The Specimen Handling of GI Mucosal Biopsy: A Simple and Effective Quality Improvement Initiative
Therdkiat Trongwongsa, Jantima Tanboon, Akarin Nimmannit, Ananya Pongpaibul. Siriraj Hospital, Bangkok, Thailand
Background: GI mucosal biopsy plays important roles in several clinical situations. Many specific diagnoses could be reached from the biopsy of patients present with GI symptoms with or without endoscopic abnormality. Diagnostic foci may be patchy or exclusively locate in certain areas of mucosa e.g. on surface of the mucus layer, tip of the villi or deep within the crypt epithelium. A perpendicular plane of tissue from surface to muscularis mucosae could increase diagnostic yield since they demonstrate the entire layer of mucosa as well as preserve its anatomic architecture. Starting in February 2010, Department of Pathology Faculty of Medicine Siriraj Hospital launched the 2 steps quality development program to improve the quality of GI mucosal biopsy slides.
Design: First step at pathology laboratory, embedding technicians were trained to recognized GI mucosal biopsy and embed tissues in a perpendicular plane not to exceed 4 tissue pieces per block. After a month, second step at endoscopy unit was introduced. Endoscopic nurses were trained to spread the tissue on a mesh before fixing it in formalin. Then 3 sets of fifty slides were collected for evaluation from before, after step 1 and after step 2 period of quality development program. All slides were independently assessed by one pathology resident (TT) and one general pathologist (JT). Any conflict in reporting was resolved by consensus. Total number of tissues and number of tissues with perpendicular plane on each slide were recorded. Slides contain tissues with perpendicular plane over a half of the tissue pieces were considered as satisfactory. Diagnosis of each slide was also recorded. The study was approved by Siriraj Institution Review Board and supported by Siriraj Research Development Fund (Managed by Routine to Research: R2R)
Results: Numbers of statisfactory slides are significantly increased from 46% to 60% and 74% (p value 0.017) and shown in Table 1.
|After step 1 |
|After step 2 |
|Satisfactory slides||23 (46)||30 (60)||37 (74)|
|Unsatisfactory slides||27 (54)||20 (40)||13 (26)|