-----Original Message-----
From: Jim Ball <xryhisto@ovis.net>
To: histonet@Pathology.swmed.edu <histonet@Pathology.swmed.edu>
Date: Friday, August 06, 1999 10:14 PM
Subject: Prostate needle biopsies


>I really consider myself some what of a nedle freak. That is when it comes
>to  needle biosies of any sort.  I really think that before any protocol is
>set up you have to look at how the needles are taken. The progress that has
>been made in radiology could limit alot of unwanted extra sections. I have
>found out that there are no real good reasons for not giving the
radiologist
>and the attending doctor the results they expect, especially since they can
>produce an xray and a ultrasound picture of exactly where the needle was
>placed. Granted on blind biopsies this is not the case. The exact location
>and isolation of that site by raidiology, and a honking 18 gauge needle,
>which is the going bore in most prostate biopsies, and in cases of very
>small lesions a word from the radiologist should cut your work cosiderable,
>and leave alot of tissue in the block for future IHC procedures yet
>undiscovered
>         Let us assume for a moment that the needle is exact and the needle
>is in the lesion dead center, will not the first -second an so on sections.
>produce a positive result be it CA or Benign in nature. The only times that
>I have any problems is when that lesion is necrotic, and guess what the
>radiologist suspected it when he drew the sample.
>          There was one practice mentioned that I have a little problem
with
>an that is the combining of samples when they come in seperate containers.
>One reason is if the hospital is charging for six samples and only two
>cassettes are produced out a possible 6 cassettes could this not be
>considered fraud. The marking of the biosies with different inks may curb
>the taste for blood by Uncle Sam. The biggest reason I object  to this
>practice of combining is because the lesion may be very small and with a
>word from the radiologist you might wish to cut a few levels on these types
>of lesions . I really perfer to cut two scout slides, and save the
majoriety
>of the tissue(think of how much better off Custer would have been if he had
>sent out two scouts)
>            I'll grant you I don't write well ( or should I have used
good )
>and I have done a bad job of expressing what I think is the correct way of
>handling needle biopsies, but I would let the results we have obtained do
>all of my rebuttals.
>
>            So in closing may I suggest your protocols all first start with
>a little more communication with the radiogy deparment, and some comments
by
>the radiologist on the surgical request they submit.
>             Second thought on necrotic specimens these should have several
>serial sections as well as levels done for these are what strain good
>relationships, again a frienly word by the radiologist will make life more
>BEAR-ABLE.
>              Third thought on seperating specimens in their own little
>cassettes. Prostate biosies seem to have a bad habit of hiding stoney type
>material. While the piece containing the stones may not contain the lesion
>you want to demonstrate it could cause you miss the lesion in the biopsy
>next to it in the paraffin.
>               Please address all replies to the NET nothing I like better
>than a public AX-acution.
>