The Biopsy Specimen - Its Value and Limitations

In an attempt to improve mutual understanding between clinician and pathologists on the matter of biopsy diagnoses, a brief review is made of the histopathologic method, and the information which can be extracted from it. Practical questions on the collection of the biopsy, its proper handling, the errors which may be due to sampling and comments on diagnostic errors and observer variation are offered. Some suggestions are offered with regard to second opinions, communication, and steps to make pathologic diagnoses more reliable (JPMA 33: 139, 1983). In a recent visit to Pakistan (an honor conferred by the Khyber Medical College and its North American Alumni Association) I met an unreasonable and somewhat disconcerting amount of criticism between surgeons and pathologists in various cities. In abbreviated form, surgeons stated “Our histopathologists are uncooperative and incompetent; they disagree in their own diagnoses; they cannot tell benign from malignant; they cannot identify the primary site of a metastatic rumor; and cannot or refuse to give us from biopsies, the information we need to treat patients”. Pathologists said, “Our surgeons are incompetent and uncooperative; they submit fat or fibrous tissue as diagnostic biopsies and expect an answer; they give us no clinical information to assist in making useful diagnoses; they ignore our reports and treat many patients without histologically confirmed diagnoses”. Recriminations of this sort (by no means unique to Pakistan) suggest that each party has inadequate knowledge and appreciation of the others difficulties. It may therefore be helpful to review the place and limitations of biopsies, and of the histopathologic method of diagnosis in general, a task which I was asked to address in Peshawar.