title: Endoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing.
abstract: OBJECTIVE
  Endoscopic forceps biopsy and fixation are laborious and prolong the procedure and anesthesia. Multiple biopsy overcomes these shortcomings with a single endoscope pass that cuts, like a needle biopsy, up to 25 biopsy samples of uniform size and depth during endoscope withdrawal. Biopsy specimens are collected in acquisition order and stored in a perforated plastic storage chamber within the perforated metal tip. The tip is cut off, immersed in fixative, and sent to pathology. A formatted log identifies each biopsy specimen by site and position. In pathology, the plastic storage cylinder, designed for processing and microtomy with biopsy specimens in situ, supports rapid diagnosis by frozen section and microwave or routine paraffin processing.
  
  
  METHODS
  After a 10-patient Institutional Review Board safety study and US Food and Drug Administration registration, biopsies were performed in 57 patients during colonoscopy, upper GI endoscopy, and ERCP. A blinded retrospective study compared colon surveillance biopsies in 15 patients who underwent multiple biopsy with 15 patients who underwent forceps biopsies performed by anonymous physicians on the same day. Patient information was removed from slides, and forceps biopsies were oriented manually for blinding.
  
  
  RESULTS
  Multiple biopsy specimens fixed and processed in situ were not significantly different from batched processed forceps biopsy specimens for depth, orientation, fixation, artifacts, and diagnostic information. Multiple biopsy colonic specimens were significantly (26%) smaller with better epithelial preservation than forceps specimens. Each biopsy saves 61 seconds during withdrawal.
  
  
  CONCLUSIONS
  Single-pass multiple biopsy reduces biopsy time with less specimen damage, work, workplace risk, and soiling. Diagnostic quality is equal to forceps biopsy with better epithelial preservation, although 26% smaller. In pathology, in situ processing and microtomy reduce work and workplace risk. Grossing and manual orientation are unnecessary. Rapid diagnosis by frozen section and microwave or paraffin processing are facilitated. Multiple biopsy speeds diagnosis and improves productivity in endoscopic biopsy and histopathologic processing.
authors.affiliation: Department of Medicine, New York Downtown Hospital, New York, New York, USA; Department of Medicine, St. Vincent's Hospital, New York, New York, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Zimmon
authors.affiliation: Department of Pathology, St. Vincent's Hospital, New York, New York, USA.
authors.forename: Fred B
authors.initials: FB
authors.lastname: Smith
authors.affiliation: Department of Medicine, New York Downtown Hospital, New York, New York, USA; Department of Medicine, St. Vincent's Hospital, New York, New York, USA.
authors.forename: Forrest
authors.initials: F
authors.lastname: Manheimer
authors.affiliation: Department of Pathology, St. Vincent's Hospital, New York, New York, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Fan
authors.affiliation: Department of Pathology, St. Vincent's Hospital, New York, New York, USA.
authors.forename: Chantel
authors.initials: C
authors.lastname: Njiwaji
authors.affiliation: Department of Pathology, St. Vincent's Hospital, New York, New York, USA.
authors.forename: Sergei
authors.initials: S
authors.lastname: Aksenov
authors.affiliation: Department of Medicine, New York Downtown Hospital, New York, New York, USA; Department of Medicine, St. Vincent's Hospital, New York, New York, USA.
authors.forename: Premtesh
authors.initials: P
authors.lastname: Chattoo
mesh_terms: D016477:Artifacts; D001706:Biopsy / Q000295:instrumentation* / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005629:Frozen Sections; D006801:Humans; D061646:Operative Time; D012189:Retrospective Studies; D016037:Single-Blind Method; D016707:Tissue Fixation