Gastrointestinal biopsies: more action and less ‘chatter’?

Abstract

‘Chatter’ is a histologic artifact which can obscure morphology, sometimes precluding histopathologic diagnosis. Chatter in gastrointestinal (GI) biopsies is a particular challenge in many laboratories. This departmental quality assurance initiative sought to determine (1) the prevalence of chatter in GI biopsies, (2) its relationship to histotechnologist, section level and anatomic site, and (3) the effectiveness of education and technical adjustments in reducing its rate. A gastrointestinal pathologist evaluated 660 randomly selected slides for chatter artifact. Biopsy site, level (slide 1,2 or 3) and sectioning histotechnologist were recorded. Histotechnologists completed a questionaire on block handling and sectioning technique. The study was repeated 6 months following feedback and implementation of technical measures to reduce chatter. Moderate-to-severe chatter was present in 9.2% of slides (61/660), with wide variation between the 11 histotechnologists (range 0-19%). All four histotechnologists with low chatter rates volunteered a constant sectioning speed in the questionaire, compared to 1/5 of those with high chatter rates (p < 0.05). Six months following implementation of measures to address chatter, its prevalence was reduced to 3.1% (9/291 slides), range 0-8% (p < 0.001). There was a higher prevalence of chatter in deeper levels (p < 0.02) and in colonic biopsies versus small intestinal biopsies (p < 0.05). In this study, chatter was operator dependent, less prevalent in histotechnologists reporting a constant cutting speed, and influenced by section level and site within the GI tract. In our experience simple technical measures and awareness were of value in reducing this troublesome artifact.