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Orientation precedes interpretation: comparison of different tissue handling techniques to attain well-oriented small-intestinal endoscopic biopsy
  1. Neha Garg,
  2. Kaushik Majumdar,
  3. Puja Sakhuja
  1. Department of Pathology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
  1. Correspondence to Professor Puja Sakhuja, Department of Pathology, GB Pant Institute of Postgraduate Medical Education and Research, Delhi, New Delhi 110002, India; pujasak{at}

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Recent deployment of minimally invasive procedures often yield smaller biopsies, demanding more meticulous tissue handling and proper orientation, ie, obtaining histological section perpendicular to the mucosal surface. But most often the biopsied tissue tends to curl up when suspended in tissue fixative, or undergo tangential or horizontal sectioning resulting in poor orientation.

A well-oriented histological section is the prerequisite for precise assessment of gastrointestinal disorders like degree of villous atrophy, depth of invasion of a tumour, proper delineation of the site of origin of growth and hence further guiding the proper management. Literature review highlights many methods already worked on for orientation of duodenal,1 2 cervical,3 urinary bladder4 and conjunctival biopsies.5 These methods include use of filter paper, vegetable matrix including cucumber paper, Gelfoam, direct mount on paper before fixation. We hypothesised that the application of albumin and introduction of lens paper could improve the orientation of the tissue, as compared with use of Whatman filter paper. Hence, an attempt was made to compare percentage oriented length of the biopsy when processed in lens paper versus Whatman filter paper, with and without application of albumin. To the best of our knowledge, we could not find any literature as per this protocol. In addition, the tissue fragmentation and loss during handling and processing was also evaluated.

We have analysed consecutive 150 small-intestinal biopsies …

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  • Handling editor Runjan Chetty.

  • Twitter @drkaushik_m

  • Contributors NG involved in laboratory work-up, measured various parameters of biopsies and wrote the manuscript. KM codesigned the experiments, analysed the data, corrected and approved the final version of the manuscript. PS had the concept of the work, codesigned the experiments, corrected and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.