The first all-in-one hybrid tissue processor, the ideal tool for “LEAN” Labs. It can be operated as a rapid, fully automated single retort processor or as a rapid, simultaneous dual retort with continuous loading for enhanced throughput. Lean lab? Think LOGOS. Addressing the needs of “lean” labs for a flexible tissue processor. Highly adaptable to customized work flow streams. Fully automated processing in overnight and rapid mode Parallel processing in continuous flexible-size batch mode Up to 140 cassettes with 1 gallon standard reagent containers Up to 210/300 cassettes with 5 liter reagent containers Any type of tissue, up to 5mm thickness in Split rack (140/210) or Random Basket rack (300) Any type of tissue, up to 8mm thickness in Supermega Cassettes rack (24) LOGOS is the all-in-one tissue processor with the exclusive Milestone patented* microwave hybrid processing technology. The software allows users to choose to use Hybrid for rapid processing, microwave only, or resistance heating only. Resistance heating mode. The LOGOS can operate as a conventional resistance heated overnight tissue processor. Its processing parameters can be set to meet your specific work ow requirements. The LOGOS fulfills all CAP/ASCO guidelines for assessing Her-2, ER, PgR testing in breast tissues. Simultaneous microwave and resistance heating mode Ultra-rapid dehydration/clearing steps are carried out by microwave heating technology for faster turnaround. The retort’s resistance heating speeds up the ramp up time to the pre-set processing temperature. With the LOGOS everyone benefits Patient: Minimize stress of waiting for diagnosis, Elimination of needless anguish, More timely start of needed treatment. Pathologist: Reduce stress through better control of workload, Same-day diagnosis of permanent slides available on demand Lab Manager: Improved work flow with night and day protocols, Improved work environment, Reduced cost. Grossing Room Operator: No need to modify your grossing procedures, No need to standardize on 1.5/2.5 mm. Histologist : Process as required: 70-140-210 cassettes; Process with no transfer of reagents from commercial containers; Four conventional reagents only. Oncologist and Clinician. Within hours oncologists and clinicians can advise patients on the basis of the definitive diagnosis. Unmatched processing times. Six times faster than conventional processing enabling same-day diagnosis LOGOS. Less stressful workload distribution Throughout the day the histotech can process urgent and small biopsies, on demand. These samples/biopsies, which can constitute 40-60% of the workload of a histopathology lab, are rapidly processed. The short processing time allows embedding, cutting and staining of specimens so that slides are available to the pathologist on the same day. The remaining cassettes can be automatically processed during the night, either by conventional or rapid hybrid heating technology. LOGOS. Innovative work flow options for the “lean” lab Night Operation As a fully automated, single retort, overnight tissue processor . During the night, LOGOS can run protocols as an advanced resistance heated conventional processor. Molten wax is transferred automatically to and from the processing retort for the impregnation step. Xylene-free protocols with four reagents only: formalin, ethanol, isopropanol and wax. If required, xylene protocols are available. As an alternative, run LOGOS as a rapid tissue processor (delayed start) with desired completion time set by user, allowing additional fixation time if needed. Day Operation (1) As a fully automated, single retort, rapid hybrid tissue processor During the day, LOGOS can run urgent biopsies with hybrid microwave technology as a fully automated unit. Molten wax is transferred automatically to and from the processing retort for the impregnation step. This mode enables single batch runs with short cleaning cycles. Day Operation (2) As a sequential, dual retort, simultaneous batch hybrid tissue processor LOGOS. Software like never before. 1.Enter the appropriate user level. The operator can recall and run existing processing protocols. Only the administrator can modify programs or store new ones. 2.The administrator can easily setup a new protocol by selecting the desired settings from the touchscreen interface. 3.The complete summary of the new protocol is displayed for approval or modification before starting the process. 4.An event log lists all activities carried out with the unit, providing documentation for service and quality assurance purposes. LOGOS. Green, safe and economical Packed with the latest technology for an improved work environment No transfer of reagents to tanks Direct transfer of solutions from commercial containers (5 l or 1 US gal) into processing retort. Slide-out ventilated reagent drawer. Reagent changes in as little as 30 seconds. Milestone world market leadership Largest installed base of microwave tissue processors Over 1,600 units in operation worldwide The de facto standard in rapid processing Lowest cost of ownership The highest quality of application and service support LOGOS with its dual retort technology can also be used with Synergy embedding system to enhance your lean lab. Eliminate bottlenecks at embedding. SYNERGY Synergy is a revolutionary method to automatically embed tissues as part of the processing protocols. This method is applied to Milestones rapid tissue processors Pathos Delta and Logos. Thanks to a dedicated rack and consumables, the same processor