# Pre-analytics: blood-collection tubes and tissue fixation

Source: https://onco.cc/technologies/preanalytics-sample-stabilisation/  
OnCo record `preanalytics-sample-stabilisation` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-08
- Tags: supporting
- Principle: Chemical stabilisers prevent leukocyte lysis and nuclease activity in blood; cross-linking fixation preserves morphology and antigens in tissue within validated time windows.
- Strengths: Enables centralised liquid biopsy testing; Standards exist for key biomarkers
- Limitations: Fixation artefacts degrade DNA/RNA; Adherence to windows uneven; Little attention outside reference labs

## Sources

- Wolff et al., HER2 testing in breast cancer: ASCO/CAP clinical practice guideline focused update, including fixation requirements (Journal of Clinical Oncology 2018): https://doi.org/10.1200/JCO.2018.77.8738

## Connected records

- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [Biobanking and tissue procurement](https://onco.cc/technologies/biobanking/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Reference laboratories and companion-diagnostic testing](https://onco.cc/technologies/reference-laboratories/)
- companies: [QIAGEN](https://onco.cc/companies/qiagen/), [Roche / Genentech](https://onco.cc/companies/roche-genentech/), [Streck](https://onco.cc/companies/streck/)
- key papers: [Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update](https://onco.cc/key-papers/paper-wolff-j-clin-oncol-2018/)

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