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DOI: 10.4103/JLP.JLP_4_17
Utility of horizontal and vertical sections of scalp biopsies in various forms of primary alopecias
Financial support and sponsorship: NilABSTRACT
BACKGROUND: This study was performed to demonstrate the usefulness of horizontal and vertical sections of scalp biopsies in diagnosing various forms of primary alopecias and to highlight the importance of error-free grossing.
MATERIALS AND METHODS: A retrospective analytical review of 228 scalp biopsies was done, noting down the diagnostic histopathological features evident in horizontal and vertical sections of each cases. The idealness of the sections, especially horizontal section, was also analyzed.
RESULTS: Out of the 228 cases, 44 scalp biopsies were classified histologically as cicatricial alopecias and the remaining 162 as noncicatricial alopecia. 22 cases were inconclusive owing to erroneous grossing. We found horizontal sections to be more useful in cases of noncicatricial alopecias, whereas vertical sections proved superior in cicatricial alopecias.
CONCLUSION: Combining both horizontally and vertically sectioned scalp biopsies maximizes the diagnostic yield. When a single biopsy is submitted, the choice between horizontal and vertical section should depend on clinical diagnosis/suspicion.
Publication History
Received: 16 April 2017
Accepted: 06 October 2017
Article published online:
19 February 2020
© 2018.
Thieme Medical and Scientific Publishers Private Ltd.
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References
- 1 Knopp E. The scalp biopsy for hair loss and its interpretation. Semin Cutan Med Surg 2015;34:57-66.
- 2 Du X, Li Z, Xu W, Zhou X, Tang S, Song C, et al. Diagnostic value of horizontal versus vertical sections for scarring and non-scarring alopecia: A systematic review and meta-analysis. Eur J Dermatol 2016;26:361-9.
- 3 Elston DM, McCollough ML, Angeloni VL. Vertical and transverse sections of alopecia biopsy specimens: Combining the two to maximize diagnostic yield. J Am Acad Dermatol 1995;32:454-7.
- 4 Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J Am Acad Dermatol 2004;51:189-99.
- 5 Stefanato CM. Histopathology of alopecia: A clinicopathological approach to diagnosis. Histopathology 2010;56:24-38.
- 6 Olsen EA, Bergfeld WF, Cotsarelis G, Price VH, Shapiro J, Sinclair R, et al. Summary of North American Hair Research Society (NAHRS)-sponsored workshop on cicatricial alopecia, Duke University Medical Center, February 10 and 11, 2001. J Am Acad Dermatol 2003;48:103-10.
- 7 Elston DM, Ferringer T, Dalton S, Fillman E, Tyler W. A comparison of vertical versus transverse sections in the evaluation of alopecia biopsy specimens. J Am Acad Dermatol 2005;53:267-72.
- 8 Özcan D, Özen Ö, Seçkin D. Vertical vs. Transverse sections of scalp biopsy specimens: A pilot study on the comparison of the diagnostic value of two techniques in alopecia. Clin Exp Dermatol 2011;36:855-63.
- 9 Bathish N, Ben Izhak O, Shemer A, Bergman R. A study of serial vertical sectioning of scalp biopsies to increase the histological diagnostic yield in alopecias. J Eur Acad Dermatol Venereol 2010;24:709-15.
- 10 Tandon YK, Somani N, Cevasco NC, Bergfeld WF. A histologic review of 27 patients with lichen planopilaris. J Am Acad Dermatol 2008;59:91-8.
- 11 Singh K, Sharma S, Singh UR, Bhattacharya SN. A comparison of vertical and transverse sections in the histological diagnosis of alopecia areata scalp biopsy specimens. Int J Trichology 2016;8:111-5.
- 12 Jameel K, Ejaz A, Sohail M, Rahman SB. Value of transverse section scalp biopsy in alopecia areata - A clinicopathological correlation. J Coll Physicians Surg Pak 2008;18:338-41.
- 13 Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Arch Dermatol 1984;120:449-56.
- 14 Frishberg DP, Sperling LC, Guthrie VM. Transverse scalp sections: A proposed method for laboratory processing. J Am Acad Dermatol 1996;35:220-2.
- 15 Elston D. The 'tyler technique' for alopecia biopsies. J Cutan Pathol 2012;39:306.
- 16 Tailor A, Asher RG, Craig PJ, Groves RW, Fenton DA, Stefanato CM, et al. The current state of play in the histopathologic assessment of alopecia: Two for one or one for two? J Cutan Pathol 2013;40:298-304.
- 17 Solomon AR. The transversely sectioned scalp biopsy specimen: The technique and an algorithm for its use in the diagnosis of alopecia. Adv Dermatol 1994;9:127-57.
- 18 Nguyen JV, Hudacek K, Whitten JA, Rubin AI, Seykora JT. The HoVert technique: A novel method for the sectioning of alopecia biopsies. J Cutan Pathol 2011;38:401-6.
- 19 Kolivras A, Thompson C. Primary scalp alopecia: New histopathological tools, new concepts and a practical guide to diagnosis. J Cutan Pathol 2017;44:53-69.