title: A multi-site cutting device implements efficiently the divide-and-conquer strategy in tumor sampling.
abstract: We recently showed that in order to detect intra-tumor heterogeneity a Divide-and-Conquer (DAC) strategy of tumor sampling outperforms current routine protocols. This paper is a continuation of this work, but here we focus on DAC implementation in the Pathology Laboratory. In particular, we describe a new simple method that makes use of a cutting grid device and is applied to clear cell renal cell carcinomas for DAC implementation. This method assures a thorough sampling of large surgical specimens, facilitates the demonstration of intratumor heterogeneity, and saves time to pathologists in the daily practice. The method involves the following steps: 1. Thin slicing of the tumor (by hand or machine), 2. Application of a cutting grid to the slices ( e.g., a French fry cutter), resulting in multiple tissue cubes with fixed position within the slice, 3. Selection of tissue cubes for analysis, and finally, 4. Inclusion of selected cubes into a cassette for histological processing (with about eight tissue fragments within each cassette). Thus, using our approach in a 10 cm in-diameter-tumor we generate 80 tumor tissue fragments placed in 10 cassettes and, notably, in a tenth of time. Eighty samples obtained across all the regions of the tumor will assure a much higher performance in detecting intratumor heterogeneity, as proved recently with synthetic data.
authors.affiliation: Department of Pathology, Cruces University Hospital, Barakaldo, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; University of the Basque Country, Leioa, Spain.
authors.forename: Jose I
authors.initials: JI
authors.lastname: Lopez
authors.affiliation: Quantitative Biomedicine Unit, Biocruces Research Institute, Barakaldo, Spain; Ikerbasque: The Basque Foundation for Science, Bilbao, Spain; Department of Cell Biology and Histology, University of the Basque Country, Leioa, Spain.
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Cortes
keywords: Tumor sampling; clear cell renal cell carcinoma; cutting grid; divide and conquer; intratumor heterogeneity; pathology routine