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.
Important information to include:10
- Oesophagus –presence of Barrett’s oesophagus, site of biopsies, previous history
- Gastric –Helicobacter pylori history, other test results
- Colorectal –Note if biopsy is follow up of bowel cancer screening program result
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
Polyps
If discernable see colorectal polyp
The appearance of fragments can be indicative of the type of tissue present:1
- Tan and firm -usual tissue appearance
- Yellow and soft -adipose tissue
- Red and friable -haemorrhagic tissue or blood clot that may not survive processing
- Brown and hard -possible foreign body e.g. seeds that may be difficult to cut on microtome
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
Generally biopsies will be received without orientation but if received on a strip of material suitable for processing, transfer as received to a cassette. This will allow embedding on edge into block to demonstrate mucosa and submucosa in microscope sections.10
Where biopsies from multiple sites are received, ensure that specimens from each site are processed in separate cassettes and identified in the block allocation key.10
Record details of each cassette.
An illustrated block key similar to the one below may be useful.
Block allocation key
Cassette id
|
Site
|
No. of pieces
|
A
|
Duodenum
|
|
Acknowledgements
Dr Ian Brown for his contribution in reviewing and editing this protocol.
References
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Lester SC. Small Biopsies. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;243-245.
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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.
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Geraghty JM and Talbot IC. Diversion colitis: histological features in the colon and rectum after defunctioning colostomy.
Gut 1991;32(9):1020-1023.
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Lester SC. Extraneous Tissue. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;33-34.
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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.