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Formalin Flush to Remove a Stuck Biopsy Specimen
*Corresponding author: Azharuddin Mazharuddin Shaikh, Department of Dermatology, Venereology and Leprosy, Pimpri Chinchwad Municipal Corporation (PCMC’s) Post Graduate Institute, Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, Maharashtra, India. sk.azharuddin1@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Shaikh AM, Palaskar NM, More YE. Formalin Flush to Remove a Stuck Biopsy Specimen. Indian J Postgrad Dermatol. doi: 10.25259/IJPGD_265_2024
BACKGROUND
During a biopsy procedure, small tissue samples are collected. These specimens sometimes get stuck in the biopsy punch or needle due to their small size, texture or adherence to the tool [Figure 1].
Specimen removal with other modalities, such as needle or toothed forceps, can damage the specimen, potentially affecting pathological findings.
The formalin flush helps avoid damage to the sample that might occur with mechanical removal methods.
- Stuck biopsy specimen.
MATERIALS REQUIRED
Formalin solution (10% neutral-buffered formalin is standard)
A syringe 2cc (appropriate size for the biopsy punch)
Sterile gloves
A sterile container to collect the specimen.
Procedure
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Attach the syringe
Fill the syringe with formalin
Secure
Gently insert the complete hub of the syringe into the back side of the punch [Figure 2].
Figure 2:- Formalin push with partially closed lid.
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Flush with formalin
Gently and steadily push formalin through the biopsy punch
Ensure the fluid flows in the direction that will expel the specimen into the sterile container containing formalin solution [Video 1].
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Collect the specimen
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Allow the specimen to enter a formalin-filled collection container with a partially closed lid. Avoid damaging it with excessive force [Figure 3].
Figure 3:- Specimen collection.
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Repeat if the punch does not get dislodged
If the first flush does not dislodge the specimen, try again with slightly more force or adjust the instrument’s angle.
Video 1:
Video 1:Video showing formalin flush.Post-procedure
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Inspect the specimen
Ensure the specimen is intact and suitable for pathological evaluation.
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Document the procedure
Note the use of a formalin flush and any complications for accurate records.
Advantage
Specimen is less damaged as compared with other modalities.
Tips
Use caution when flushing to avoid damaging delicate biopsy samples
If the specimen remains stuck despite flushing, consider alternative methods.
CONCLUSION
Formalin flush is a reliable, safe, and efficient technique for retrieving stuck biopsy specimens, improving specimen preservation, and contributing to more accurate diagnostic results. When used appropriately, it enhances the overall effectiveness of biopsy procedures, ensuring that quality specimens are available for further analysis.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
Patient’s consent not required as there are no patients in this study.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
