[Histonet] Re: Prostate Needle Bx

[Bob Richmond]

Jay Lundgren thought of several more things I didn't think of.

It's essential to get the biopsy cores strung out straight - remember the
pathologist has to measure them on the slide. You do of course have to use
two of the blue sponges.

If the tissue is adequately fixed, you shouldn't get crush artifact
handling the specimens with tweezers, which is what I do (and I think what
the large volume labs do).

I haven't used safranin O for prostate biopsies, though I certainly have
for GI biopsies. Your microbiology lab uses quite a lot of safranin O
solution for the Gram stain, and this preparation works quite well for
small biopsy specimens. (Once again, don't use eosin - it fluoresces and
interferes with fluorescent techniques.)

Bob Richmond
Samurai Pathologist
Maryville TN

On Thu, Dec 4, 2014 at 4:11 PM, Jay Lundgren <jaylundgren <@t> gmail.com> wrote:

>      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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>
>