Evaluation of Initial and Deeper Sections of Esophageal Biopsy Specimens for Detection of Intestinal Metaplasia

Department of Laboratory Medicine, Carondelet St, Mary's Hospital, Tucson, AZ 85745, USA.
American Journal of Clinical Pathology (Impact Factor: 2.51). 07/2005; 123(6):886-8. DOI: 10.1309/MGRX-LQG9-QVRV-VMCG
Source: PubMed


There are wide variations in the preparation of histologic sections from endoscopic esophageal biopsy specimens. We evaluated serial step sections from 261 esophageal or gastroesophageal junction biopsies at 4 levels to determine the first level at which goblet cell metaplasia (GCM) was detected. Deeper step sections of 152 paraffin blocks also were obtained to determine whether additional sections are useful in detecting GCM not seen in initial levels. GCM was identified in 95.3% of blocks in 3 levels. GCM was seen at level 4 in 12 blocks (4.7%). In the blocks that did not reveal intestinal metaplasia in the initial 4 levels, deeper sections disclosed GCM in only 1 (0.8%) of 120 blocks. However, deeper sections revealed initially undetected GCM in 4 of 32 blocks from patients with a history of documented Barrett esophagus. We conclude that 4 levels of step sections are adequate in routine processing of esophageal biopsy specimens for demonstration of GCM. Deeper sections may be obtained for patients with known Barrett esophagus to better evaluate for dysplasia or find additional foci of GCM.

9 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: In our laboratory, for small skin biopsies or curetted specimens, 3 slides are prepared before the case is reviewed by the dermatopathologist. To examine the utility of these "prospective" step sections in improving diagnostic accuracy and turnaround time. Five hundred consecutive cases, in which step sections had been cut prior to slide review, were studied. For each specimen, 3 slides, each consisting of 1 ribbon of tissue containing 4 to 6 sections, were obtained at 50-microm intervals from the paraffin block. Fifty-eight biopsies (12%) were nondiagnostic using slide 1 alone. Step sections provided a diagnosis in 19 of 58 cases. In an additional 15 cases (3%) in which a diagnosis was possible using slide 1, deeper levels resulted in a change in diagnosis. Thus, in 34 (7%) of 500 biopsies, deeper levels resulted in improved diagnostic accuracy. In addition, the pathologist would have ordered step sections in a further 117 cases (23%) to clarify the diagnosis rendered on level 1 or to exclude other lesions. Thus, 30% of small skin biopsies would have required deeper levels if step sections had not been obtained prior to slide review. In our laboratory, the use of prospective step sections is essentially cost-neutral and case turnaround time is improved by 9% to 45%. Step sections result in a changed diagnosis in 7% of small skin biopsy specimens.
    Archives of pathology & laboratory medicine 02/2007; 131(1):107-11. DOI:10.1043/1543-2165(2007)131[107:PSSFSS]2.0.CO;2 · 2.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Histopathology is a gold standard diagnostic tool for many lesions. Interpretation of tissue sections is a pivotal step in giving the diagnosis. Usually, initial tissue sections may not show complete features of the lesion, so deeper sections of the specimen may play a significant role at times for final diagnosis. In small biopsy specimens, deeper sectioning is routinely used in many laboratories to enhance the sensitivity and accuracy of the diagnosis. Aim: To analyze the percentage of deeper sections taken and its significance in the final diagnosis of oral lesions. A total of 500 cases from the files of Department of Oral and Maxillofacial Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh were analyzed, and cases of deeper sections were selected. The present retrospective study involves comparison of initial histological findings with those seen in deeper tissue levels of same specimen. 40 cases (8%) were selected for our analysis. Out of these, 19 cases (47.5%) required deeper sections as the initial sections were superficial and undiagnostic. 21 (52.5%) cases were advised for additional sections to confirm, rule out or clarify certain diagnoses, out of which 15 (37.5%) disclosed additional pathological findings, whereas 6 cases (15%) showed the same histological features. Diagnostic laboratories must balance the utility of deeper levels with the additional time required and expense incurred and the impact on patient care. Deeper sections are inevitable in certain situations and periodical auditing of laboratory work will reduce the need for additional sections and delay in the dispatch of biopsy report.
    Indian journal of dental research: official publication of Indian Society for Dental Research 01/2011; 22(1):62-5. DOI:10.4103/0970-9290.79980
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract is missing (Letter).
    Acta Dermato-Venereologica 06/2013; 94(1). DOI:10.2340/00015555-1603 · 3.03 Impact Factor
Show more


9 Reads
Available from