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Length of prostate biopsies is not necessarily compromised by pooling multiple cores in one paraffin block: an observational study.

Tolonen TT, Isola J, Kaipia A, Riikonen J, Koivusalo L, Huovinen S, Laurila M, Porre S, Tirkkonen M, Kujala P - BMC Clin Pathol (2015)

Bottom Line: For individual site-designated cores, the median length was 11 mm (range 7 mm -15 mm).The core length was not correlated with the number of cores embedded into one paraffin block (r = 0.015).We conclude that carefully embedded multiple (three to nine) cores per block may yield cores of equal quality in a more cost-efficient way and that current guidelines favoring individually submitted cores may be too strict.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland ; Department of Cancer Biology, Institute of Biomedical Technology, University of Tampere, Tampere, Finland.

ABSTRACT

Background: Individually submitted prostatic needle biopsies are recommended by most guidelines because of their potential advantage in terms of core quality. However, unspecified bilateral biopsies are commonly submitted in many centers. The length of the core is the key quality indicator of prostate biopsies. Because there are few recent publications comparing the quality of 12 site-designated biopsies versus pooled biopsies, we compared the lengths of the biopsies obtained by both methods.

Methods: The material was obtained from 471 consecutive subjects who underwent prostatic needle biopsy in the Tampere University Hospital district between January and June 2013. Biopsies from 344 subjects fulfilled the inclusion criteria. The total number of cores obtained was 4047. The core lengths were measured on microscope slides. Extraprostatic tissue was subtracted from the core length.

Results: The aggregate lengths observed were 129.5 ± 21.8 mm (mean ± SD) for site-designated cores and 136.9 ± 26.4 mm for pooled cores (p = 0.09). The length of the core was 10.8 ± 1.8 mm for site-designated cores and 11.4 ± 2.2 mm for pooled cores (p = 0.87). The median length for pooled cores was 11 mm (range 5 mm - 18 mm). For individual site-designated cores, the median length was 11 mm (range 7 mm -15 mm). The core length was not correlated with the number of cores embedded into one paraffin block (r = 0.015). There was no significant difference in cancer detection rate (p = 0.62).

Conclusions: Our results suggest that unspecified bilateral biopsies do not automatically lead to reduced core length. We conclude that carefully embedded multiple (three to nine) cores per block may yield cores of equal quality in a more cost-efficient way and that current guidelines favoring individually submitted cores may be too strict.

No MeSH data available.


Related in: MedlinePlus

Biopsy protocol for 12 individually submitted site-designated biopsy cores.
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Fig2: Biopsy protocol for 12 individually submitted site-designated biopsy cores.

Mentions: The lengths of the biopsy cores were collected from pathology reports. For individually processed biopsies, the lengths were reported for each biopsy core in millimeters. The 12 loci of individual biopsies were standardized as follows: 1–3 were right lateral base, mid and apex, 4–6 were right medial base, mid and apex, 7–9 were left lateral base, mid and apex, and 10–12 were left medial base, mid and apex, respectively. The current scheme for site-specific needle biopsies in the TAUH district is presented in Figure 2. In the case of multiple biopsies per paraffin block, the information regarding the number of biopsies in the block and the total length of the biopsies in millimeters was required. Separately submitted additional cores targeting a region of palpable resistance were excluded from the length measurements but were included in the cancer detection rate. The length of the core and the possible length of the cancerous tissue were measured from hematoxylin-eosin (H&E) -stained slides either under a light microscope as multiples of 4x/10x objectives visual field diameter or by a liner, depending on the extent of the cancer. According to our standardized protocol, extraprostatic tissue was subtracted from the total core length to obtain the most accurate percentage of cancer. Tissue was considered extraprostatic when containing obvious fat or loose mesenchymal tissue that was distinct from the (pseudo)capsule. For cancerous prostates, a standardized scoring table was applied. The recorded parameters included primary and secondary Gleason patterns, the number of positive cores/total number of cores, cancer length/total length, the percentage of cancer, high grade prostatic intraepithelial neoplasia, and perineural invasion. The microscopic appearance of slides with individually embedded and pooled biopsies are represented in Figure 3.Figure 2


Length of prostate biopsies is not necessarily compromised by pooling multiple cores in one paraffin block: an observational study.

