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Observational Study
. 2023 May 17;23(1):242.
doi: 10.1186/s12887-023-04048-4.

Systematic orientation of fresh rectal suction biopsies improves histopathological diagnostics in hirschsprung's disease - a method description and preliminary report

Emma Fransson  1 , Emilia Gottberg  2 , Rodrigo Munoz Mitev  2 , David Gisselsson  2 , Kristine Hagelsteen  1 , Louise Tofft  1 , Pernilla Stenström  1 , Christina Granéli  3
Affiliations
Observational Study

Systematic orientation of fresh rectal suction biopsies improves histopathological diagnostics in hirschsprung's disease - a method description and preliminary report

Emma Fransson et al. BMC Pediatr. .

Abstract

Background: Optimizing rectal suction biopsy (RSB) diagnostics in Hirschsprung's disease (HD) may shorten diagnostic time and prevent need for repeated biopsies.

Aim: To explore whether systematic orientation of fresh RSB specimens increased biopsy quality, diagnostic times, diagnostic efficacy, and histopathologic workload, and to explore these outcome measures for aganglionic specimens.

Materials/methods: This was an observational case-control study conducted at a national referral center for HD on data collected from the local HD-diagnostic register. From 2019 each fresh RSB was oriented by the collector in a notch in a foam cushion, placed in a separate cassette, and sent in formalin for pathological analysis. Outcome measures of oriented RSB samples collected 2019-2021 were compared to those of non-oriented RSB samples collected 2015-2018. Staining/immunohistochemistry consisted of hematoxylin eosin, S-100 and calretinin.

Results: 78 children with 81 RSBs and 242 biopsy analyzes were included. The frequency of high-quality RSB specimens was higher in oriented: 40% (42/106) versus non-oriented 25% (34/136) (p = 0.018), the diagnostic turnaround time was shorter: 2 days (1-5) versus 3 days (2-8) (p = 0.015), and the number of additional sectioning/leveling/re-orientation per biopsy was lower: 7 (3-26) versus 16 (7-72) (p = 0.011). Specifically for aganglionic specimens, the frequency of high-quality biopsies was generally higher in oriented than in non-oriented RSB specimens: 47% (28/59) versus 14% (7/50) (p < 0.001); the diagnostic efficacy was higher 95% (19/20) versus 60% (9/15) (p = 0.027) and the diagnostic turnaround time shorter: 2 days (2-3) versus 3 days (2-8) (p = 0.036).

Conclusions: Systematic orientation of fresh RSB specimens improves HD diagnostics. Improvement was consistent in aganglionic specimens.

Keywords: Diagnosis; Hirschsprung’s disease; Orienting; Rectal suction biopsy; Specimen handling.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Rectal suction biopsy (RSB) orientation method: Each small RSB specimen is placed carefully within a precut slide in the foam cushion, with its mucosal side in one direction, and its submucosal side in the other. Each foam-cushion pillow is placed within a box, and each box is placed in its own container, pre-filled with formalin, pictured on the upper row. The lower row shows the whole setting for the RSB procedure and orientation
Fig. 2
Fig. 2
a. Schematic illustration of the rectal suction biopsy (RSB) within the precut slide in the foam cushion, as seen from above
Fig. 2
Fig. 2
b. Detailed image of the fresh rectal suction biopsy (RSB) specimen placed in the precut slide in the foam cushion
Fig. 3
Fig. 3
The rectal suction biopsy’s progress from collection to first and final answers at the department of pathology. RSB = Rectal suction biopsy. G-series = ganglion cell series
See this image and copyright information in PMC

References

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