“Adjustable Immobilization” Concept in Uniform and Perpendicular Surgical Pathology Gross Section

In surgical pathology, the goal has always been to attain uniformity of a grossed section. Accelerated microwave technology has made it a necessity for quality tissue processing. The high speed microwave processor protocols determine the separation of samples by size.

Perpendicularity of the gross section is also a technical requirement, especially in dermatopathology. Perpendicularity is vital in order to determine tumor-free margins in surgical oncology. The subsequent trimming during microtomy cannot compensate for tangential gross section.

There are three main technical conditions that are vital to a representative and uniform biopsy section: visibility of the area of section, adequate instruments, and immobilization. The latter is the key. Immobilization should be both secure and flexible. It means that the thickness of the section can be adjusted within a certain range while maintaining the specimen unmovable during the cut. The basic principle of slicing surgical pathology specimens, especially biopsies, is that the thickness of the section is sacrificed for the sake of providing the most representative sample while maintaining the perpendicularity and uniformity of the serial sections. The diagnostic considerations are paramount in every action during gross sections.

“Adjustable immobilization” would be an appropriate term for the technique that provides stability of the specimen during sectioning, which is a prerequisite of any meaningful section while adjusting the thickness of the most diagnostically valuable parts of the specimen. This term is not commonly used. Actually, it has been introduced by this author in a recent Journal of Histotechnology publication. Although adjustable or flexible immobilization might sound contradictory, even an oxymoron, it is vital for every diagnostically valuable gross section.

A skilled grossing person can make adequately uniform sections which in most cases will satisfy the diagnostic goals of the specimen. Appropriate conditions of firm underlying surface, holding instruments, and sharp cutting devices are obviously necessary. The medical instrument manufacturing industry provides some devices that suit this purpose. However, surgical pathology laboratory mass production “assembly line” and special diagnostic goals often require additional specialized devices that provide a definite visualization of the area of the section, which is the main prerequisite of a diagnostically sound microsection.

The concept of adjustable immobilization is in the background of a device for Biopsy Uniform Section (BUS). The device opens a new approach to achieve uniformity as well as to obtain a perpendicular biopsy section.

The concept of “adjusted immobilization” prompted a different technical solution for uniform serial surgical pathology specimens sections. A platform device with a horizontal bar whose width allows the preset thickness(3, 4, 5 mm)  of a section to be cut was developed.Visinoni prototype 266  Figure 1. Skin ellipse. The vertical bar provides immobilization and facilitates stability for a strong perpendicular section.BUSMilestonePrototype Figure 2 Placenta The vertical bar functions as the “third hand” for immobilization, which is the  second principle  that is required to obtain a uniform and perpendicular section.

Both “adjusted immobilization” concept and “third hand” principle of immobilization can be placed in the background of development a variety of devices for uniform and perpendicular gross section in surgical pathology. They can be expanded to other need of gross sectioning as well.

Conclusion

Professional sectioning in surgical pathology aims for uniformity at all times. Two basic principles, namely, immobilization and visualization, are especially significant in biopsy sampling. However, uniformity should yield to the informative value of the section. The concept of “adjustable immobilization” requires appropriate instruments for implementation. The device for Biopsy Uniform Section is one example. The concept of “adjustable immobilization” offers a new technical approach to the methodology of sampling biopsies in order to achieve the most diagnostically valuable uniform perpendicular section.

 

 

 

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