Article

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: 3.01). 07/2005; 123(6):886-8. DOI: 10.1309/MGRX-LQG9-QVRV-VMCG
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Since histopathologic assessment is subject to sampling error, some institutions 'pre-order' deeper sections on some or all cases (hereafter referred to as prospective deeper sections), while others order additional sections only when needed (hereafter referred to as retrospective deeper sections). We investigated how often additional sections changed a diagnosis and/or clinical management. Given the recent decrease in reimbursement for CPT-code 88305, we also considered the financial implications of ordering additional sections. Cases (n=204) were assigned a preliminary diagnosis, based on review of the initial slide, and a final-diagnosis, after reviewing additional sections. Cases with discordant diagnoses were assessed by 2 dermatologists, who indicated whether the change in diagnosis altered clinical management. Expenses were estimated for 3 scenarios: a) no additional sections, b) prospective deeper sections, c) retrospective deeper sections. Diagnoses were modified in 9% of cases, which changed clinical management in 56% of these cases. Lesions obtained by punch-biopsy and inflammatory lesions were disproportionately overrepresented amongst cases with changed diagnoses (p<0.001, p=0.12, respectively). The cost of prospective deeper sections and retrospective deeper sections represented a 56% and 115% increase over base-costs, respectively. Labor costs, particularly the cost of dermatopathologist evaluation, were the most significant cost-drivers. While additional sections improve diagnostic accuracy, they delay turn-around-time and increase expenditures. In our practice, prospective deeper sections are cost effective; however this may vary by institution.
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