His and Her’s

IMG_1094

The photo is of two different types of biopsies embedded in two paraffin blocks. These are the what we make in histology from every biopsy and surgical specimen.

I will tell you what types of biopsies are in these two blocks soon, but first I want to explain why I have shown them to you. Basically, one of the blocks has one piece of tissue in it. The other block has many.

When many pieces of tissue are put in a block they are difficult to put in the block flat. When they aren’t flat, they aren’t all cut. Thin slices come off the face of the block. The tissue must be close enough to the face of the block to be cut. If they aren’t cut, a pathologist will not see it.

The yellow block contains one needle biopsy, a single piece. For decades biopsies from this type of organ, which I haven’t revealed yet, has been presented to the lab in single pieces. Long ago, when I was a new tech, this type of tissue came wadded in multiple pieces (like those in the green block). Techs had to separate them and try to get them flat, like in the green block. But techs couldn’t always get them flat because there were too many pieces and so tiny areas of cancer got missed.

After enough cases were misdiagnosed as false negatives, the procedure changed. I think it is high time the type of biopsy in the green block gets the same sort of change.

The type of biopsy in the yellow block no longer has tiny bits of cancer missed. The type of biopsy in the green block does.

Now I will tell you the yellow block has a prostate needle biopsy in it. The green block has multiple needle biopsies from breast in it.

This particular green block has been embedded so all the tissue has been sampled but that is often not the case. Often, there is too much tissue. Often it can’t even lay side by side because there is too much. When biopsies aren’t flat in the block, they aren’t cut, they aren’t sampled, and they aren’t used to diagnose a patient.

prostate dish
Photo from Fisher Scientific 

This blue container in the above photo shows a specific kind of dish used to collect the prostate biopsies. Dishes like these arrive in the lab with one needle biopsy in each spot.

Breast biopsies come in a mass all tangled together and floating in a jar.

Why aren’t breast biopsies collected in single pieces like prostate biopsies? Why not use a dish like the one in the photo for both? These special dishes can be used for all sorts of biopsies.

As a woman, I don’t want needles poked into my breast only to have the cancer missed because the tissue was crammed in one block. I want my needle biopsies to be completely useful to me. I want the entire biopsy to be seen by a pathologist. The trauma of the procedure demands that.

breast biopsy needle
Breast biopsy needles from Medical Expo

As a patient, when, if, I should ever have to have a needle biopsy taken of my breast, I will tell the doctor my concern and tell him to put one biopsy in each specimen container. Send it to the lab so there is one piece per block. I will explain why I want this and I hope he or she understands my reason is sound and not just more work for them. I believe all breast biopsies need to be treated with as much respect and care as a man’s prostate biopsy but I’m not sure they even think about it.

If you need to have a breast biopsy done, show this post to your doctor. That way they might see how their work effects your diagnosis in more ways than simply taking the biopsy. With the right changes, every breast biopsy  can be sampled completely.

 

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