Does the diagnosis and Time required to perform the procedure essential components of a request for a histological report of an excisional biopsy ?

Dear Mohammed, if I understood correctly (the following only as example):

You examine a patient and (hopefully) end up with a "clinical diagnosis". If you cannot be sure about what you see, you will have at least a view of and will establish (a) "differential diagnosis, -es". If you are responsible to chose the method (and ONE of methods may be an excisional biopsy for histological examination - which means usually: fixation, dehydration, embedding in paraffin, sectioning, staining and examination by a (histo-)pathologist, who will write a report....) you - perhaps as internal specialist - will order an excisional biopsy (e.g. performed by a specialized colleague, or - e.g. a surgeon in an other Department will have to do it). If the circumstances are life-threatening, it might be too late to order an excisional biopsy, I guess.... since usually such a routine method lasts at least some hour(s) (up to 24/48 hours - the latter especially if Immunohistochemistry is needed), including a written report. Even if you order a method it will last - depending on the organisational circumstances and distances to the Pathology Labs - at least 1 hour to arrive at a pretty certain diagnosis (and there might be differences regarding the different organ systems .... skin, muscle, vs. suction or needle - FNA - biopsies from certain organs, like kidney, liver etc.). Usually the Clinician/Internal specialist does have at least a certain clue (knowledge) about the methodology (or useable techniques) for taking a representative excisional biopsy for histopathological examination.... but usually (and this has been my experience for long) there will be at least direct and personal consultation with (histo-)pathologist how to do which technique (at least until such biopsies become routine standard by consent or S.O.P.('s) respectively)...And finally: the method used and the skills of the performer(s) / the organisation will define "the time required to perform the procedure".

Olga M Pulido

Dear Mohammed. I agree with other responders that the question is not clear so it is difficult to formulate a proper response, however as pathologist that has worked in a variety of laboratory and sites my response is as follows:

Clinical diagnosis and full clinical history is very important for the pathologist. Pathology and biopsy procedures are not isolated events but an integrated component of patient health care and the pathologist is or should be part of the health care team, well informed of the clinical history. Ideally with direct access to the clinical team for discussion and questions. After all pathologists are physicians capable and trained to integrate histopathological findings and the overall clinical presentation.

Timing to request the procedure is also important and will depend of many factors which is also linked to the clinical findings, posible differential diagnosis, affected organ, if the condition is acute or chronic, the procedure is diagnostic or therapeutic e.g. needle biopsy or surgical treatments. E.g prostate cancer management includes physical rectal examination , prostatic specific antigen determination, needle biopsy following specific guidelines etc. Treatment will vary depending of factors such as age, type of cancer based of biopsy diagnosis which also follows specific guidelines, oncologist consultation and availability on site of choices of therapeutic procedures.

Time required by the pathology lab and the pathologist to proses the biopsy and to provide a diagnosis are important, but most important is to reduce the risk of miss diagnosis. Pathology diagnosis are not always straight forward and may need incorporation of specialized techniques to aid in the differential diagnosis or to refine the diagnosis for better therapeutic choice e.g. presence or absence of hormonal receptors. Furthermore the pathologist may also require to consult with other pathologists which may have more expertise in the specific case at hand.

Ultimately the main objective is team work for higher quality health care. Emergency cases follow emergency procedures, but do not preclude team work,

Dear Mohammed, so what is your question? I can't find out really (but am a non-native regarding the English mothertongue too)....

Mohammed Sultan Alakhali

which is more important to write a report for doing the excisional biopsy : the diagnosis or the time required to perform the procedure?

Adil H.H. Bashir

Dear Mohammad, the diagnosis or the differential diagnosis or in some cases the clinical findings give the histopathologist a guide lines for a proper report as well as a proper biopsy sample taken whatever technique followed.

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