June 2005
Feature Story
Mammography-directed breast biopsies
Charles Huizenga, MD, of Emerson Hospital, Concord, Mass., writes that
the challenge in dealing with the wire-directed breast biopsy is to put
a mark on the specimen that closely approximates the mammographic area
of interest.
The pathologist must precisely identify and embed the area of interest
because the diameter of the area with the microcalcifications can be less
than the thickness of that block. The marker must endure manipulation
and be visible after inking. The radiologist marks the area with a hypodermic
needle and sends the specimen and clinical mammograms to the pathologist.
The pathologist orients the specimen using the Kopans wire, the mammographer’s
needle, and the mammographic film.
The mammographer’s needle is removed promptly for safety and replaced
by a clip directly over the area of interest. Dr. Huizenga uses miniclips
($2.50 for a package of eight from Radio Shack—part No. 270-1540)
that are designed for soldering but will mark a small area on the surface
of a biopsy almost as accurately as a needle with an attached suture,
which is both expensive and sharp.
When microcalcifications are not seen histologically, the selected block
or blocks are sectioned again. This maneuver is usually successful. If
not, then all blocks are radiographed and productive areas are sectioned.
An immunohistochemistry vade mecum
In the September 2004 “Innovations in Pathology” column,
we described the system of Stephen Peters, MD (www.pathologyinnovations.com),
which makes it far easier to cut better frozen sections. Now, Dr. Peters,
of Hackensack (NJ) University Medical Center, writes to recommend the
workshop of Paul Bishop, MB, BCh, FRCPath, on interpreting immunohistochemistry.
Dr. Bishop, author of this excellent program and consultant histopathologist
at Wythenshawe Hospital, South Manchester, UK (100046.1102@compuserve.com),
made it downloadable from his Web site (www.e-immunohistochemistry.info/)
so that you can keep it close at hand for consultation. It does not work
on Macintosh computers, but Dr. Bishop is working on a platform-independent
Web version.
His friend, David Agbamu, BChir, MB, MA, FRCPath, has designed an adaptation
for PDAs. Dr. Agbamu is consultant histopathologist, Wirral Hospital NHS
Trust (Arrowe Park), Wirral, Merseyside, UK (vm@pathport.org.uk).
Another similar site is “ImmunoQuery,” developed by Dennis
M. Frisman, MD, of San Diego. It can be accessed at www.ipox.org/login.cfm,
though you have to register and be assigned a user’s name and password.
Try them both and, if you like them, you might drop a note of appreciation
and gratitude to all of the authors for designing these free sites for
your benefit. And please don’t forget to let me know about your
favorite Web sites.
Caveat emptor
The National Subscription Bureau, Naples, Fla., produces a “Pathology/Lab
Coding Alert” that you may have already purchased. Rather than extol
their product, or even describe it, the company sends out just personalized
bills for $309 marked “past due.” They do this presumably
in the hope that some overworked pathologists or secretaries will pay
without checking to see if they ever ordered, received, need, or use the
product. Let the buyer/payer beware of this innovation in marketing, which
preys on pathologists and other laboratory workers.
Taring the scale
Arthur H. Mensch, MD, of Inova Alexandria (Va.) Hospital, shared with
us in my September 2003 column his method of weighing messy specimens
without having to clean his scale pan repeatedly. He now reports that
he uses an Acculab GSI-2001 scale that he got from Mopec. It has a 2 Kg
capacity, and the pan is removable so the specimen, in its container or
on its lid, can be placed directly on the scale. Since it tares itself
when turned on, removing the specimen from the container gives a negative
weight that is the actual weight of the specimen.
"If not now, when?"
Timing can be everything. If you’ve been waiting for the ideal
time to submit your innovation, to share with your colleagues, let me
assure you that now is that time. The well is again running dry. Please
send in your innovations today. Your colleagues and I will be most grateful.
Dr. Haber is emeritus chief of the department
of pathology, Kaiser Permanente Medical Center, Santa Clara, California,
and clinical professor of pathology at Stanford University School of Medicine.
He can be reached at 1375 Pitman Avenue, Palo Alto, CA 94301; 650-321-3441;
slhaber@stanford-edu; fax 650-321-6773.
CAP members can refer to or download Innovation in Pathology: The Best
of Thirty Years, without charge, at www.cap.org.
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