College of American Pathologists
Printable Version

  Innovations in Pathology


cap today

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 (, 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 (, made it downloadable from his Web site ( 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 (

Another similar site is “ImmunoQuery,” developed by Dennis M. Frisman, MD, of San Diego. It can be accessed at, 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