[Histonet] Re: Exhaust Block

[RSRICHMOND <@t> aol.com]

Cindy Dubois (Stockton CA) and Douglas D. Deltour (at the US naval hospital 
in Sigonella, Italy) comment on a pathologist's practice of having a block 
destroyed by cutting it down, in order to keep anyone else from doing additional 
studies on it.

I've never heard of such a practice, in a great number of pathology 
laboratories. It's irresponsible patient care, and, far from being a CYA, leaves the 
pathologist open to litigation, simply because it isn't anybody's standard of 
care.

I frequently have a lot of difficulty - when I'm new on a pathology service - 
in communicating to histotechnologists just what I want them to do to a 
block. Usually I go get the paraffin block myself, to look at it and see whether 
it's already been exhausted, or whether it's been inadequately cut into. 
Sometimes I want a block cut with minimal trimming - say if I'm looking at a small 
focus of cancer in a prostate biopsy specimen - and sometimes I want it 
exhausted, say if I'm looking for a cervical dysplasia that probably isn't there. 
Requests like "please recut without trimming" or "please cut through the block x3 
or more" often aren't understood. In particular, many histotechnologists are 
reluctant to exhaust a block, even when the pathologist specifically requests 
it.

There is no reason to send an obviously exhausted block to a consultant. The 
pathologist's covering letter (he DOES write a covering letter, doesn't she?) 
should state that the block has been exhausted.

[I apologize for sending this letter HTML formatted - the present version of 
AOL's mail client requires it. I look forward to the coming update of this 
listserv that will strip HTML from posts.]

Bob Richmond
Samurai Pathologist
Knoxville TN
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