Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies
Introduction: Small skin biopsies offer a cosmetic advantage to the patient but may provide limited information for making a diagnosis. Non specific and overlapping microscopic features often seen on superficial histopathology sections contribute to this challenge. In such cases, the use of step...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/18552/63870_CE[Ra1]_F(IS)_QC(SHK_RDW_SS)_PF1(AG_OM)_PFA(KM)_PB(AG_SL)_PN(SL).pdf |
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| author | HK Manjunath M Bhargavi VC Dharani MJ Thej M Lakshmidevi BM Mythri K Vinitra B Akshatha |
| author_facet | HK Manjunath M Bhargavi VC Dharani MJ Thej M Lakshmidevi BM Mythri K Vinitra B Akshatha |
| author_sort | HK Manjunath |
| collection | DOAJ |
| description | Introduction: Small skin biopsies offer a cosmetic advantage
to the patient but may provide limited information for making a
diagnosis. Non specific and overlapping microscopic features
often seen on superficial histopathology sections contribute to
this challenge. In such cases, the use of step deeper and reverse
embedding (re-embedding) sections has utility in improving
diagnostic accuracy in dermatopathology practice.
Aim: To examine the use of prospective step sectioning and
reverse embedding in skin biopsies to improve diagnosis.
Materials and Methods: This prospective, cross-sectional
study included 200 consecutive skin biopsies received in the
Department of Pathology, BGS Global Institute of Medical
Sciences, Bengaluru, Karnataka, India, over an eight-month
period from June 2022 to January 2023. Only skin biopsies
smaller than 5 mm were included, while large punch biopsies
(larger than 5 mm) were excluded. For each sample, a superficial
section, step deeper section, and reverse embed section were
taken. The pathologist reviewed the microscopic findings and
rendered a diagnosis on the first slide. The other two slides
were then reviewed, and the information provided by slides 2
and 3 was categorised as either no new information, additional
information to make a diagnosis, or a change in diagnosis. Any
change in diagnosis based on the information from slides 2 and
3 was noted and analysed.
Results: Out of the 200 skin biopsies studied, 32 cases (16%)
were non diagnostic on the first slide. Step deeper sections
helped in making a diagnosis in 16 (8%) cases, and reverse
embedding aided in the diagnosis of 9 (4.5%) cases. For the
remaining seven cases where no additional information was
obtained even after deeper and reverse embed sectioning, a
descriptive report was provided. In eight (4%) cases out of the
200 biopsies where a diagnosis was made on the first slide,
deeper/reverse embedding led to a change in diagnosis. Thus,
deeper sectioning and reverse embedding improved diagnostic
accuracy in 33 cases out of the total 200 skin biopsies studied
(16.5%).
Conclusion: This study highlights the utility of step deeper and
reverse embed (re-embedded) sections in increasing diagnostic
accuracy in small skin biopsies. Therefore, implementation of
standardised protocol for studying multiple sections of small
skin biopsies before rendering a diagnosis can significantly
reduce diagnostic errors and aid in providing appropriate
treatment to patients. |
| first_indexed | 2024-03-11T15:56:02Z |
| format | Article |
| id | doaj.art-8dc56532bd3c4672b87362381f1f4eed |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-11T15:56:02Z |
| publishDate | 2023-10-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-8dc56532bd3c4672b87362381f1f4eed2023-10-25T10:51:30ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-10-011710081310.7860/JCDR/2023/63870.18552Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin BiopsiesHK Manjunath0M Bhargavi1VC Dharani2MJ Thej3M Lakshmidevi4BM Mythri5K Vinitra6B Akshatha7Professor and Head, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Associate Professor, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Associate Professor, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Professor, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Postgraduate Student, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Assistant Professor, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Assistant Professor, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Assistant Professor, Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.Introduction: Small skin biopsies offer a cosmetic advantage to the patient but may provide limited information for making a diagnosis. Non specific and overlapping microscopic features often seen on superficial histopathology sections contribute to this challenge. In such cases, the use of step deeper and reverse embedding (re-embedding) sections has utility in improving diagnostic accuracy in dermatopathology practice. Aim: To examine the use of prospective step sectioning and reverse embedding in skin biopsies to improve diagnosis. Materials and Methods: This prospective, cross-sectional study included 200 consecutive skin biopsies received in the Department of Pathology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India, over an eight-month period from June 2022 to January 2023. Only skin biopsies smaller than 5 mm were included, while large punch biopsies (larger than 5 mm) were excluded. For each sample, a superficial section, step deeper section, and reverse embed section were taken. The pathologist reviewed the microscopic findings and rendered a diagnosis on the first slide. The other two slides were then reviewed, and the information provided by slides 2 and 3 was categorised as either no new information, additional information to make a diagnosis, or a change in diagnosis. Any change in diagnosis based on the information from slides 2 and 3 was noted and analysed. Results: Out of the 200 skin biopsies studied, 32 cases (16%) were non diagnostic on the first slide. Step deeper sections helped in making a diagnosis in 16 (8%) cases, and reverse embedding aided in the diagnosis of 9 (4.5%) cases. For the remaining seven cases where no additional information was obtained even after deeper and reverse embed sectioning, a descriptive report was provided. In eight (4%) cases out of the 200 biopsies where a diagnosis was made on the first slide, deeper/reverse embedding led to a change in diagnosis. Thus, deeper sectioning and reverse embedding improved diagnostic accuracy in 33 cases out of the total 200 skin biopsies studied (16.5%). Conclusion: This study highlights the utility of step deeper and reverse embed (re-embedded) sections in increasing diagnostic accuracy in small skin biopsies. Therefore, implementation of standardised protocol for studying multiple sections of small skin biopsies before rendering a diagnosis can significantly reduce diagnostic errors and aid in providing appropriate treatment to patients.https://www.jcdr.net/articles/PDF/18552/63870_CE[Ra1]_F(IS)_QC(SHK_RDW_SS)_PF1(AG_OM)_PFA(KM)_PB(AG_SL)_PN(SL).pdfhistopathologyre-embeddingreverse embeddingsmall skin biopsiesstep deeper |
| spellingShingle | HK Manjunath M Bhargavi VC Dharani MJ Thej M Lakshmidevi BM Mythri K Vinitra B Akshatha Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies Journal of Clinical and Diagnostic Research histopathology re-embedding reverse embedding small skin biopsies step deeper |
| title | Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies |
| title_full | Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies |
| title_fullStr | Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies |
| title_full_unstemmed | Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies |
| title_short | Utility of Prospective Step Sections followed by Reverse Embedding Technique in Increasing Diagnostic Accuracy of Skin Biopsies |
| title_sort | utility of prospective step sections followed by reverse embedding technique in increasing diagnostic accuracy of skin biopsies |
| topic | histopathology re-embedding reverse embedding small skin biopsies step deeper |
| url | https://www.jcdr.net/articles/PDF/18552/63870_CE[Ra1]_F(IS)_QC(SHK_RDW_SS)_PF1(AG_OM)_PFA(KM)_PB(AG_SL)_PN(SL).pdf |
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