Re: GI biopsies

From:Rhonda Rogers <>

Hi Jude,

For many years (imaybe 15 - 20 years or longer) the laboratory I worked in
made cucumber pads for the endoscopy suites to use to orient the GI
biopsies.  I know this may sound strange, but it really works great.
Improper orientation of the biopsies as we embedded was eliminated.

Explaining to new endoscopy nurses exactly how the pads were  made or
requisitioning a dozen cucumbers from the cafeteria or having a tour group
come through the lab while we were peeling and chopping cucumbers caused
some very humorous situations over the years.  Usually, while trying to look
very serious and having difficulty holding in the laughter, I answered the
cafeteria staff's questions with, "Don't ask me what I am going to do with
12 cucumbers in the laboratory.  I am very sure that if I told you,  would
not want to know.  Believe me; we are not making a salad."

At any rate, the procedure is simple.
(1)  Peel the cucumber (thinly, being careful not to leave any of the dark
green skin).  Slice the cucumber in fourths and remove the seeded part in
the center.
(2)  Slice the cucumber into sticks (sort of like French fries) and then
slice into little rectangles.  The object is to create pieces of cucumber
that measure approximately 6x6x2 cm or a little larger or smaller according
to your needs. (Too thin and they break up;  too thick and they are too
crowded in the cassette; too small and the biopsy can be too large for the
(3)  Place the sliced and diced cucumber pads in a container and dehydrate
in 70% EtOH overnight, then 95% EtOH for the next two overnights, followed
by two overnights 100% EtOH.  Store in 100%.

We kept the main supply in the laboratory and gave small cups of "GI Biopsy
Pads" to the endoscopy rooms as needed.  The nurses teased each biopsy off
the biopsy forceps and onto the pad with the mucosa facing up and dropped
the biopsy on the pad into the fixative.  (We used Hollande's fixative.)
The pads were slightly dry when the biopsy was placed on it.  The tissue
rarely, if ever, failed to stick to the pad.  We never noticed artifacts
caused from the alcohol the pads were stored in.  Once we had a dry tissue
artifact that was caused by a very slow, nervous nurse, but with a little
additional training and experience she improved.

In the lab, the biopsies (remaining stuck to the pads) were counted,
measured, described, wrapped in biopsy paper, and processed.  When we were
ready to embed, we gently removed the biopsy from the pad and turned the
biopsy 90 degrees to embed on edge.  On very rare occasions, the biopsy
could not be removed from the cucumber, but that was not a problem because
the pad could be embedded along with the biopsy still on it, if necessary.
The cucumber cuts like a breeze with no problems and does not interfere with
the biopsy.

Before using the cucumber pads, we tried various ideas including filter
paper and some sort of mesh used in surgery (the name was gel-something, I
don't remember the exact name).  The biopsies were difficult to remove from
both, the gel-something was scratchy to cut, and the filter paper dried out
the biopsy.  The cucumber pads were perfect.

This may seem time consuming, but it is very easy to do once you get the
hang of slicing and dicing the pads.  Every three or four months, we would
cut several thousand of the little pads.  The satisfaction of a properly
embedded biopsy was well worth the time we spent manufacturing the pads.  As
we worked cutting the pads, we always joked about leaving histotechnology
and going into the cucumber pad business.  We were positive we would end up
as millionaires!

Do give the cucumbers a try.  I hope you will like them.

Institute for Molecular Medicine and Genetics
Medical College of Georgia
Augusta, GA

 ----- Original Message -----
From: Carpenter, Judith A. <>
To: 'NSH' <>
Sent: Friday, December 08, 2000 8:27 AM
Subject: GI biopsies

> Hi folks-
> Can anyone relay to me what their GI (Endoscopy) clinics use  (if they do
> use some medium)
> to orient their small mucosal biopsies ?
> If it a commercially produced medium please include the product/company
> information.
> Have a warm weekend (avoid Vermont).
> Thanks-
> Jude
> Jude Carpenter,BS, HTL(ASCP)
> Chief Technologist/Surgical Pathology/Histology/Autopsy
> FAHC/MCHV Campus
> 111 Colchester Ave.
> Burlington,   VT  05401
> (802)847-5116
> FAX : (802)847-3509

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