Immunohistochemical assays in prostatic biopsies processed in Bouin’s fixative

V Ananthanarayanan; M R Pins; R E Meyer; P H Gann

doi:10.1136/jcp.2004.019299

Responses

Short reports/Case reports

Immunohistochemical assays in prostatic biopsies processed in Bouin’s fixative

Compose a Response to This Article

Compose Response

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

PLEASE NOTE:

A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.

I agree to and have read the terms and conditions for rapid responses and BMJ Privacy Notice *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

Dangers of Bouin's Fixation.
Daniel M Berney
Published on: 18 April 2016
Re: Dangers of Bouin's Fixation.
Vijayalakshmi Ananthanarayanan
Published on: 18 April 2016

Published on: 18 April 2016
Dangers of Bouin's Fixation.
- Daniel M Berney, Consultant Genitourinary Pathologist
Dear Editor,
I read with interest the paper by Ananthanarayanan et al.[1] on ‘Immunohistochemical assays in prostatic biopsies processed in Bouin’s fixative’. They rightly point out the problems encountered when trying to perform immunohistochemistry or other molecular techniques on Bouin’s fixed biopsies.
However, there are other and more fundamental problems with Bouin’s fixative for prostatic tissue t...
Show More

Dear Editor,
I read with interest the paper by Ananthanarayanan et al.[1] on ‘Immunohistochemical assays in prostatic biopsies processed in Bouin’s fixative’. They rightly point out the problems encountered when trying to perform immunohistochemistry or other molecular techniques on Bouin’s fixed biopsies.
However, there are other and more fundamental problems with Bouin’s fixative for prostatic tissue that have not been considered. The main reason for using Bouin’s is the better fixation of the cells achieved. There is superior visualisation of nucleoli and other nuclear details. This will be especially helpful in the diagnosis of high grade prostatic intraepithelial neoplasia (PIN). The advantages of this are superficially obvious, but the dangers are many. The technique will logically mean an increase in the diagnosis of PIN and carcinomas. However there is, to my knowledge, no study delineating the accuracy of Bouin’s fixed material in diagnosing prostate cancer or PIN. None is quoted in the paper by Ananthanarayanan et al and correlation with radical prostatectomy specimens is crucial for a determination of the uses of this technique. Research and audit of the diagnosis of prostatic cancer and PIN has occurred virtually exclusively in formalin fixed specimens. Therefore, whether this change in fixative is justified is entirely unknown.
The supposition is that Bouin’s fixed biopsies will lead to an increase in test sensitivity. However, there are obvious dangers of loss of test specificity: an over diagnosis of PIN leading to unnecessary re- biopsies, or in worst case scenarios, even unnecessary surgery could occur. It should also be held in mind that while Ananthanarayanan et al are using this method for biopsies, they do not state whether this method is used for radical prostatectomies or trans-urethral specimens leading to further possible problems in interpretation and diagnostic correlation. The variability of prostate biopsy processing and staining has been pointed out in previous issues.[2, 3] There is huge pressure, in the current climate, to diagnose more prostate cancer. The validity and intra observer variations of new methodologies, which potentially increase the sensitivity of a test should be thoroughly audited and ideally published before they take over as a routine part of clinical practice.
References
1. Ananthanarayanan V, Pins MR, Meyer RE, Gann PH. Immunohistochemical assays in prostatic biopsies processed in Bouin's fixative. J Clin Pathol 2005;58:322-4.
2. O Biedryzci, M Varma, DM Berney. Variations in the processing of prostatic needle cores in the UK: What is safe?. J Clin Path 2003; 56:341-3.
3. M Varma, D M Berney, B Jasani, A Rhodes. Technical Variations In Prostatic Immunohistochemistry: Need For Standardisation And Stringent Quality Assurance In PSA And PSAP Immunostaining J Clin Pathol 2004; 57:687-90.
Show Less

Conflict of Interest:
None declared.
- Back to top
Published on: 18 April 2016
Re: Dangers of Bouin's Fixation.
- Vijayalakshmi Ananthanarayanan, Research Associate
- Other Contributors:
  Gann PH.
Dear Editor
In a previous issue of this journal, we presented problems of using Bouin’s fixative for immunohistochemical and nuclear morphometric assays on prostatic biopsies(1). We agree with the important comment offered by Berney that Bouin’s fixative could increase the sensitivity for detection of high grade prostatic intraepithelial neoplasia (HGPIN) and prostate cancer. Furthermore, we agree that increa...
Show More

Dear Editor
In a previous issue of this journal, we presented problems of using Bouin’s fixative for immunohistochemical and nuclear morphometric assays on prostatic biopsies(1). We agree with the important comment offered by Berney that Bouin’s fixative could increase the sensitivity for detection of high grade prostatic intraepithelial neoplasia (HGPIN) and prostate cancer. Furthermore, we agree that increased sensitivity could occur at the cost of decreased specificity, as is the case for most diagnostic assays.
Bouin’s fixation was used as a routine fixative for prostatic biopsies at our institution owing to the better nuclear detail offered by this fixative, making the diagnosis of HGPIN easier. Diagnosis of HGPIN assumed greater importance in the ‘sextant biopsy era’, as men with HGPIN had a higher chance of being diagnosed with cancer on repeat biopsies (2). The relevance of finding HGPIN has now decreased owing to extended prostatic biopsy sampling (3). At our institution, there has been switch to formalin for fixing prostatic biopsies for the above two reasons — i.e., decreased predictive value of HGPIN on biopsies, and difficulties with various molecular assays following fixation in Bouin’s fluid. We have noticed a decrease in the prevalence of HGPIN on biopsies following this switch, though a formal analysis has not been performed.
The radical prostatectomy specimens at our institution continue to be fixed with formalin, as they have always been. We agree that using a discrepant fixative such as Bouin’s on biopsies could lead to different patterns of agreement between biopsy and surgical specimens. It indeed would be interesting to analyze the correlation between formalin and Bouin’s fixed specimens to gain a better understanding of how these fixative differences affect the likelihood of diagnosing both HGPIN and cancer.
References
1. Ananthanarayanan V, Pins MR, Meyer RE, Gann PH. Immunohistochemical assays in prostatic biopsies processed in Bouin's fixative. J Clin Pathol 2005;58(3):322-4.
2. Keetch DW, Humphrey P, Stahl D, Smith DS, Catalona WJ. Morphometric analysis and clinical followup of isolated prostatic intraepithelial neoplasia in needle biopsy of the prostate. J Urol 1995;154(2 Pt 1):347-51.
3. Moore CK, Karikehalli S, Nazeer T, Fisher HA, Kaufman RP, Jr., Mian BM. Prognostic significance of high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. J Urol 2005;173(1):70-2.
Show Less

Conflict of Interest:
None declared.
- Back to top

Main menu

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Log in using your username and password

Main menu

Log in using your username and password

You are here

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Read the full text or download the PDF:

Log in using your username and password