Deep Sections, a Guiding Path for Accurate Diagnosis in Histopathology - A Retrospective Study

Paul, Shankargouda; Rao, Roopa S; Nagaraja, A. S.

doi:10.1177/2229411220130204

Cited by 4 publications

(8 citation statements)

References 12 publications

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“…Our study showed that a total of 125 cases (26.9% of the total 464 cases) had deeper sections at various levels, compared to 10% in Patil et al's [ 8 ] study and 8% in Manyam et al's [ 7 ] study. This shows that our study had a slightly higher frequency of deeper sections which can be assumed owing to the fact that our study included noncutaneous biopsy samples from two different organ systems unlike in the other two studies which used only the similar cases from oral histopathology archive.…”

Section: Discussioncontrasting

confidence: 46%

“…Multiple serial sections will allow the pathologist to get more detailed information in each level than step sections in which we discard the sections at certain interval. Due to this, some diagnostic lesion could be missed; on the contrary, step sections can allow the remaining sections to be used for other purposes like for special stains [ 8 ]. Similarly, better section will minimize the artefacts like shattering effects caused by blunt blades.…”

Section: Discussionmentioning

confidence: 99%

“…Like in many hospitals, deeper sections are regularly practiced in our laboratory setup as well. Deeper sections have been found to be helpful in providing additional information during the final diagnosis of small biopsy specimens, thereby increasing the diagnostic accuracy leading to subsequent improvement in overall patient care [ 8 , 9 , 14 – 16 ]. This study has therefore been conducted to find the overall frequencies and levels of deeper section requested for small biopsy specimens of various organs and the factors warranting its need.…”

Section: Introductionmentioning

confidence: 99%

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Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal

Lama

Upadhyaya

Karki

et al. 2021

Advances in Medicine

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Background. Biopsy is an important tool for accurate diagnosis of disease in histopathology which can be examined at multiple levels during microscopic examination. The initial sections may not be representative of the entire biopsy, which leads to frequent request for deeper sections. This study assessed the frequency and diagnostic utility of deeper sections in noncutaneous small biopsy specimens at a tertiary hospital. Material and Methods. All the formalin fixed noncutaneous small biopsy specimens received were processed for grossing followed by tissue processing and embedding. The paraffin-embedded blocks were cut into 3–5 µm sections, fixed in a glass slide, deparaffinised, and then stained with hematoxylin and eosin (H&E) stain as per the standard protocol. Deeper sections were instructed based on microscopic findings of initial slides. The overall frequency of deeper section, its levels of cutting, tissue survival, and outcome were assessed and interpreted for the final diagnosis. Results. A total of 125 cases (26.9%) from 464 samples received were requested for deeper sections. The most frequent deeper sections were from cervix (72 cases) followed by stomach (18 cases) and endometrium (17 cases). The deeper sections were performed most frequently at 4 levels (17.8%) followed by 5 levels (14.8%) and 6 levels (13.3%). Deeper sections revealed nondiagnostic additional features in 28.2%, while 2.2% showed additional diagnostic features. Likewise, 2.2% had tissue segment loss. The overall mean level showing additional features was 6 levels. Tissue survival increased in 13% cases and 1.5% had decreased survival. The most common reason for requesting deeper section was to enhance sensitivity and diagnostic accuracy of disease. Conclusions. Deeper sections often contribute to final diagnosis. Therefore, deeper sections on biopsies that cannot readily be diagnosed on routine levels are recommended regardless of size of the lesion and there should be uniformity in the practice of deeper sections across the globe.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal

Lama

Upadhyaya

Karki

et al. 2021

Advances in Medicine

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“…When a pathologist demands many sections at varying depths before providing a conclusive diagnosis, this creates a situation in which deeper sectioning becomes necessary. [16,17] Because of the lack of precision and overlap among microscopic features, doing routine histology might make it challenging to make a diagnosis of a medical condition. [21] After going through the initial slides, if the oral pathologist notices something that should raise some red flags, they may suggest that the use of retrospective step sections obtain deeper levels.…”

