2007 Winter Meeting - London - The Pathological Society of Great ...

P73The Contribution of Formal Neuropathological Examinationin Paediatric Autopsies{P} MA Weber, TS Jacques, B Harding, M Malone, NJ SebireUCL Institute of Child Health and Great Ormond Street Hospital forChildren, London, United KingdomIntroduction: In the UK there are only a small number of paediatric institutionsthat offer a specialist paediatric neuropathological autopsy service. This is areview of the role of formal neuropathology in paediatric post-mortemexaminations.Methods: Retrospective analysis of >1,500 post-mortem examinationsperformed over a 10-year period, from 1996 to 2005, in a single paediatricspecialist centre; those cases referred for formal specialist neuropathologicalexamination of the brain were included in this study.Results: There were 1,516 paediatric post-mortem examinations, of which themajority included some form of examination of the brain. Of these, 651 (53%)were examined by a paediatric neuropathologist, either for specific neurologicalindications, or as part of the local autopsy protocol for sudden and unexpecteddeaths. Overall, there were positive findings in 55% of cases. Restricting casesto those that were performed for possible neurological indications, includingforensic autopsies, abnormal findings were demonstrated in 87% of cases.Diagnoses ranged from complex congenital malformations to hypoxicischaemicencephalopathy, head injury and rare mitochondrialencephalopathies.Discussion: Specialist paediatric neuropathological examination at autopsyyields positive findings in the majority of cases where there is a clinical historysuggestive of possible neurological disease. Neuropathological services play animportant role in the investigation of paediatric deaths.P74Challenges of the New Coroners (Amendment) Rules 2005:Experience at a Specialist Paediatric Pathology Centre{P} MA Weber, N Baxter, MT Ashworth, M Malone, NJ SebireUCL Institute of Child Health and Great Ormond Street Hospital forChildren, London, United KingdomIntroduction: With the implementation of the Coroners (Amendment) Rules2005 on 1 June 2005, relatives of the deceased must consent to one of threeoptions concerning the handling of tissue taken during the post-mortemexamination: 1) disposal of the tissue by the pathologist, 2) returning thematerial to the relatives, or 3) retention of the tissue for research or otherpurposes. It is the duty of the coroner to inform the pathologist of the relatives’wishes, usually by means of a signed coroner’s consent form, within a specifiedtime period.Methods: Retrospective audit of the coroners’ consent forms of all coronialpaediatric autopsies performed in a single institution from 1 June 2005 to 31May 2006.Results: Of 209 coronial autopsies, only 38 (18%) had submitted a form inaccordance with the new rules. The forms varied widely between differentcoroners, with up to a third of forms lacking an option for tissue disposal, andalmost one quarter of forms without an option for tissue retention or returningtissue to the family. Of the 29 forms in which relatives were given an option fortissue retention, only 21 (72%) specifically addressed consent for research, andof these, relatives consented to research in only 14 (67%). Whilst some formswere confusing, even contradictory, the majority (82%) also failed todistinguish between blocks and slides, and other tissue samples or organs.Discussion: The new Coroners (Amendment) Rules are variably interpreted bydifferent coroners, resulting in substandard consent forms. We recommend thatthe coroners’ consent forms are drawn up in consultation with the RoyalCollege of Pathologists, that a single standardised form is used by all coroners,and that coroners’ officers receive appropriate training in taking consent.P75Needle Core Biopsies for the Pathological Investigation ofPaediatric Tumours: A Single Centre ExperienceS Gibson, D Rampling, {P} MA Weber, M Malone, DJ Roebuck,NJ SebireGreat Ormond Street Hospital for Children, London, United KingdomIntroduction: The use of image guided, minimally invasive, needle corebiopsies for the primary diagnostic investigation of paediatric tumours isbecoming increasingly important. One potential argument against the use ofsuch minimal sampling has been the assumption that insufficient tissue will beavailable for the full range of investigations required.Methods: It has been our departmental policy to handle all tumour core biopsiesaccording to a predefined protocol. We retrospectively report the results of sucha protocol on 100 unselected consecutive needle core biopsies obtained during2005-2006.Results: Of 100 consecutive biopsies for the assessment of paediatric tumours,adequate tissue was obtained for histopathological assessment in 100%, imprintpreparations for fluorescence in-situ hybridisation in 100%, snap frozen tissuefor storage in 96%, tissue for immediate molecular analysis stored in RNAprotection medium in 92%, sufficient tissue for tumour banking in 88%, andtissue was submitted for cytogenetic analysis in 76%.Discussion: The use of image guided, needle core biopsies for the assessment ofpaediatric tumours, when performed by experienced interventional radiologistsin conjunction with specialist pathology departments optimised for dealing withsmall fresh specimens, can allow a full range of diagnostic and prognostichistopathological and molecular assessments to be performed with minimalpatient morbidity.P76Needle Core Biopsy Diagnosis of Neuroblastic Tumours inChildhood: A Single Centre ExperienceDJ Roebuck, D Rampling, S Gibson, {P} MA Weber, J Anderson,NJ SebireGreat Ormond Street Hospital for Children, London, United KingdomIntroduction: Traditionally, histopathological diagnosis of paediatric tumourshas been on the basis of open biopsies. However, increasingly, minimallyinvasive image-guided needle core biopsies are being performed for thisindication.Methods: We retrospectively reviewed the outcomes of consecutive unselectedneedle core biopsies carried out at our paediatric centre with regard to clinicaland histopathological features.Results: There were 110 separate needle biopsy procedures carried out forsuspected neuroblastic tumours of 121 lesions in 105 children aged 0-12 years(median 2.6 years) from a range of anatomical sites, predominantly (50%)abdomen / retroperitoneum. Sufficient tissue was initially obtained fordiagnostic pathological assessment in 118 (98%) cases. The final diagnosisfrom needle biopsy was neuroblastic tumour in 100 (83%), other malignanttumours in 13 (11%), other benign lesions in 5 (4%), and 3 (2%) were nondiagnostic;of these 3, 2 had a rebiopsy demonstrating neuroblastoma, and inone the presumed lesion has spontaneously resolved. In 4 cases, needle biopsyrevealed ganglioneuromatous elements only, and the final resection diagnosiswas nodular ganglioneuroblastoma. There were no significant clinicalcomplications. The overall diagnostic accuracy rate, including the rebiopsiedcases, was 99%.Discussion: Minimally invasive needle core biopsy is a safe approach to thediagnosis of neuroblastic tumours in children and can provide sufficientmaterial for pathological diagnosis. As suggested in current guidelines,ganglioneuroma and ganglioneuroblastoma cannot be reliably distinguished onneedle biopsy alone.46 Winter Meeting (191 st ) 3–5 January 2007 Scientific Programme