Prostate needle biopsies

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From:"Jim Ball" <>
Date:Fri, 6 Aug 1999 22:14:15 -0400
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I really consider myself some what of a nedle freak. That is when it comes
to  needle biosies of any sort.  I really think that before any protocol is
set up you have to look at how the needles are taken. The progress that has
been made in radiology could limit alot of unwanted extra sections. I have
found out that there are no real good reasons for not giving the radiologist
and the attending doctor the results they expect, especially since they can
produce an xray and a ultrasound picture of exactly where the needle was
placed. Granted on blind biopsies this is not the case. The exact location
and isolation of that site by raidiology, and a honking 18 gauge needle,
which is the going bore in most prostate biopsies, and in cases of very
small lesions a word from the radiologist should cut your work cosiderable,
and leave alot of tissue in the block for future IHC procedures yet
         Let us assume for a moment that the needle is exact and the needle
is in the lesion dead center, will not the first -second an so on sections.
produce a positive result be it CA or Benign in nature. The only times that
I have any problems is when that lesion is necrotic, and guess what the
radiologist suspected it when he drew the sample.
          There was one practice mentioned that I have a little problem with
an that is the combining of samples when they come in seperate containers.
One reason is if the hospital is charging for six samples and only two
cassettes are produced out a possible 6 cassettes could this not be
considered fraud. The marking of the biosies with different inks may curb
the taste for blood by Uncle Sam. The biggest reason I object  to this
practice of combining is because the lesion may be very small and with a
word from the radiologist you might wish to cut a few levels on these types
of lesions . I really perfer to cut two scout slides, and save the majoriety
of the tissue(think of how much better off Custer would have been if he had
sent out two scouts)
            I'll grant you I don't write well ( or should I have used good )
and I have done a bad job of expressing what I think is the correct way of
handling needle biopsies, but I would let the results we have obtained do
all of my rebuttals.

            So in closing may I suggest your protocols all first start with
a little more communication with the radiogy deparment, and some comments by
the radiologist on the surgical request they submit.
             Second thought on necrotic specimens these should have several
serial sections as well as levels done for these are what strain good
relationships, again a frienly word by the radiologist will make life more
              Third thought on seperating specimens in their own little
cassettes. Prostate biosies seem to have a bad habit of hiding stoney type
material. While the piece containing the stones may not contain the lesion
you want to demonstrate it could cause you miss the lesion in the biopsy
next to it in the paraffin.
               Please address all replies to the NET nothing I like better
than a public AX-acution.

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