Endoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing.

TitleEndoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing.
Publication TypeJournal Article
Year of Publication2017
AuthorsZimmon DS, Smith FB, Manheimer F, Fan C, Njiwaji C, Aksenov S, Chattoo P
JournalGastrointest Endosc
Volume86
Issue2
Pagination333-342
Date Published2017 Aug
ISSN1097-6779
KeywordsArtifacts, Biopsy, Cholangiopancreatography, Endoscopic Retrograde, Colonoscopy, Equipment Design, Frozen Sections, Humans, Operative Time, Retrospective Studies, Single-Blind Method, Tissue Fixation
Abstract

BACKGROUND AND AIMS: Endoscopic forceps biopsy and fixation are laborious and prolong the procedure and anesthesia. Multiple biopsy overcomes these shortcomings with a single endoscope pass that cuts, like a needle biopsy, up to 25 biopsy samples of uniform size and depth during endoscope withdrawal. Biopsy specimens are collected in acquisition order and stored in a perforated plastic storage chamber within the perforated metal tip. The tip is cut off, immersed in fixative, and sent to pathology. A formatted log identifies each biopsy specimen by site and position. In pathology, the plastic storage cylinder, designed for processing and microtomy with biopsy specimens in situ, supports rapid diagnosis by frozen section and microwave or routine paraffin processing.

METHODS: After a 10-patient Institutional Review Board safety study and US Food and Drug Administration registration, biopsies were performed in 57 patients during colonoscopy, upper GI endoscopy, and ERCP. A blinded retrospective study compared colon surveillance biopsies in 15 patients who underwent multiple biopsy with 15 patients who underwent forceps biopsies performed by anonymous physicians on the same day. Patient information was removed from slides, and forceps biopsies were oriented manually for blinding.

RESULTS: Multiple biopsy specimens fixed and processed in situ were not significantly different from batched processed forceps biopsy specimens for depth, orientation, fixation, artifacts, and diagnostic information. Multiple biopsy colonic specimens were significantly (26%) smaller with better epithelial preservation than forceps specimens. Each biopsy saves 61 seconds during withdrawal.

CONCLUSIONS: Single-pass multiple biopsy reduces biopsy time with less specimen damage, work, workplace risk, and soiling. Diagnostic quality is equal to forceps biopsy with better epithelial preservation, although 26% smaller. In pathology, in situ processing and microtomy reduce work and workplace risk. Grossing and manual orientation are unnecessary. Rapid diagnosis by frozen section and microwave or paraffin processing are facilitated. Multiple biopsy speeds diagnosis and improves productivity in endoscopic biopsy and histopathologic processing.

DOI10.1016/j.gie.2016.12.004
Alternate JournalGastrointest Endosc
PubMed ID27988287
Related Faculty: 
Cathy Fan, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
Surgical Pathology: (212) 746-2700