The vast majority of PCR protocols have been developed to amplify soluble DNA or RNA, which has been extracted from its in situ environment, i.e. from clinical or environmental samples. However, the process of removing target nucleic acid from its in situ environment necessarily means that questions such as: is the nucleic acid specific for a particular diseased tissue type; is the nucleic acid derived from extracellular or internalised bacteria or parasites; is viral DNA integrated into the host chromosome or present in episomal form? etc, cannot easily be answered. In situ hybridisation (ISH) and in situ amplification (ISA) techniques help provide the answers to these questions, as the nucleic acid is not extracted during testing. In addition, in situ protocols are the assays of choice when investigating the local expression of particular genes. Many pathology laboratories maintain extensive historical collections of well-preserved, most frequently paraffin embedded, tissue specimens. In addition, collections of native, deep-frozen samples are usually available as well. These archives have most probably previously been investigated using pathological staining techniques and/or ISH tests. However, non-PCR-based ISH protocols tend to exhibit a limited sensitivity, even though several non-nucleic acidbased immunohistochemical signal amplification methodologies have been developed (e.g. use of tyramine derivatives [Speel et al., 1999]). This is why the development of in situ amplification (in situ PCR) techniques has been so important. These methods allow for the investigation of both tissue sections and cell suspensions, such that nucleic acid targets may be detected in an exquisitely specific manner in their native, tissue- or cell-embedded environment. However, this technology itself also faces a range of technical obstacles, including (1) the fact that DNA targets must be made accessible to PCR enzymes and reagents, (2) PCR inhibitors should be removed or diluted without extensive tissue damage, (3) PCR amplimers must remain at the site of their synthesis, (4) non-specific amplification must be prevented, (5) target DNA degradation may be a problem even before PCR thermocycling begins, and (6) the PCR thermocycling conditions should not destroy the physical status of the sample tissue or its intracellular compartmentalization. Perhaps most important is the initial processing and preparation of (tissue) samples even before PCR thermocycling begins, steps being necessary to control any (pre-) autolytic processes that may occur during post-mortem tissue processing. In this respect, the extent of fixative penetration, duration of fixation, type of fixative used, nuclease and protease inhibition in the specimens, the presence of DNA degrading metal ions, acidification of the fixative, extensive cross-linking of proteins and nucleic acids etc, should all be optimised prior to PCR processing [Golenberg et al., 1996]. In addition, immersion in paraffin, the use of aggressive detergents, the presence of picric acid or mercury containing fixatives, hypo-osmosis, electrostatics, and heat treatment can all frustrate the application of ISA. These considerations are especially important with respect to the preservation of RNAs, and mRNAs in particular, and it is always necessary to control for both false positive and false negative results in ISA protocols. It should also be remembered that the effect of fixation is not always beneficial, as the use of fresh specimens is advisable in certain situations [Jackson et al., 1990]. This chapter aims to summarise the most important considerations for the implementation of ISA (in situ PCR) protocols in the clinical laboratory. Advances in both tissue processing and ISA protocols have helped to establish a technology that generates reliable results, provided that tissue sections are handled correctly, before, during and after ISA processing. [ABSTRACT FROM AUTHOR]