757 AJCP / ORIGINAL ARTICLE Am J Clin Pathol 2019;152:757-765 DOI: 10.1093/ajcp/aqz101 © American Society for Clinical Pathology, 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Prostate Biopsy Processing An Innovative Model for Reducing Cost, Decreasing Test Time, and Improving Diagnostic Material Paari Murugan, MD, 1 Dip Shukla, 3 Jennifer Morocho, HTL, 4 Deanne Smith, PA, 1 Drew Sciacca, PA, 1 Meghan Pickard, PA, 1 Michelle Wahlsten, HTL, 4 Ashley Gunderson, HTL, 3 Badrinath Konety, MD, 2 Mahmoud A. Khalifa, MD, 1 and Christopher Warlick, MD 2 From the Departments of 1 Laboratory Medicine and Pathology and 2 Urology, University of Minnesota, Minneapolis; 3 University of Minnesota Medical School, Minneapolis; and 4 Fairview Health Services Laboratory, Minneapolis, MN. Key Words: Genitourinary pathology; Technique; Prostate biopsy processing; Multiplex tissue processing Am J Clin Pathol December 2019;152:757-765 DOI: 10.1093/AJCP/AQZ101 ABSTRACT Objectives: Current protocols for processing multiple prostate biopsy cores per case are uneconomical and cumbersome. Tissue fragmentation and loss compromise cancer diagnosis. We sought to study an alternate method to improve processing and diagnosis of prostate cancer. Methods: Two sets of sextant biopsy specimens from near-identical locations were obtained ex vivo from 48 prostate specimens. One set was processed in the standard fashion while the other was processed using the BxChip, a proprietary biomimetic matrix that accommodates six cores on a single chip. Parameters including grossing, embedding, sectioning and reading time, length of tissue, and degree of fragmentation were compared. Results: A significant reduction (more than threefold) in preanalytical and analytical time was observed using the multiplex method. Nonlinear fragmentation was absent, in contrast to standard processing. Conclusions: The BxChip reduced tissue fragmentation and increased efficiency of prostate biopsy diagnosis. It also resulted in overall cost savings and significantly increased tissue length. Prostate cancer is the second highest incident cancer in American men, with a rising rate over the past 60 years and an incidence of 164,690 cases in 2018. 1 A systematic transrectal ultrasound (TRUS)–guided prostate needle biopsy diagnosis is the cornerstone of risk stratification for appropriate patient management. The diagnosis in- volves evaluation of each mapped site for the presence of carcinoma, with subsequent quantification and Gleason score/Grade Group assignment. This information is critical for determining disease management strategy (active surveillance vs definitive management). In addi- tion, when definitive therapy is indicated, it guides the extent of surgery as well as the type and dose of radia- tion therapy. 2 Historically, six-core “sextant” biopsy specimens that sampled the bilateral base, middle, and apical regions were used to survey the prostate. Due to concerns of insuffi- cient tissue for analysis and inaccurate cancer detection rates (CDRs), the current standard of care is to use a 10- to 14-core sampling technique that allows for more exten- sive investigation of the peripheral zone. 2-6 The extended biopsy protocol not only has increased the CDR but also has resulted in better concordance with the prostatectomy Gleason score. Increasing the number of cores beyond 12 (up to 24 cores for saturation biopsy specimens) has in ge- neral yielded modest improvements in the CDR 6 but may be warranted in patients with negative biopsy specimens and persistent suspicion of prostate cancer. 5 Downloaded from https://academic.oup.com/ajcp/article/152/6/757/5552533 by guest on 28 October 2023