Section: Introductionmentioning

confidence: 99%

Histopathology of Noncutaneous Small Biopsy Specimens: The Diagnostic Value of Deeper Sections

Malik¹,

Muhammad²,

Jadoon³

et al. 2022

PJMHS

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Objective: This study aims to determine the incidence of deeper sections and the diagnostic value of these sections in non-cutaneous small biopsy specimens taken at a hospital. Study Design: Cross-sectional study Place and Duration: DHQ Teaching Hospital, Abbottabad; Jan 2022-Jun 2022. Methods: 76 patients aged 18-48 were presented in this study. Patients admitted to the oral and maxillofacial department who underwent deeper sections were included. After obtaining informed and written consent, complete demographic information was obtained. In all cases, the sites of organs and levels for seep sections were recorded. Categorical variables were assessed using mean, standard deviation, frequency, and percentages. Results: Researchers found that majority of the deeper sections, 40 (52.6%) cases were from the cervix, followed by stomach, endometrium, and colorectal. Level 4 was the most commonly performed deeper section among 18 (23.7%) cases. Even though a diagnosis could be made from the first slide, deeper levels were examined in 41 (53.9%) cases to explore other histological characteristics. This was to either increase the reliability of the diagnosis made from the first slide or to confirm that diagnosis. Of these 41 instances, 14 (34.1%) revealed the same histological characteristics in deeper sections, whereas 27 (65.9%) revealed new pathological abnormalities. Conclusion: A definitive diagnosis often has to be based on a deeper section. Therefore, regardless of the lesion size, it is advised that deeper areas be performed on samples that cannot be reliably identified on normal levels. This procedure should be standardized worldwide. Keywords: Deeper Sections, Histopathology, Biopsy, Non-cutaneous

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“…There are studies in which the utility of step sections has been evaluated in biopsies from various organs including skin. [2][3][4][5][6][7][8][9] Interestingly small skin biopsies have a cosmetic advantage and are thus preferred in day-to-day practice, but for dermatopathological diagnosis they pose difficulty because most of the skin biopsy specimens often exhibit nonspecific and overlapping microscopic features. There are not many studies done on the utility of step sections in dermatopathological practice and also, currently no standard protocols are available for its routine use.…”

Section: Introductionmentioning

confidence: 99%

Stepping on diagnosis with step sections- An institutional experience

Kulkarni¹,

Sushmita.²,

Bijjaragi³

et al. 2020

ACHR

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Introduction: A thorough morphological assessment plays a central role in evaluation of skin biopsies. Overlapping microscopic features pose additional diagnostic challenges in dermatopathological practice. More over skin biopsies are of small size and diagnostic findings may not be present in the initial section. Hence, step sectioning may have added value as in adjunct in contemplating the final diagnosis. Objective: The study was aimed to evaluate the diagnostic utility of step sectioning in dermatopathology. Materials and Methods: A total of 478 skin biopsies were received over a period of 2 years from January 2015 to December 2016 at the Department of Pathology, JJMMC. Two prospective step sections (A2, A3) were cut at an interval of 50µm from the original section (A1). The findings were evaluated by two pathologists independently. The results were analysed and evaluated statistically. Results: Majority of cases (n= 453, 94.7%) were diagnostic. Out of these, many cases (n= 400, 83.6%) showed no additional findings on step sections. In a few cases (n= 32, 6.7%), step section provided additional findings which contributed to the diagnosis. There were some cases (n= 14, 3%) in which findings were noted only on step section leading to the diagnosis. Some cases (n=7, 1.46%) were such that the step sections changed the diagnosis made on original section. Conclusion:Step sectioning enhances the diagnostic accuracy of morphological assessment in ermatopathology practice.

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Deep Sections, a Guiding Path for Accurate Diagnosis in Histopathology - A Retrospective Study

Cited by 4 publications

References 12 publications

Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal

Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal

Histopathology of Noncutaneous Small Biopsy Specimens: The Diagnostic Value of Deeper Sections

Stepping on diagnosis with step sections- An institutional experience

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