[Histonet] Prostate Needle Biopsies

[NICK KIRK]

I agree with the sentiments below, it's difficult enough searching for a translucent biopsy in a clear fluid, searching for a blue biopsy in a blue fluid (or whatever colour the ink is) would be even more difficult.
 
We address the issue of prostate biopsies by giving the Urology department a bag of biopsy sponges. When they take the needle cores they then place them on a single damp biopsy sponge, when all the biopsies have been taken, they then place the sponge into a formalin pot.
99% of the biopsies stay on the sponges and we only get the occasional "stray", which is picked up easily, as we routinely check the pot and the inside of the lid for any missed biopsies.
(It's surprising what will sometimes cling to a biopsy pot lid)
 
As for the other issues, well we routinely receive two biopsy pots, one sampled from the left and the second from the right in annotated pots. Each request card details the number of cores in each pot. Then at the macroscopic description phase, the cores are counted and any discrepancies noted and detailed in the report itself.
All the cores from each pot are placed in a single cassette and processed as per normal. The resultant blocks are then serially cut with as many sections as possible on each slide. We stain slides 1, 3, 5, 7 and 9 with H&E, sections 2 and 4 are unstained and kept and filed, sections 6 and 8 are placed onto coated slides and the majority of these are then immunostained for high molecular weight cytokeratin.
 
However, we recently did an audit on this process due to the increasing numbers and time consuming nature of the work, to see if this was an effective method.
We stained the slides as per normal and gave slides 1, 3 and 5 to the Pathologist to read and diagnose. They then looked at slides 7 and 9 to see if these slides made any difference to their diagnosis. The idea being that if slides 7 and 9 made no difference to their diagnosis we would change our working practice accordingley.
The results showed overwhelmingly that slides 7 and 9 made no difference to the diagnosis in over 98% of cases and in the remaining 2% they didn't change the diagnosis from benign to malignant, just a different degree of benign disease. 
 
Due to this data, we are currently changing our working practice so that we don't have to cut so many sections, this will be more cost and time effective and should have little or no effect on the end diagnosis.
After all, if we don't cut so many sections, there will still be the oppertunity to cut further sections should the pathologist be uncertain of the diagnosis.
 
Nick Kirk
Histopathology
Hinchingbrooke Hospital
Huntingdon
England


RSRICHMOND <@t> aol.com wrote:
Becky Garrison in Jacksonville FL observes:

>>Just this week, our Urology Center, in reviewing its QA measures, wanted to 
know if it's OK for them to ink the specimen by color to reduce specimen 
identification mixups. My first reaction was no because of concerns that unknown 
inks might interfere with fixation and ultimately IHC and the possibility of 
crush artefact introduced by "non-pathology" hands.<<

I agree - no. I want them to handle the specimen as little as possible - the 
ink needs to be added after fixation. They could use colored pens to mark the 
outsides of the containers with a set of laboratory-prescribed colors that the 
lab would use to select cassette and slide frosting colors.

I know that there are services that pre-ink the specimens, but I've never 
actually seen it done.

Bob Richmond
Samurai Pathologist
Gastonia NC
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