Value of Skin Biopsy as a Diagnostic Procedure in Dermatology

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Value of Skin Biopsy as a Diagnostic Procedure in Dermatology

   

Safa Elfaituri1*and Fatma Emaetig2

1Professor in Dermatology Department, Medical faculty, Benghazi University

2Pathology Department, Medical faculty, Benghazi University

*Corresponding author: Safa Elfaituri, Professor in Dermatology Department, Medical faculty, Benghazi University

Citation: Elfaituri S, Emaetig F. (2022) Value of Skin Biopsy as a Diagnostic Procedure in Dermatology. Adv Clin Med Res. 3(2):1-11.

Received: May 24,  2022 | Published: June 23, 2022

Copyright© 2022 by Elfaituri S. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI: https://doi.org/10.52793/ACMR.2022.3(2)-29

Abstract

Introduction & objectives: The role of dermatopathology has expanded in the past decades from routine histology to involve immune pathology, ultrastructural, and molecular biological techniques. The aim of this study was to test the value of skin biopsy as a diagnostic procedure in the diagnosis of variable skin disorders in Benghazi, Libya.


Materials and Methods: Over a period of 4 years; 200 patients were seen by a consultant dermatologist in Jumhori hospital skin department-Benghazi, Libya, for them a skin biopsy was performed to establish the diagnosis. Specimens were subjected to routine histopathological examinations (Haematoxylin and Eosin) by a general pathologist then reviewed clinically and pathologically by the dermatologist. There was a direct communication between the dermatologist and pathologist to obtain final diagnosis after clinicopathological correlation and to plan for further workup if needed.


Results: Pathological diagnosis was consistent with one of the clinical differential diagnoses in 82%, gave a new diagnosis in 6% and was non-diagnostic in 12 %. After clinicopathological reviewing of the cases; concordance between pathological and final diagnosis occurred in 58% whereas clinicopathological correlation gave the diagnosis in 18%. In 24% further investigations were required; special stains were needed in 7 %, immunofluorescent studies in 9%, electron microscopy in 2%, immunohistochemistry in 6% and molecular biological technique was required in 3 %. Special stain was done for 2%, immunohistochemistry for 1%,  whereas in the remaining 21% we could not sit a final diagnosis due to the unavailability of the required techniques.

Conclusions: Dermatohistopathology is an important diagnostic procedure in clinical dermatology, considering the clinicopathologic correlation as an essential step in the diagnostic process. It must be coupled with other techniques as immunofluorescence, immunohistochemistry, electron microscopy and molecular pathology to make the exact diagnosis of some skin diseases.

Keywords

Biopsy; Dermatologistis; Haematoxylin; Immunofluorescence

Introduction

Although most skin diseases can be diagnosed with inspection, the clinical appearance of skin lesions may overlap, mandating skin biopsy and histopathologic examination [1]. The dermatologist is responsible for obtaining the biopsy and submitting it to the pathology laboratory together with clinical information [2-5] where microscopic examination and interpretation of skin biopsy carried out by the pathologist. Interpretation of histological reports by the dermatologist is important to put it in the clinical context. The integration of clinical information with the pathological findings is important for the diagnosis of many skin disorders [3, 7]. Some skin diseases overlap clinically and pathologically and for definitive diagnosis, techniques as immunofluorescence, immunohistochemistry, electron microscopy and molecular pathology are needed [5,6]. The aim of this study was to test the value of skin biopsy as a diagnostic procedure in the final diagnosis of variable skin disorders in Benghazi, Libya.

Materials and Methods: Over a period of 4 years; 200 patients were seen by consultant dermatologists in Jumhori hospital skin department-Benghazi, Libya, for them a skin biopsy was performed to establish the diagnosis.  Clinical differential diagnoses along with a brief history and clinical description was provided with the request of histopathology.  Skin specimens were subjected to histopathological examinations by randomly selected general pathologists; the specimens were processed and then stained with Haematoxylin and Eosin. Special stains were used when requested and available to identify infectious agents as fungi or specific substances deposited in the skin as the amyloid.  All histological specimens were reviewed by the dermatologist. There was a direct communication between the dermatologist and pathologist for discussion to obtain final diagnosis after clinicopathological correlation and to plan for further workup.

Results:  Two hundred cases were studied clinically and pathologically. They included inflammatory skin diseases as well as tumours. (Table 1) Pathological diagnosis matched one of the clinical differential diagnoses in 82%, gave a new diagnosis in 6% and was non-diagnostic in 12 %. (Figure 1) Out of the 12% where the histopathological reports were non-diagnostic; the histopathology of 5% could only provide a pattern analysis; as granulomatous and interface lichnoid reaction and in 7% only a descriptive report with non-specific features had been issued. After clinicopathological reviewing of the cases; definite final diagnosis could be sited in 76%; concordance between pathological and final diagnosis occurred in 58% whereas clinicopathological correlation gave the diagnosis in 18%.  Out of the 6% new pathological diagnosis, only 1% was accepted.  Figure 2 demonstrate the results after clinicopathological correlation and special tests. Reaching definite diagnoses in 24% were not possible without certain technique; special stains were needed in 7 %, immunofluorescent studies in 9%, electron microscopy in 2%, immunohistochemistry in 6% and molecular biological technique was required in 3 %. (Figure 3) Unfortunately these diagnostic tests were not available in Benghazi pathological laboratories; special stain was done for 2%, immunohistochemistry for 1%, whereas in the remaining 21% we could not sit a final diagnosis due to the unavailability of the required techniques. (Figures 4-10) show clinical and pathological results of variable cases.

Category:

Diseases:

Cases number:

Papulosquamous

Lichen planus

Psoriasis

Pityriasisrosea

Pityriasisrubra pilaris

23

14

2

3

Dermatitis

Contact dermatitis

Discoid eczema

Nodular prurigo

Stasis dermatitis

2

2

5

1

Neoplasia

Basal cell carcinoma

Squamous cell carcinoma

Kaposi  sarcoma

7

2

1

Pilosebaceous diseases

Rosacea

Demodex infection

Acne

Lupus milaridissaminatusfacii

7

4

2

1

Benign tumours

Seborrheic keratoses

Syringoma

leomyoma

3

3

1

Vascular

Vasculitis

Pigmented purpura

Purpurfulminans

5

1

1

Connective tissue

Scleroderma

Lupus erythematosus

1

8

Infections

Scabies

Leishmania

4

2

Pigment disorders

Ashy dermatosis

Post inflammatory.

Lentigo

Beckers melanosis

Reticulate pigmentation

2

2

2

1

2

Miscellaneous

Xanthogranuloma

Perforating collagenosis

Others

5

9

29

Further investigations needed for final diagnosis

 

42

Total

 

200

 
Table 1: Various skin disorder seen in the study.
Figure 1: Initial histopathological outcome of the 200 skin biopsies.
                Figure 2: Results in figure 1 after clinicopathological correlation and special tests.
 Figure 3: Techniques needed to reach definite diagnoses. 

Figure 4: A case of basal cell carcinoma, Pathological diagnosis match clinical diagnose.