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Live Blog: Better Biopsies – Pitfalls in Dermatopathology – Part One. Faculty: Michael Conroy, MD.

In this live blog from the Annual Fall SDPA Conference in Orlando, Michael Conroy, MD, presented a lecture on “Better Biopsies: Pitfalls in Dermatopathology.” Here are some of the highlights of part one of his lecture: The Journey of the Biopsy.

The Journey of the Biopsy
Dr. Conroy began his lecture by providing a little background on how one becomes a dermatopathologist. A dermatopathologist is a board-certified dermatologist and a board-certified pathologist who accomplishes a one-year dermatopathology fellowship and then takes the exam to be a board-certified dermatopathologist.

Dr. Conroy spoke about the detailed process that a piece of biopsied tissue goes through before it is diagnosed by a dermatopathologist. The following is what happens to a biopsy after it’s been taken from the patient and shipped from the dermatologist’s office.

The biopsy is placed in a cassette, depending the size of the biopsy. Sometimes biopsies can be so small they can slip through the cassette’s grate. Those tiny specimens are then caught in a bowl under the cassette.

The biopsy then goes through tissue processing to remove all the fat and water from the sample (the water is removed with EtOH and the EtOH is then removed with Xylene).

Paraffin embedding then hardens the sample making it ready to be cut. There is tissue in the hardened paraffin: that’s the block that must be cut with a very sharp blade in order to create thin cut-layers of the paraffin tissue (thin enough for light to pass through). The paraffin pieces look like a jellyfish in the water that the examiner then extracts onto a glass slide.

A piece of jellyfish-like paraffin is then collected onto a slide and processed through an H&E Tissue Stainer & Coverslipper which seals the sample onto the slide to then get inspected under the microscope.

Upon microscopic examination (and in this day and age a slide can also be made digital and examined on a computer) the biopsy undergoes the case signout phase. Essentially, the slides, requisition forms, and numbers are sent to the dermatopathologist to examine. The dermatopathologist then replies to the healthcare provider via a transcription assessment as an EMR report and/or faxing report.

There are a lot of steps to obtaining a proper biopsy diagnosis (Dr. Conroy emphasized that this list doesn’t even cover what happens on the healthcare provider’s side of the initial biopsy removal). Consequently, there are a lot of opportunities for errors and missteps.

You can view part two of Dr. Conroy’s lecture here.

Image: University of Liverpool Faculty of Health & Life Science

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