Tolonen TT, Isola J, Kaipia A, Riikonen J, Koivusalo L, Huovinen S, Laurila M, Porre S, Tirkkonen M, Kujala P - BMC Clin Pathol (2015)

Biopsy protocol for 12 individually submitted site-designated biopsy cores.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4373419&req=5

Fig2: Biopsy protocol for 12 individually submitted site-designated biopsy cores.
Mentions: The lengths of the biopsy cores were collected from pathology reports. For individually processed biopsies, the lengths were reported for each biopsy core in millimeters. The 12 loci of individual biopsies were standardized as follows: 1–3 were right lateral base, mid and apex, 4–6 were right medial base, mid and apex, 7–9 were left lateral base, mid and apex, and 10–12 were left medial base, mid and apex, respectively. The current scheme for site-specific needle biopsies in the TAUH district is presented in Figure 2. In the case of multiple biopsies per paraffin block, the information regarding the number of biopsies in the block and the total length of the biopsies in millimeters was required. Separately submitted additional cores targeting a region of palpable resistance were excluded from the length measurements but were included in the cancer detection rate. The length of the core and the possible length of the cancerous tissue were measured from hematoxylin-eosin (H&E) -stained slides either under a light microscope as multiples of 4x/10x objectives visual field diameter or by a liner, depending on the extent of the cancer. According to our standardized protocol, extraprostatic tissue was subtracted from the total core length to obtain the most accurate percentage of cancer. Tissue was considered extraprostatic when containing obvious fat or loose mesenchymal tissue that was distinct from the (pseudo)capsule. For cancerous prostates, a standardized scoring table was applied. The recorded parameters included primary and secondary Gleason patterns, the number of positive cores/total number of cores, cancer length/total length, the percentage of cancer, high grade prostatic intraepithelial neoplasia, and perineural invasion. The microscopic appearance of slides with individually embedded and pooled biopsies are represented in Figure 3.Figure 2

Bottom Line: For individual site-designated cores, the median length was 11 mm (range 7 mm -15 mm).The core length was not correlated with the number of cores embedded into one paraffin block (r = 0.015).We conclude that carefully embedded multiple (three to nine) cores per block may yield cores of equal quality in a more cost-efficient way and that current guidelines favoring individually submitted cores may be too strict.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland ; Department of Cancer Biology, Institute of Biomedical Technology, University of Tampere, Tampere, Finland.

ABSTRACT

Background: Individually submitted prostatic needle biopsies are recommended by most guidelines because of their potential advantage in terms of core quality. However, unspecified bilateral biopsies are commonly submitted in many centers. The length of the core is the key quality indicator of prostate biopsies. Because there are few recent publications comparing the quality of 12 site-designated biopsies versus pooled biopsies, we compared the lengths of the biopsies obtained by both methods.

Methods: The material was obtained from 471 consecutive subjects who underwent prostatic needle biopsy in the Tampere University Hospital district between January and June 2013. Biopsies from 344 subjects fulfilled the inclusion criteria. The total number of cores obtained was 4047. The core lengths were measured on microscope slides. Extraprostatic tissue was subtracted from the core length.

Results: The aggregate lengths observed were 129.5 ± 21.8 mm (mean ± SD) for site-designated cores and 136.9 ± 26.4 mm for pooled cores (p = 0.09). The length of the core was 10.8 ± 1.8 mm for site-designated cores and 11.4 ± 2.2 mm for pooled cores (p = 0.87). The median length for pooled cores was 11 mm (range 5 mm - 18 mm). For individual site-designated cores, the median length was 11 mm (range 7 mm -15 mm). The core length was not correlated with the number of cores embedded into one paraffin block (r = 0.015). There was no significant difference in cancer detection rate (p = 0.62).

Conclusions: Our results suggest that unspecified bilateral biopsies do not automatically lead to reduced core length. We conclude that carefully embedded multiple (three to nine) cores per block may yield cores of equal quality in a more cost-efficient way and that current guidelines favoring individually submitted cores may be too strict.

No MeSH data available.


Related in: MedlinePlus