Optimum Number of H&E Levels in the Workup of Bronchial Biopsies
Jacqueline Nunez, Jan F Silverman, Uma Krishnamurti. Allegheny General Hospital, Pittsburgh, PA
Background: Transbronchial biopsies are often used in the initial work up of lung lesions providing important information for diagnosis, treatment and prognosis. In addition to evaluation of H& E sections, there is a growing need to conserve tissue for ancillary studies such as immunohistochemistry, molecular studies and occasionally histochemistry. The optimum number of H&E levels for evaluation has not been clearly established. In the past, 5 H&E levels were performed at our institution. However, recently we obtained three levels with the intent of conserving tissue for potentially needed ancillary studies. The aim of this study was to determine the optimal number of H& E levels for diagnosis of bronchial biopsies to allow conservation of tissue for additional ancillary studies.
Design: A total of 52 cases of bronchial biopsies were retrieved from the pathology data base (01/2004 to 04/2012), with 45 cases having 5 levels and 7 cases having only 3 levels. There were 20 cases of non-small cell lung carcinoma, 9 cases of small cell lung carcinoma and 24 cases of granulomatous and infectious processes. The slides were reviewed by two investigators, and an evaluation of the amount of diagnostic material in each H&E level was recorded.
Results: Adequate diagnostic material was found in 50/52 (96%) cases in level 1, 52/52 (100%) cases in level 2, 52/52 (100%) in level 3, 40/45 (88%) cases in level 4 and 36/45 (80%) cases in level 5. Therefore, limited amount of diagnostic material was present in levels 1, 4 and 5 in 4%, 12% and 20% of cases respectively. The maximum amount of diagnostic material was seen in levels 2 and 3 in 100% of cases.
Conclusions: Our study demonstrates that it is optimal to initially obtain only 3 H&E levels in bronchial biopsies, in order to conserve tissue for potential ancillary studies. In cases with no diagnostic material present initially in the first 3 levels, additional levels can then be obtained. In our laboratory, we are currently obtaining 3 H&E levels for initial evaluation of bronchial biopsies without any compromise of diagnostic material.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 312, Monday Morning