytogenetic laboratories are under increasing pressure, can automation be used to help work flow more efficiently?

Over the years, increasing workloads – both in terms of volume testing and the amounts of analyses that a cytogenetics laboratory is expected to handle – have been posing significant challenges to both laboratory staff and laboratory equipment. Today’s laboratories are required to supply a seamless 24-hour service, seven days a week, while also being driven by financial pressures to make savings and provide a more cost-effective service.

With emphasis being placed heavily on speed and reduced turnaround time, it is important that cytogenetics laboratories have efficient processes in place to maximise efficiency and productivity while also delivering optimal results. By using solutions that improve laboratory automation and increase throughput of samples, laboratories can support and enhance their workflows. In response, advanced automated methods have been developed to improve consistency in cytogenetics, cytology and immunohistochemistry by developing a smoother laboratory workflow and increasing throughput.

The cytogenetics field is concerned with the study of the structure and function of the cell, especially the chromosomes and their role in heredity. Cytogenetics laboratories perform analyses to identify chromosome structure and composition, constitutional and acquired chromosome abnormalities associated with diseases, the roles that chromosomes play in sex determination and changes in chromosomes during evolution.

Cytogenetics testing includes routine analysis of G-Banded chromosomes, using cytogenetic banding techniques as well as molecular cytogenetics such as fluorescent in situ hybridisation (FISH) and comparative genomic hybridisation (CGH). The preparation and study of karyotypes – namely the standardised formats into which chromosome pairs are arranged – is also a part of cytogenetics, enabling scientists to detect alterations in chromosome number and structure that are associated with diseases and developmental defects.

Chromosome analysis involves slide preparation, banding techniques and subsequent analysis. Traditionally, the processes of slide making and banding have been undertaken manually; however, these manual methods are associated with a number of important limitations.

Traditionally, chromosome analysis commences by obtaining white blood cells and placing them into a bottle of culture medium to grow. At a certain stage in the growing process, chemicals are added to stop the progression of phases at a given metaphase. Chromosome spreads are then placed onto microscope slides, stained and flattened out in order to identify the best metaphase spreads. Following completion of the coverslipping process, banding of chromosomes is undertaken. This entire procedure has been performed manually for many years.

Nevertheless, in an active laboratory, staining and coverslipping workflow patterns constantly fluctuate and optimal precision banding is required. Conventional manual coverslipping and banding techniques are expensive, time-consuming, inconsistent and inaccurate. These methods require dividing cells as well as performing labour- and time-intensive manual preparation and analysis of the slides.

Cytogenetics laboratories need automated banding and coverslipping machines to facilitate improvements in sample throughput to ensure efficient and rapid sample turnaround and slide preparation as well as accurate and fast reporting of results.

To address the challenges, new automated coverslipping and banding technologies have been introduced. These advanced coverslipping methods offer increased ease-of-use and enhanced tissue positioning to improve consistency in cytogenetics, immunohistochemistry and cytology laboratories. Recent developments in laboratory automation systems provide significant benefits for researchers who deal with large numbers of samples. By incorporating new automation, solutions laboratory efficiency can be improved and results communicated more easily and effectively.

New systems work by automatically covering the portion of the slide containing tissue using a thin glass coverslip and applying a clear synthetic mounting medium to act as a bond. The latest instruments ensure that coverslips are positioned correctly in relation to the slides and tissue without user intervention, thereby improving laboratory workflow and increasing throughput. In addition, newly introduced technology is also capable of managing up to 11 slide racks simultaneously while also automatically adjusting mountant volume, allowing a smooth workflow. By enabling this smoother workflow, new coverslipping technology helps ensure that patients receive faster, more accurate diagnoses for diseases such as cancer. New methods also offer particular benefits to the cytology industry by minimising bubble formation without the need for excessive mountant, thus being an ideal technique for the coverslipping of thin layer, liquid-based cytology slides that have raised fiducial marks.

Additionally, new multi-dimensional banding technology further maximises laboratory efficiency by organising the staining workflow. Designed to offer simultaneous performance, the latest banding instruments run multiple separate protocols at the same time with multiple baskets in process. New banding techniques also have the ability to optimise reagent usage and effectively use available staining stations to calculate the quickest throughput path for a particular protocol. In general, advanced banding machines are designed for high throughput, precision, safety, durability and flexibility in histology and cytology staining applications.

The West of Scotland Regional Cytogenetics postnatal division at the NHS Greater Glasgow and Clyde (NHSGGC) had traditionally implemented manual coverslipping and banding methods to undertake blood chromosome analyses in order to identify constitutional abnormalities. However, these manual processes pose significant challenges with regards to consistency and speed of analysis, necessitating the use of a method capable of improving the overall automation of the throughput of blood samples to ensure efficient sample turnaround, slide preparation and reporting of results. On average, the division processes 2800 samples per year and with such a high turnaround it was important to implement automated procedures to improve reporting times, quality and success rates.    

To improve automation and maximise the efficiency of its banding and coverslipping procedures, the postnatal cytogenetics division chose to invest in new banding and coverslipping machines. Over the last year, several automated techniques have been introduced into the laboratory, including a Thermo Scientific Varistain Gemini ES banding machine and a Thermo Scientific ClearVue automated coverslipping machine.

The implementation of the new banding machine has set new standards for the efficiency of slide banding. The overall slide-making and banding workload of the technical laboratory staff has been reduced by around 50% meaning that patients are being diagnosed and put into treatment faster. Prior to the implementation of the machine, four slides were prepared and manually banded from each blood culture. Automation of the process has reduced this to two slides per culture.

The implementation of the new coverslipping machine has provided a solution to address the workflow hassles facing the postnatal cytogenetics laboratory. Each slide is uniform in both the placement of the coverslip and the depth of the mountant, which has significantly improved procedures.

Overall, the new technologies have led to a considerable improvement in reporting times, quality and success rates and have also decreased the poor quality rate for both routine and urgent blood samples.

In their day-to-day routine, cytogeneticists are challenged to complete slide preparation and staining in limited timeframes and at a minimum cost. It is also vital that the slides produced deliver optimal accuracy and consistency. Until recently, chromosome analysis was carried out using manual coverslipping and banding techniques, which were very tedious, time-consuming and often resulted in imprecise results. Latest technological advancements have seen the development of automated coverslipping and banding methods, capable of offering a smoother laboratory workflow and increased sample throughput. The new technologies help cytogenetics laboratories to easily achieve their goals with regards to improved automation, fast turnaround of results, cost-efficient operation and results accuracy.