how much tissue is actually examined in post op pathology

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North Alabama
New Member


Date Joined Jan 2010
Total Posts : 18
   Posted 3/7/2010 12:13 AM (GMT -6)   
I was curious about how much of the tissue is looked at under the microscope by the pathologists. Do they slice it and exam all of it. When I did a search I could not find very much info on what they actually do, but I did find some studies that dealt with the subject of whether it was useful to go to the extra expense and time of examining "all" of tissue or just selected segments (the usual practice). So I got the impression that they don't look at all of it based on some statistics that gave correct results for most cases. By the way, the studies found that in examining all of the tissue compared to selected segments of the tissue that there were some cases where the Gleason score was under graded. I did the search a while back and I don't have the links to the studies and I don't remember exactly what phrase I used for the google search. I will ask my doctor the next time I see him but does anyone know something about this or are there some pathologists out there that can explain how they determine what part of the tissue is examined ?

Post Edited (north alabama) : 3/6/2010 11:25:15 PM (GMT-7)


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 3/7/2010 6:38 AM (GMT -6)   
North, are you asking about samples from a biopsy or from a surgical pathology (prostatectomy)? If the latter, the pathologist takes the entire specimen (everything removed) and slices and dices it into sections. My husband's surgical path report was quite detailed about the sections looked at, and even indicated which cassette the section could be found on.

If biopsy, the pathologist reviews every sample submitted - the average seems to be between 10 and 12 cores taken during biopsy.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 3/7/2010 6:39 AM (GMT -6)   
Duh, sorry I missed the post-op in your subject line. Everything given to the pathologist is put under a microscope. That's why it can take up to a week to get the results. Usually, a second pathologist looks at the findings to confirm.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 3/7/2010 6:46 AM (GMT -6)   
Great question and I don't know on this, but this "honest" answer from a local surgeon whom came to an open PCa support meeting as a speaker, and was open to our questions. Naturally, I had been waiting to ask someone like him about the sampling of prostate during prostate removal, as is supposed to occur and be checked immediately to determine if PCa has escaped beyond the capsule...and thus usually the patient is informed and sewed back up...as surgery would be done without cure (surgery still could be done to debulk tumor burden-however with patient agreeing). His answer floored me in that he said he did not sample all patients and patients with gleason 6 or 7 he didn't believe it was necessary to always sample??????? So some patients were never informed, I don't know if they didn't know to ask about such or if thereafter the doc sugar coats rehtoric back saying in your case, 'all good' or such.  I don't know alot about surgery I could not go that route after investigation enough on my own case, do know more on radiations, hormone therapies.
 


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 3/7/2010 7:07:29 AM (GMT-7)


brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 3/7/2010 8:55 AM (GMT -6)   
Micro sections of any tissue are only a few microns thick, so a complete sectioning would encompass several hundred slides. The specimen is examined grossly and described as such. The representative sections taken from each of the lobes for preparation and slide fixation. The whole specimen is kept in fixative. If the pathologists want more sections of a given area or special stains, then the tissue remains available. It takes about 4 days from receipt of the tissue, sectioning, preparation of slides, exam by the doc, transcription of the report, and delivery to the surgeon. Nowadays, this may be faster with computer transmission.

The only time that I ever saw a total sectioned specimen was with mouse embryos (about 30 mm in length) that we studied in embryology.
70 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. Doubled from 3.5 to 7.0 in one year.
Neg. CT and Bone Scan
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland by Dr. A. Mattei in the Kantonsspital. New Gleason was 4+4=8
pT2c G3 pN0 (0/14 nodes +, Margins, etc. clear
Catheter out in 5 days (home in 3 days). No incontinence
Positional neurpraxia in hip and knee resolved 90+% in 5 months.
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO. Nearly usable one month later. At 5 mo. with 100 mg Vitamin V, pretty good. Now beginning 5 mg Cialis daily.
3month PSA less than 0.01, 6 month PSA less than 0.01

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