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

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.

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

“…[2] Various studies have suggested opting for deeper sections in case of incorrect orientation & unclear histological findings in initial sections. [8,11] Sampling error…”

“…• Initial sections when obtained are superficial and undiagnostic [2] • To identify positive areas that could contribute to a proper diagnosis and rule out certain diagnosis [2,4] • To avoid diagnostic error and subsequent malpractice claims [5] • To enhance sensitivity & diagnostic accuracy [2,6,7] • Disclosing additional pathological findings & hidden malignancies [1,2] • Orientation & plane of sectioning of the tissue specimen pose problems [8,9] labelling of sections.) [1] • Increased supply costs for staining materials, glass slides, etc., and the costs for an Increased storage volume must be considered [1] • Delay in dispatching the report [2] The studies undertaken emphasizing its importance is sparse.…”

Utility of additional tissue sections in dermatopathology: diagnostic, clinical and financial implications

“…When an initial section is non‐diagnostic, it is customary for the dermatopathologist to order one or more deeper/level sections (retrospective deeper sections), which may cause a delay in turn‐around‐time. To prevent this delay, some laboratories order deeper sections in advance for some or all biopsies (prospective deeper sections) . Because many biopsies do not require deeper sections, however, this leads to wasted time, cost and materials.…”

“…Prior studies have investigated the diagnostic utility of deeper sections in small specimens from a variety of organs, including the esophagus, colon, prostate, breast and cervix . In cutaneous specimens, research has been limited and has produced mixed results .…”

Utility of Additional Tissue Sections in Surgical Pathology

“…However, recuts and additional sections (AS) have drawbacks, including increased processing costs and increased turnaround times. Multiple studies have assessed the utility of recuts and levels in improving diagnostic accuracy [4][5][6][7][8] ; however, the diagnostic utility of "additional tissue sections" in a surgical pathology specimen has not been completely elucidated.…”