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Biopsy Specimen Handling, Processing, and Quality Assurance Program

  • Rajal B. ShahEmail author
  • Ming Zhou
Chapter

Abstract

With widespread use of prostate-specific antigen (PSA) screening, a greater number of prostate biopsies are performed. It is estimated that more than one million prostate biopsies are performed in the United States annually, with each biopsy consisting of an average of eight to ten sample cores, creating an estimated ten million tissue samples. This trend has created a challenge for effective and timely handling and processing of prostate biopsies in histology laboratories, in addition to their accurate interpretation and quality assurance by surgical pathologists. Various laboratory-controlled factors influence the prostate cancer detection rate in contemporary prostate biopsy practice.

In addition, genomic testing is increasingly utilized following prostate biopsy for potential treatment decisions. This practice requires that laboratory adequately control various pre-, intra-, and post-analytic factors that can potentially affect outcome of genomic testing. This chapter addresses ideal practices for the submission, handling, and processing of prostate biopsies, as well as commonly applied quality assurance programs known to improve overall practice.

Keywords

Biopsy specimen handling Processing Quality assurance program Prostate-specific antigen PSA Hematoxylin-and-eosin stain H&E stain High-grade prostatic intraepithelial neoplasia HGPIN Atypia Error reduction Transurethral resection of prostate TURP Interobserver reproducibility Disease-focused review Consensus diagnosis Second opinion 

References

  1. 1.
    Gupta C, Ren JZ, Wojno KJ. Individual submission and embedding of prostate biopsies decreases rates of equivocal pathology reports. Urology. 2004;63:83–6.CrossRefGoogle Scholar
  2. 2.
    Kao J, Upton M, Zhang P, Rosen S. Individual prostate biopsy core embedding facilitates maximal tissue representation. J Urol. 2002;168:496–9.CrossRefGoogle Scholar
  3. 3.
    Allen EA, Kahane H, Epstein JI. Repeat biopsy strategies for men with atypical diagnoses on initial prostate needle biopsy. Urology. 1998;52:803–7.CrossRefGoogle Scholar
  4. 4.
    Brat DJ, Wills ML, Lecksell KL, Epstein JI. How often are diagnostic features missed with less extensive histologic sampling of prostate needle biopsy specimens? Am J Surg Pathol. 1999;23:257–62.CrossRefGoogle Scholar
  5. 5.
    Green R, Epstein JI. Use of intervening unstained slides for immunohistochemical stains for high molecular weight cytokeratin on prostate needle biopsies. Am J Surg Pathol. 1999;23:567–70.CrossRefGoogle Scholar
  6. 6.
    Renshaw AA. Adequate tissue sampling of prostate core needle biopsies. Am J Clin Pathol. 1997;107:26–9.CrossRefGoogle Scholar
  7. 7.
    Srodon M, Epstein JI. Central zone histology of the prostate: a mimicker of high-grade prostatic intraepithelial neoplasia. Hum Pathol. 2002;33:518–23.CrossRefGoogle Scholar
  8. 8.
    McDowell PR, Fox WM, Epstein JI. Is submission of remaining tissue necessary when incidental carcinoma of the prostate is found on transurethral resection? Hum Pathol. 1994;25:493–7.CrossRefGoogle Scholar
  9. 9.
    Nakhleh RE. Error reduction in surgical pathology. Arch Pathol Lab Med. 2006;130:630–2.PubMedGoogle Scholar
  10. 10.
    Nguyen PL, Schultz D, Renshaw AA, Vollmer RT, Welch WR, Cote K, et al. The impact of pathology review on treatment recommendations for patients with adenocarcinoma of the prostate. Urol Oncol. 2004;22:295–9.CrossRefGoogle Scholar
  11. 11.
    Raff LJ, Engel G, Beck KR, O'Brien AS, Bauer ME. The effectiveness of inking needle core prostate biopsies for preventing patient specimen identification errors: a technique to address Joint Commission patient safety goals in specialty laboratories. Arch Pathol Lab Med. 2009;133:295–7.PubMedGoogle Scholar
  12. 12.
    Shah RB, Leandro G, Romerocaces G, Bentley J, Yoon J, Mendrinos S, et al. Improvement of diagnostic agreement among pathologists in resolving an “atypical glands suspicious for cancer” diagnosis in prostate biopsies using a novel “Disease-Focused Diagnostic Review” quality improvement process. Hum Pathol. 2016;56:155–62.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Robert J Tomsich Pathology and Laboratory Medicine InstituteCleveland ClinicClevelandUSA
  2. 2.Tufts Medical CenterBostonUSA

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