unit can achieve automatic embedding. All kinds of tissues and dimensions can be processed and embedded with this method. Specimens are placed in the mold during grossing. Much like embedding. A special pad is placed on top of the tissue to maintain positioning. The cassette is clipped in place as a cover of the mold. The mold plus cassette is then inserted into the Synergy rack. The specially designed rack is angled during the fixation and regent steps so fluids flow in and out without retention. When the rack moves to wax the leverage system of the rack allows the molds go to a flat position. This collects and holds the necessary paraffin to embed the tissue. The cassettes are then simply removed from the rack and placed on a cold plate. After ten minutes the cassettes are easily removed from the disposable molds and are ready for cutting. Synergy Benefits Fully automated processing and embedding in one unit Optimal flat positioning of small biopsies such as needle cores Tissue is handled once at grossing. Accidental tissue loss during processing and embedding is eliminated. The Milestone Xylene Free Processing Protocols Optimized xylene free protocols are the heart of the Pathos LOGOS efficiency. Using only four reagents each protocol has been developed to provide superior quality. Small biopsies can be processed in just over an hour. The single Ethanol dehydration step eliminates over processing for your most delicate specimens. Larger or fatty tissues up to 5mm may be processed in as little as 8 hours with quality that may surpass results seen in twelve hours when processed conventionally. The Xylene free protocols utilize a flush phase and two rinses that are used to help maintain the reagent integrity. When combined with a reduction in the overall time of the active steps due to application of gentle heat Milestone is able to achieve rapid tissue processing that delivers high quality with the added advantage of xylene free processing. These protocols have been developed and standardized across the Milestone platforms for over thirteen years. The following outlines the steps used for rapid xylene free processing. Fixation: 10% Neutral Buffered formalin is heated to 50C during the optional heated fixation phase. The length of the fixation phase is dictated by the sample size. Standardized and complete fixation can be achieved through use of presoak and the heated fixation phase. Flush: Seventy percent alcohol is utilized for 1 minute at ambient temperature to rinse off formalin and eliminate buffer salts from precipitating in subsequent alcohol steps. Flush is run as part of every protocol and eliminates the need for a weekly hot water flush. Rinse: Two Ethanol rinses of two minutes each are used to eliminate water carryover from the flush step. This allows for the use of a single dehydration step. Dehydration: Ethanol is used for the single dehydration step. Heating to 65C provides rapid but gentle dehydration. Clearing: Isopropyl Alcohol is used as the clearing reagent in the xylene free rapid tissue processing protocols. Heated to 68C the Isopropyl extracts lipids and is miscible with the subsequent paraffin step. Wax infiltration: A single paraffin is used for wax infiltration. Vacuum allows for improved infiltration with moderate temperatures During wax infiltration the Isopropyl evaporates out of the paraffin. The Xylene free protocols mean that there is no solvent present to break down the wax. Since Isopropyl will readily evaporate out of the wax a weekly cleaning cycle is effective in maintaining wax integrity for up to a month. The efficiency of the LOGOS allows for improved workload management. The rack can be manually moved from the processing retort to the paraffin retort. While the protocol is completed in the wax retort the next rack can be immediately loaded without waiting for a cleaning cycle to be performed. With processing times of just over an hour for 1mm biopsies multiple processing cycles can be performed daily to balance workload throughout the day. This allows for improved turnaround times and efficiency in the lean histology lab. The value of Logos for quality improvement Rapid tissue processing and Lean Histology are reported in the following publications. Evaluation of Xylene-free Tissue Processing on the LOGOS all-in-one Hybrid Tissue Processor. The Pathology department at Aberdeen Royal Infirmary was in a position to replace one of their tissue processors. As part of this process, we considered same-day processing and also the Health & Safety issues concerning xylene. We investigated several of the processors on the market, Milestone LOGOS tissue processor fulfilled our requirements: Xylene-free processing Microwave technology for same-day processing Two members of staff were invited to a demonstration in the Milestone factory near Milan and were impressed by the LOGOS, therefore an on-site demonstration was arranged. The LOGOS was on trial in the department for 2 weeks over which time various tissue blocks were processed on 3 different protocols. H&E, Special stains and Immunohistochemistry were carried out on the sections. Processing Results Conclusion Acknowledgements Comparison of Conventional & Xylene-free Tissue Processing Evaluation Conventional Tissue Processing – Peloris Fixation – 10% Neutral Buffered Formalin Dehydration – Graded Alcohols Clearing – Xylene Paraffin Wax Infiltration Xylene-free Tissue Processing – LOGOS Fixation – 10% Neutral Buffered Formalin Dehydration – Alcohol Clearing – Isopropanol