[Histonet] Re: Prostate Needle Bx

[Jay Lundgren]

     I would like to amplify Dr. Richmond's comments by saying that the
grossing and embedding are absolutely critical with prostate bxs.

    While on assignment in the north, I helped to improve a protocol in use
at a regional medical center.  Changing cassettes or purchasing esoteric
equipment was out of the question.  I found the most important thing, from
the pathologist's standpoint, was getting complete, full, representative
sections, right from the first level to the last.  They can't diagnose what
isn't on the slide, or heaven forfend, tissue that has been cut away trying
to get a full face section.

     The cutters can't get a full section unless the embedding is *ABSOLUTELY
FLAT*.  This takes skill and time.

     Two sponges should be used to keep the bxs flat in processing, but the
bxs will pretty much come out of wax the way they went in, with a little
shrinkage.  So *you cannot have the bx folded over, or overlapping another
bx when it goes onto the first sponge.*

      I find a good technique for the grosser is to use a cut off
disposable pipette to suck up the bx and place it onto the sponge.  This
avoids crush artifact from forceps as well
.
     To reiterate; Gross it flat and straight (between sponges), embed it
flat and straight, and the cutter has the best chance of getting full
sections.  Dyeing the bxs with safranin helps the cutter to visualize when
they have a full face section.

                                  Sincerely.
                                     Jay A. Lundgren, M.S., HTL (ASCP)



On Wed, Dec 3, 2014 at 7:07 PM, Bob Richmond <rsrichmond <@t> gmail.com> wrote:

> Laurie Colbert asks about processing prostate needle biopsy specimens.
>
> The subject is extensively reviewed in this month's or last month's
> Archives of Pathology. Your pathologists have copies of this if they're
> fellows of the College of American Pathologists. Here's the method as
> presented in that article - I've been doing this for a good many years now.
>
> The urologist should submit six containers, three for each side of the
> prostate, each container containing two or more cores. No more than two
> cores should be put in one cassette. Use those little blue sponges in the
> cassettes to keep the cores flat. Measure each core, and record the
> measurements. Don't dye the cores with eosin (fluorescent) - if you want to
> dye them use safranin O.
>
> Process with other small biopsy specimens.
>
> Embed using a tamper to get the cores flat in the bottom of the boat.
>
> Cut sections onto slides suitable for immunohistochemistry. Cut 5 sections
> of each block, with little if any trimming. Stain slides 1, 3, and 5 with H
> & E. Reserve slides 2 & 4 for possible immunohistochemistry (needed in
> about a tenth of cases).
>
> It's a lot of work, but it makes cancer diagnoses. Expect a cancer
> diagnosis in about a third of cases.
>
> Bob Richmond
> Samurai Pathologist
> Maryville TN
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