Histopathology In Brazil

By: Janet Tunnicliffe, MLT, ART and Jerry Santiago, PhD, HTL, QIHC

My forty year involvement in the National Society for Histology has brought me many benefits, with the two most important being friendships and an endless source of knowledge. In early November of 2018, I was able to combine both of these things when I traveled with my good friend Jerry Santiago to the Sociedade Brasileira De Histotechnologia (Brazilian Histology Society) meeting in Ribeirão Preto, Brazil.

First flight of the trip (Orlando, FL to Sao Paulo, Brazil) for Jerry. Third flight or ten hours into a 26.5-hour trip for Janet.

Brazil is a Portuguese speaking country so Jerry had a definite advantage being able to speak Spanish, which many of the Brazilian techs understand, as Brazil is surrounded by Spanish speaking countries. Fortunately, a young man in the audience volunteered to translate for me, which made listening to and answering questions so much easier, when he understood the technical terminology and English.

After listening to the first day of presentations, it amazed me how much I could understand and follow even with the language barrier. Although technical terms are spelled differently, the accompanying imagery assisted in understanding. What was great to see and experience, was the engagement of the techs and their eagerness to learn.

Brazilian Histology Training

Brazil does not have a formal histology training or certification program, so on the job training is the norm. Not unlike the NSH, the Brazilian Histology Society is pushing to have Histopathology recognized as a profession and thereby establish a formal training and certification program.

With this goal in mind, Jerry presented information about how techs can get ahead by obtaining an international ASCP certification. Obtaining this certification will not only give the Brazilian techs an advantage when applying for positions within Brazil but open up job opportunities to work in the USA and other countries that recognize the ASCP certification. It was rewarding to see that by the end of Jerry’s presentation, several techs had already signed on to the ASCP website and started asking questions directly related to the exam process. This allowed Jerry to expand on the topic of support and educational aides that are available through being an NSH member. I added to Jerry’s presentation by talking about the personal side of being an NSH member, highlighted by Jerry’s and my long-time friendship, passion for education and sharing our collective knowledge.

Most histology techs in Brazil bring home the equivalent of $300.00 to $500.00 US per month, depending on their position and responsibilities, making NSH membership out of reach for them. Therefore, it was exciting to be able to present on behalf of the NSH, two memberships to two lucky attendees.

Histology Equipment in Brazil

Like most educational meetings, the support of the vendors was important with several Brazilian based companies displaying small consumable products imported from North American or European manufacturers. The shock for me was the high cost of the products; related to shipping, duty, and import taxes. Several vendor specialists presented on new technology and equipment, much of which, we in North American labs consider a basic requirement.

High volume, enclosed tissue processors are not in use in most labs in Brazil, microwave processors, automated embedding equipment and automated IHC testing are the things dreams are made of.

The initial high cost of the capital equipment is one consideration, followed by the cost of service when all repair parts have to come from outside the country. Imagine having to wait days or weeks for a replacement part to arrive from overseas then clear custom inspections. Yes, when comparing Brazil to third world countries even having a semi-automated processor like seen in the image below would be a luxury.

On a tour of a private pathology laboratory, Jerry was surprised to see a CO2 freezing microtome, in use for frozen sections. However, with my senior status, I actually remember training to use a freezing microtome in my student years. Equipment design changes usually occur to improve efficiency, cost, and safety but more often, things remain the same because the design works. Check out these images that span over 100 years of histology history. The use of a CO2 freezing microtome at this lab was an anomaly. The other labs visited did have in place modern cryostats.

A. Early CO2 freezing microtome on display in the Museum of Science and Medicine (Rijksmuseum Boerhaaven te Leiden) Netherlands. B. CO2 freezing microtome in use at Columbia University Laboratory, New York. Image captured in 1918 and originally published in the Histologic newsletter. C. CO2 freezing microtome in use in Brazil, November 2018.

Automated equipment for H&E, special stains, and IHC testing are still things of the future in Brazil, however automated or manual methods still have the technical problems. Using the CAP/NSH HistoQIP criteria as a basis, I presented on troubleshooting fixation, processing, and H&E and special stains. With a few clicks on the computer keyboard, we moved into the digital age, where standard still images were left behind and case studies with whole slide scanned images were displayed. After the initial amazed looks on faces, it was great to see the attendees become engaged and asking questions via Leandro, my translator. This re-enforced my belief that technologists who have worked in or are still working in the manual world have the need and better ability to understand the science behind the procedures they perform. The presentation ended with many techs pulling out cell phones with microscopic images and asking questions specific to their lab’s problems.

Although the labs we toured were still using manual techniques, I was surprised to see that they were farther ahead than many labs in North America in the level of their quality assurance programs. Key Performances Indicators (KPI) such as turnaround times, number of surgical cases and number of consultation cases, are tracked, monitored and reported on a regular schedule. This is an accreditation requirement that I have seen many labs fail to meet.

In the NSH tradition, Jerry and I now have new colleagues in Brazil who have become part of our extended histology family. We both hope that other trips to South America are in our future and we cannot thank our Brazilian technologists enough for the kindness shown to us during this trip.

A special thanks to Dimitrius Pito, Marie Helena Carabolante and José Luis Souza for arranging our invitation, access to the local laboratories and sharing of their local knowledge.

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