Paraffin Wax Infiltration 1. Various biopsy size tissues were processed on the LOGOS 2mm thick programme – processing time 2hours 5 minutes 2. Various large tissue blocks were processed in parallel: Peloris conventional overnight processing (13hours) LOGOS 5mm programme (5 hours 56 minutes) 3.H&E and Special Staining were compared from the sections produced after the Peloris processing and the sections produced after the LOGOS processing 4. Immunohistochemistry using several different antibodies was carried out on the Peloris and LOGOS sections and comparisons were made Staining results H&E Several Pathologists assessed the H&E staining and listed below are some of their comments. No issues impossible to tell the difference No issues generally looks good All seem fine No difference seen-Quality is the same No noticeable difference Immunohistochemistry CK20, CK7, CDX2 NO difference CA125, ER, WilmsT Same pattern and intensity and specificity of staining CK20, CK7, CEA No difference in staining /histological appearance ER, CK7, Vimentin same pattern and intensity of staining ER, PR, E-cadherin, Appearances are equivalent. No appreciable difference CD3, CD10, C20, bcl-2, Ki-67 all similar Vimentin, S100 both good Conclusion After trialing the LOGOS tissue Processor, it was concluded that the xylene-free processing had no adverse effects on tissue processing or staining, while improving safety. The Processing times were greatly reduced which could allow same –day processing, thus enabling the introduction of LEAN working in the department. EVALUATION OF ISOPROPANOL AS A BETTER ALTERNATIVE TO XYLENE IN TISSUE PROCESSING BY THE PARAFFIN WAX METHOD Adediran OA, Ibikunle DE Department of Histopathology and Morbid Anatomy, Federal Medical Centre, Owo, Ondo State, Nigeria Corresponding author: Adediran OA ABSTRACT Aim: The aim of the study was to find a suitable less toxic alternative to xylene in the paraffin wax method of tissue processing. Methods: One group of the tissues were processed by the paraffin wax technique while the second group was processed with replacement of xylene with isopropyl alcohol. Sections were stained with hematoxylin and eosin and examined. Results: There was no difference between the xylene treated routine paraffin wax method and the isopropanol replacement method in the sectioning, staining and diagnosis of the tissues of stomach, liver and kidney. The isopropanol method was also faster. Conclusion: Xylene in the paraffin wax method should be replaced with a less hazardous isopropanol. Validation of Histology Tissue Processing and Stain Quality of LOGOS Rapid-Cycle Microwave Processor in LEAN Continuous Flow Operations Richard J Zarbo, Ruan C Varney, Michael Dib, Beverly Maher and Jason Wozniak Department of Pathology, Henry Ford Health System, Detroit Michigan Quality of LOGOS Rapid−Cycle Microwave Processor in Lean Continuous Flow Operations Henry Ford Health System, Detroit, Michigan Pathology report timeliness can be enhanced by technology that reduces time waste in histology. The largest delay is overnight fixation and prolonged processor times. These throughput bottlenecks can be targeted by integrating tissue processors capable of rapid-cycle times especially when aligned with continuous flow Lean work design. Design: Evaluation of a rapid-cycle microwave processor (Logos, Milestone Medical, Kalamazoo, MI) was performed at Henry Ford Hospital Histology Core Laboratory with aims to 1) Integration of processor into continuous flow work process; 2) Compare specimen quality in split samples processed by Conventional overnight processors and the rapid-cycle Instrument. We assessed technical quality of block processing, slide cutting and H+E staining by histotechnologists and quality of H+E, special and immunohistochemical stains by pathologists with a standard input form. 238 specimens were dissected fresh and split by 2 PAs. 3 part scheme with free text comments was used for histology assessment (High, Average, Low Quality) and pathologists’ microscopic evaluation (Acceptable, Inferior, Unacceptable for Diagnosis). Analysis was stratified by tissue type and processed thickness. Results: In 238 tissues (fat, liver, placenta, ovary, colon, stomach, endometrium, cervix, ovary, uterus, prostate, testis, skin, thyroid, gallbladder, soft tissue, heart, POC, lymph node, salivary gland, thrombus, esophagus, lung, larynx), no significant quality differences were noted between rapid cycle and conventional processors in any parameter assessed in 49 needle biopsies (1mm), 28 small biopsies (2mm) and 161 large specimens (3mm). Technical cutting quality was at variance in a minority, better in 9 cases from the rapid-cycle processor with embedded tissue being less dry or brittle whereas only 3 of the conventionally processed tissues were noted of better cutting quality. Pathologists detected no difference between the 2 types of processed specimens in any H+E stain, 10 special stains and 30 immunostains. None were of inferior technical quality for diagnosis. Conclusion: This study validates the technical, H+E and immunohistochemical stain quality obtained with a new rapid cycle microwave processor over a range of tissue types and processed thicknesses. The abbreviated cycle time including fixation (1.25-3 hours) facilitates the Lean approach to continuous flow processing with continuous slide production. Used in this fashion, the instrument facilitates potentially shorter report turnaround times compared to conventional overnight processing.