Dictation Template

Gastrointestinal endoscopic biopsy

Background

Biopsies are commonly taken during endoscopic investigation of gastrointestinal lesions and inflammatory conditions.^1-9 There is conflicting evidence as to the benefit of biopsy of mucosa that appears normal endoscopically.^10,11

This protocol is also applicable to other small biopsies taken during gastrointestinal procedures such as peritoneal biopsies.

Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Follow best practice procedures to minimise cross over contamination of small fragments to other specimens.¹²

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External Inspection

Describe the following features of the specimen:

Number of pieces

• Record the number of pieces of tissue present. Multiple” should only be used to describe specimens where biopsies are too numerous to count.

Colour

• Tan
• Red
• Yellow
• White

Polyps

If discernable see colorectal polyp

• Sessile
• Pedunculated

Specimen size (mm)

• Each fragment in three dimensions

Where multiple fragments are present, the range of maximum sizes may be appropriate.

Dissection

Not required.

Internal Inspection

Not required.

Processing

Submit all tissue. Transfer directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.¹³

Record details of each cassette.

An illustrated block key similar to the one below may be useful.

Block allocation key

Acknowledgements

Dr Ian Brown for his contribution in reviewing and editing this protocol.

References

1. Lester SC. Small Biopsies. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;243-245.
2. Holscher AH, Vallbohmer D and Bollschweiler E. Early Barrett's carcinoma of the esophagus. Ann Thorac Cardiovasc Surg 2008;14(6):347-354.
3. Miehlke S, Hackelsberger A, Meining A, Hatz R, Lehn N, Malfertheiner P, Stolte M and Bayerdorffer E. Severe expression of corpus gastritis is characteristic in gastric cancer patients infected with Helicobacter pylori. Br J Cancer 1998;78(2):263-266.
4. Vannella L, Lahner E and Annibale B. Risk for gastric neoplasias in patients with chronic atrophic gastritis: A critical reappraisal. World J Gastroenterol 2012;18(12):1279-1285.
5. Geraghty JM and Talbot IC. Diversion colitis: histological features in the colon and rectum after defunctioning colostomy. Gut 1991;32(9):1020-1023.
6. Lanza G, Messerini L, Gafà R and Risio M. Colorectal tumors: The histology report. Digestive and Liver Disease 2011;43:S344-S355.
7. Muto T, Bussey HJ and Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975;36(6):2251-2270.
8. Kleer CG and Appelman HD. Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am J Surg Pathol 1998;22(8):983-989.
9. Guindi M and Riddell RH. Indeterminate colitis. J Clin Pathol 2004; 57(12):1233-1244.
10. Feakins R, Campbell F, Mears L, Moffat C, Scott N and Allen D. Tissue pathways for gastrointestinal and pancreatobiliary pathology, The Royal College of Pathologists, London, 2009.
11. Howat A, Boyd K, Jeffrey M, Lessells A, Shepherd NA and McCluggage G. Histopathology and cytopathology of limited or no clinical value, The Royal College of Pathologists, London, 2005.
12. Lester SC. Extraneous Tissue. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;33-34.
13. Ibrahim NB. ACP. Best Practice No 155. Guidelines for handling oesophageal biopsies and resection specimens and their reporting. J Clin Pathol 2000;53(2):89-94.