IBF as a Formalin Substitute Fixative in Prostate Biopsy Pathology
Notice bibliographique
Résumé
To the Editor.—We read with interest the study by Titford and Horenstein,1 who concluded that formalin fixation in comparison with 5 formalin substitutes provided the highest histomorphologic quality for 7 different surgical pathology specimens stained with hematoxylin-eosin. However, fixatives other than formalin are widely used in selected areas of surgical pathology practice because they provide for better evaluation of specific diagnostic criteria in different tissues and tumors (eg, B-Plus Fix in lymphomas).Optimal fixation of prostate biopsies is of utmost importance for biopsy evaluation. Most laboratories fix prostate biopsies in 10% neutral-buffered formalin, which often produces suboptimal, smudged, or blurred nuclear morphology. Nucleus-enhancing fixatives, such as Bouin and Hollande fixatives, are also used for prostate biopsy fixation and contain picric acid, which is biohazardous and potentially explosive when dry.2 Bouin fixative has been reported to decrease the immunoreactivity for cytokeratin.3 Since 1993, we have routinely fixed all prostate biopsies in our institution with IBF fixative (Surgipath, Richmond, Ill), which contains isopropyl alcohol, methanol, barium chloride, and low percent formalin (<3% by weight). Since 2000, we have processed more than 7000 prostate biopsies in IBF through our centralized urologic pathology practice in Calgary, Alberta. Prostate cores are typically placed in 30-mL containers with IBF immediately after the biopsy and are fixed between 3 and 24 hours in IBF, which is followed by routine processing. IBF-fixed prostate biopsies consistently exhibit excellent cellular morphology on hematoxylin-eosin staining. Prostate cancer glands demonstrate crisp nuclear morphology with clearly visible and prominent nucleoli, which is particularly helpful in establishing a diagnosis of high-grade prostatic intraepithelial neoplasia and small foci of prostatic cancer. Since other diagnostic features of prostatic cancer in IBF-fixed biopsies are identical to those seen in formalin-fixed biopsies, having an opportunity to see the nucleoli clearly in the atypical or suspicious glands may resolve pathologists' uncertainty about the presence of the nucleoli, which is often difficult to visualize in formalin-fixed biopsies. We do not find problems comparing the prominent nucleoli in the neoplastic glands with the inconspicuous or delicate nucleoli that may be seen in the adjacent benign glands.Obviously, it is also paramount to deal with other common technical pitfalls, such as thick and overstained sections that obscure the nuclear morphology. High-molecular-weight cytokeratin (34βE12 or keratin 903), which stains the basal cells in prostatic glands, demonstrates variations of sensitivity and specificity, which are dependent on the duration of formalin fixation and the antigen retrieval technique.4 IBF-fixed prostate biopsies demonstrate preserved immunoreactivity for high-molecular-weight cytokeratin (for antibodies 34βE12 and cytokeratin 5/6) and for α-methylacyl-CoA racemase/P504S.5 Sectioning of IBF-fixed biopsies does not require additional time or technical skill in comparison to the similar formalin-fixed small biopsies (eg, liver and lung), and IBF has a comparable cost to formalin. In our experience, in addition to proper handling, processing, sectioning, and staining of the prostate biopsies, fixation in IBF improves the resolution of the cytologic and nuclear detail and preserves the immunoreactivity of the prostate biopsy tissue.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,004 | 0,004 |
| Science ouverte | 0,005 | 0,001 |
| Intégrité de la recherche | 0,009 | 0,016 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».