Prostate Biopsy Processing

An Innovative Model for Reducing Cost, Decreasing Test Time, and Improving Diagnostic Material

Paari Murugan, MD; Dip Shukla; Jennifer Morocho, HTL; Deanne Smith, PA; Drew Sciacca, PA; Meghan Pickard, PA; Michelle Wahlsten, HTL; Ashley Gunderson, HTL; Badrinath Konety, MD; Mahmoud A. Khalifa, MD; Christopher Warlick, MD


Am J Clin Pathol. 2019;152(6):757-765. 

In This Article


The use of the MC allowed an organized, multiplexed processing of prostate needle biopsy specimens. It eliminated tissue manipulation and handling, a staple of the standard protocol, thereby limiting tissue fragmentation and loss. Nonlinear fragmentation was entirely absent with the MCP due to the cores being held linear, constrained, and separate in their designated grooves. In contrast, the SP produced a mean of 2.19 (interquartile range [IQR], 0–4) nonlinear fragments per biopsy core (P = .0001). Linear fragmentation was noted with the MCP and was not significantly different from the SP (P = .32). The biopsy tissue core length increased from a SP mean of 74.25 mm (IQR, 65.5–81.5) to an MCP mean of 83.35 mm (IQR, 74.5–94), resulting in an average increase of 9.10 mm (P = .0001) per case. The cancer length increased by an average of 0.5 mm in the new processing method (P = .54). No significant difference in the number of cores with cancer or Gleason score was observed between the two methods Table 1. A comparison of tissue length and cancer length in benign and malignant cores between SP and MCP is depicted in Table 2.

In addition to improvements in tissue quality, significant reductions in time required for tissue processing were also observed. A greater than fourfold reduction (P = .0001) in preanalytical time was observed using MCP. As expected, this improvement resulted from processing one tissue matrix compared with six individual tissue cores. Grossing time was reduced from a mean of 4.69 minutes (IQR, 4–5) to 1.02 minutes (IQR, 1–1) per case while embedding time was reduced from a mean of 6.25 minutes (IQR, 5.5–7) to 1.06 minutes (IQR, 1–1). In particular, a marked reduction, from a mean of 23.02 minutes (IQR, 19–27.5) to 6.23 minutes (IQR, 5–7), was noted in sectioning time. Furthermore, the organization of the cores in the MC reduced the slide microscopic examination time by 2.72 minutes per case (Table 1).

Use of the MCP was associated with an overall cost savings. A comparison of pathology assistant, histology technician, and pathologist time per case and material costs between the two protocols projected savings in excess of $10 per case Table 3 without including potential reduction in immunohistochemistry and processing reagents expenditure. The use of the MC also resulted in a sixfold reduction in storage space of tissue blocks and slides.