Pre-analytics: blood-collection tubes and tissue fixation
The tubes and fixatives that keep a sample stable between the patient and the lab. Unglamorous, but they decide whether a liquid biopsy or PD-L1 stain is trustworthy.
Cell-free DNA stabilising tubes (Streck Cell-Free DNA BCT, PAXgene ccfDNA, Roche Cell-Free DNA Collection Tube) allow ctDNA to be shipped at room temperature for days; formalin fixation time and ischaemia time affect IHC scoring and nucleic-acid quality (CAP/CLSI and ASCO/CAP HER2 guidelines set 6-72 hour fixation windows); RNAlater and vacuum-sealed transport are alternatives. Pre-analytic variability is a major source of discordant biomarker results.
How it works
Chemical stabilisers prevent leukocyte lysis and nuclease activity in blood; cross-linking fixation preserves morphology and antigens in tissue within validated time windows.
- Enables centralised liquid biopsy testing
- Standards exist for key biomarkers
- Fixation artefacts degrade DNA/RNA
- Adherence to windows uneven
- Little attention outside reference labs
Latest papers
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