Numerical Fidelity of Endoscopic Biopsy Fragments in the Processing Sequence of a University Surgical Pathology Laboratory

Abstract

Context.—Diagnostic specimens in surgical pathology are, in general, becoming smaller and smaller, as minimally invasive surgical procedures are used to obtain representative tissue. Conservation and effective utilization of small biopsy tissue is therefore crucial in the pathology laboratory. Objective.—To identify potential areas where biopsy tissue may be lost in the course of processing in our university-based laboratory. Design.—We followed 2934 endoscopic biopsy samples as they moved through our grossing area and histology laboratory by documenting the number of fragments inked and placed within tissue paper at the time of gross assessment, the number of fragments found in each cassette after processing and subsequently embedded in paraffin, and the number of pieces of tissue present on glass slides after staining. Results.—In 805 (27.4%) cases, the number of fragments of tissue noted on glass slides containing 2 levels of the paraffin block differed from the number submitted in the tissue cassette. Of these, most (137, 17%) differed between the number of fragments embedded in paraffin and those identified on glass slides. Loss of tissue fragments occurred in only 7.2% of cases, while 26.3% had gains in tissue fragments. Conclusions.—Recognition of type(s) and source(s) of variation in biopsy fragment numbers is important in quality control and in the overall practical management of a histology laboratory.