Biopsy Orientiation in the Processing Cassette

Biopsy orientation while embedding is the very important prerequisite for diagnostically valuable histological slide, although not always a biopsy needs an orientation. It would be right to say that for many reasons is not always possible to do orientation. However, the embedding person ought to have as much as possible definite clarity how the biopsy should be placed in the mold.

There are different ways of communication with the embedding person regarding specimens orientation including, but not limited by them:

direct instructions, for example,embed on edge as notes on the grossing log or on//in the cassette,

shape of the section by way of gross cutting,

and, of course, special inking.

The article Introduction in Biopsy Grossing Techniques is presenting these techniques.

Foam pads (ubiquitous blue messengers) are usually used for keeping the specimen in a position for embedding. However, this method often does not work if the specimen were too flat, small, of uncertain shape. Sometimes the specimen sticks to the upper pad or pops out when the cassette is opened.

This website tries to propagate a different use of spongy pads for orientation biopsies and some sections. The aim of the method is to give the embedding person unambiguous instruction.

There is a known but rarely employed simple method of effective foam pad use as a tool for orientation. This method ought to be used for routine practice predominately in grossing biopsies, especially skin, gynecology, and oral specimens.

Technique

When a biopsy or a section is ready to be placed in the cassette, an incision is made in the wet pad with a sharp edged small scissor. The incision is widened with small, preferably sharp branch, forceps. (Figure 1).

The specimen/section is placed in the widened incision using another delicate forceps in the way how it should be embedded (Figure 2).

The foam recoils by contraction keeping the specimen in a secure position even if it falls down on the floor. The embedding person does not have any doubt how to place the specimen in the embedding mold.

There can be several incisions with different sections/samples in the foam pad or two sections/samples (more is difficult to manage) in one incision. One long incision can be made to place a recoiled skin or an ovary cyst wall just to flatten them. The latter can be done better than by placing them between two pads, as it is traditionally done.

The pad with samples is usually placed in the cassette above another wet pad (Figure 3). This is reasonable to do especially if the section is thin or the biopsy is very small.

Discussion

Biopsy orientation in the cassette by using spongy pad with an incision is especially useful for correct embedding thin triangular tips of ellipse skin excisions when sometimes is difficult to distinguish the section part that has diagnostic value from the sides of excision. In vaginal and, especially, vulvae excisions, when every millimeter counts, correct embedding of the tips is crucial for diagnosis. Cervical biopsies, where a wrong embedding can cause a complete loss of diagnostically significant material, are another example of usefulness of incision foam pad orientation. Even a gastrointestinal biopsy, if taken properly, requires orientation, and the embedding person can barely see the ten dot/s of the area of biopsy.

This method can be more universal if the foam material were tailored completely to the size of the cassette. There can be carved thicker pad from abundant in the laboratories foam materials. If the method becomes popular, manufacturers can produce thicker pads (1 ¼ x 1 x ¼) along with traditional (1 ¼ x 1 x 1/8) S/P Foam Biopsy Pads.

 

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