RE: [Histonet] Re: GI biopsies
Yes Dr. Richmond GI biopsies are prone to processing issues and shatter/chatter artifact. I like to put three true levels on one slide with unstained for later SS IHC , OR put two parallel ribbons on one slide, ( 2 slides of 2 ribbons, for 4 actual levels). I put three ribbons for Hirshsprungs on each slide to provide the section numbers without making multitudes of slides. I have a hard time getting this accepted- The pathologist almost always wants three ribbons on 2-3 slides, and I think that is because only some of the sections are truly readable- the section quality is too variable for these specimens for them to feel comfortable. I like to reveiw these under the microscope since when they are tiny, it is hard to see the shatter, folds and fragmentation on the water bath. I agree it is definately a quality problem to be addressed. Joelle Weaver MAOM, HTL (ASCP) QIHC Date: Fri, 14 Mar 2014 08:37:46 -0400 From: rsrichm...@gmail.com To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Re: GI biopsies An anonymous query: I was just curious about how your institutions handle GI biopsies, specifically how many slides you cut off the bat. We presently cut 2 levels on each GI biopsy block, but I'm hearing that more and more places only cut 1 slide per GI biopsy block. Please share what you are doing at your establishment. Well, I take what I can get. Many histotechs lack the skill, or are unwilling to lay more than one ribbon on a slide. I do like more than one level. A more serious problem is maintaining the quality of GI biopsy sections, one of the most difficult quality assurance issues in histopathology. (It was reviewed in J HIstotechnol last year - I can find the reference.) The problem is at its worst with duodenal biopsies, where some services never prepare an adequate slide. As the celiac disease fad spreads and bread is the Evil Food of the Year, I am really concerned about signing out duodenal biopsies where I can't even distinguish the lymphocytes. Edwards Deming lives! Bob Richmond Samurai Pathologist Maryville TN ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Re: GI biopsies
Dr. Richmond, A large portion of our business is GI biopsies. We cut three levels per slide. We achieve this by cutting three ribbons at different levels and picking up two sections from each ribbon. If an H.pylori or AB/PAS is ordered we choose two sections from the middle ribbon. I check the quality of the slides before handing them out to the pathologists. I encourage the pathologists to share any unhappiness they have with our microtoming and work to improve the problem ASAP. It seems to me that skilled, caring histotechnologists plus good communication with the pathologists is the magic equation for excellent quality slides. Barbara S. Tibbs Histology Supervisor Accurate Diagnostic Labs South Plainfield, NJ barbara.ti...@accuratediagnosticlabs.com 732-839-3374 Cell: 610-809-6508 From: histonet-boun...@lists.utsouthwestern.edu histonet-boun...@lists.utsouthwestern.edu on behalf of Bob Richmond rsrichm...@gmail.com Sent: Friday, March 14, 2014 10:37 AM To: Histonet@lists.utsouthwestern.edu Subject: [Histonet] Re: GI biopsies An anonymous query: I was just curious about how your institutions handle GI biopsies, specifically how many slides you cut off the bat. We presently cut 2 levels on each GI biopsy block, but I'm hearing that more and more places only cut 1 slide per GI biopsy block. Please share what you are doing at your establishment. Well, I take what I can get. Many histotechs lack the skill, or are unwilling to lay more than one ribbon on a slide. I do like more than one level. A more serious problem is maintaining the quality of GI biopsy sections, one of the most difficult quality assurance issues in histopathology. (It was reviewed in J HIstotechnol last year - I can find the reference.) The problem is at its worst with duodenal biopsies, where some services never prepare an adequate slide. As the celiac disease fad spreads and bread is the Evil Food of the Year, I am really concerned about signing out duodenal biopsies where I can't even distinguish the lymphocytes. Edwards Deming lives! Bob Richmond Samurai Pathologist Maryville TN ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Re: GI biopsies
I prefer to put 3 true levels (2 sections off of 3 different ribbons, 50-60 um between levels, given adequate tissue size), picking up the sections horizontally on the slide. In this way you get 6 diagnostic sections on one slide. Saves space on the stainer. I find you really have to stress adequate hydration/cooling of the blocks to avoid artifact, especially in a lab where the bxs are not run on a separate processor/ protocol. This doesn't mean you can leave blocks floating in your icetray while you go to lunch. But a good 5-10 mins on ice really helps. Also, I find I physically slow down my microtome stroke a little when cutting GI bxs, and cut nice long ribbons. The sections in the middle of a long ribbon will exhibit very little variability in thickness. When you see a slide with 3 sections on it, each of a different thickness, it's usually the result of an inexperienced or rushed tech cutting 3-4 section ribbons without allowing for adequate cooling/hydration time. I have also frequently QC'd slides in which the first slide is good, but the next 2 levels progressively deteriorate. This is due to inadequate hydration/cooling between levels. Again, it behooves everyone to really slow down and take your time cutting GI bxs. On Fri, Mar 14, 2014 at 1:35 PM, Barbara Tibbs barbara.ti...@accuratediagnosticlabs.com wrote: Dr. Richmond, A large portion of our business is GI biopsies. We cut three levels per slide. We achieve this by cutting three ribbons at different levels and picking up two sections from each ribbon. If an H.pylori or AB/PAS is ordered we choose two sections from the middle ribbon. I check the quality of the slides before handing them out to the pathologists. I encourage the pathologists to share any unhappiness they have with our microtoming and work to improve the problem ASAP. It seems to me that skilled, caring histotechnologists plus good communication with the pathologists is the magic equation for excellent quality slides. Barbara S. Tibbs Histology Supervisor Accurate Diagnostic Labs South Plainfield, NJ barbara.ti...@accuratediagnosticlabs.com 732-839-3374 Cell: 610-809-6508 From: histonet-boun...@lists.utsouthwestern.edu histonet-boun...@lists.utsouthwestern.edu on behalf of Bob Richmond rsrichm...@gmail.com Sent: Friday, March 14, 2014 10:37 AM To: Histonet@lists.utsouthwestern.edu Subject: [Histonet] Re: GI biopsies An anonymous query: I was just curious about how your institutions handle GI biopsies, specifically how many slides you cut off the bat. We presently cut 2 levels on each GI biopsy block, but I'm hearing that more and more places only cut 1 slide per GI biopsy block. Please share what you are doing at your establishment. Well, I take what I can get. Many histotechs lack the skill, or are unwilling to lay more than one ribbon on a slide. I do like more than one level. A more serious problem is maintaining the quality of GI biopsy sections, one of the most difficult quality assurance issues in histopathology. (It was reviewed in J HIstotechnol last year - I can find the reference.) The problem is at its worst with duodenal biopsies, where some services never prepare an adequate slide. As the celiac disease fad spreads and bread is the Evil Food of the Year, I am really concerned about signing out duodenal biopsies where I can't even distinguish the lymphocytes. Edwards Deming lives! Bob Richmond Samurai Pathologist Maryville TN ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
