[Histonet] Re: GI biopsies

[Jay Lundgren]

       I prefer to put 3 true levels (2 sections off of 3 different
ribbons, 50-60 um between levels, given adequate tissue size), picking up
the sections horizontally on the slide.  In this way you get 6 diagnostic
sections on one slide.  Saves space on the stainer.
       I find you really have to stress adequate hydration/cooling of the
blocks to avoid artifact,  especially in a lab where the bxs are not run on
a separate processor/ protocol.  This doesn't mean you can leave blocks
floating in your icetray while you go to lunch.  But a good 5-10 mins on
ice really helps.  Also, I find I physically slow down my microtome stroke
a little when cutting GI  bxs, and cut nice long ribbons.  The sections in
the middle of a long ribbon will exhibit very little variability in
thickness.
     When you see a slide with 3 sections on it, each of a different
thickness, it's usually the result of an inexperienced or rushed tech
cutting 3-4 section "ribbons" without allowing for adequate
cooling/hydration time.  I have also frequently QC'd slides in which the
first slide is good, but the next 2 levels progressively deteriorate.  This
is due to inadequate hydration/cooling between levels.  Again, it behooves
everyone to really slow down and take your time cutting GI bxs.


On Fri, Mar 14, 2014 at 1:35 PM, Barbara Tibbs <
barbara.tibbs <@t> accuratediagnosticlabs.com> wrote:

> Dr. Richmond,
>
> A large portion of our business is GI biopsies.  We cut three levels per
> slide.  We achieve this by cutting three ribbons at different levels and
> picking up two sections from each ribbon.  If an H.pylori or AB/PAS is
> ordered we choose two sections from the middle ribbon.  I check the quality
> of the slides before handing them out to the pathologists.  I encourage the
> pathologists to share any unhappiness they have with our microtoming and
> work to improve the problem ASAP.
>
> It seems to me that skilled, caring histotechnologists plus good
> communication with the pathologists is the magic equation for excellent
> quality slides.
>
> Barbara S. Tibbs
> Histology Supervisor
> Accurate Diagnostic Labs
> South Plainfield, NJ
> barbara.tibbs <@t> accuratediagnosticlabs.com
> 732-839-3374
> Cell: 610-809-6508
>
>
> ________________________________________
> From: histonet-bounces <@t> lists.utsouthwestern.edu <
> histonet-bounces <@t> lists.utsouthwestern.edu> on behalf of Bob Richmond <
> rsrichmond <@t> gmail.com>
> Sent: Friday, March 14, 2014 10:37 AM
> To: Histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] Re: GI biopsies
>
> An anonymous query: >>I was just curious about how your institutions handle
> GI biopsies, specifically how many slides you cut off the bat. We presently
> cut 2 levels on each GI biopsy block, but I'm hearing that more and more
> places only cut 1 slide per GI biopsy block. Please share what you are
> doing at your establishment.<<
>
> Well, I take what I can get. Many histotechs lack the skill, or are
> unwilling to lay more than one ribbon on a slide. I do like more than one
> level.
>
> A more serious problem is maintaining the quality of GI biopsy sections,
> one of the most difficult quality assurance issues in histopathology. (It
> was reviewed in J HIstotechnol last year - I can find the reference.) The
> problem is at its worst with duodenal biopsies, where some services never
> prepare an adequate slide. As the "celiac disease" fad spreads and bread is
> the Evil Food of the Year, I am really concerned about signing out duodenal
> biopsies where I can't even distinguish the lymphocytes.
>
> Edwards Deming lives!
>
> Bob Richmond
> Samurai Pathologist
> Maryville TN
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