Step Section Analysis in Routine Dermatopathology practiceA study.

Abstract

Background: Nonspecific and overlapping microscopic features often pose diagnostic challenges in routine dermatopathology practice. Objectives: To detect additional findings on step sections of routine skin biopsies and study the significance of the same in improving the diagnostic accuracy. To formulate possible prerequisites to order step sections and study the economical aspects and turn around time alterations. Settings:Tertiary Hospital based Dermatopathology practice. Materials and Methods:Routine skin biopsies received in department of pathology, Dr B.R.Ambedkar Medical College/Hospital(BRAMCH) were processed. Initial sections were interpreted and step sections were ordered in lesions which showed nonspecific features, clinically non correlating importantly those with clinical suspicion of malignancy. Step sections obtained at different levels at 50 µ intervals were reinterpreted and compared with the initial sections (retrospective step sections). Results: Of the 70 cases studied additional diagnostic findings were present in 23 cases (38.3%) including 2 cases of Squamous cell carcinoma and1 case of Basal cell carcinoma. Diagnosis of 18(30%) cases were revised following step sections analysis including 2 cases of Squamous cell carcinoma and 1 case of dcis with invasion. The possible prerequisites for ordering step sections included nonspecific histopathological features and clinical non correlation. Retrospective step sections promise to be economy friendly and more effective. No significant turn around time changes were observed with respect to dermatopathology practice. Conclusions: This study highlights the essential utility of retrospective step sections to improve diagnostic accuracy and to discover hidden malignancies in routine dermatopathology practice without compromising on economy and turnaround time.