{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:03:28Z","timestamp":1784282608613,"version":"3.55.0"},"reference-count":16,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2026,5,25]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The traditional three-level H&amp;E sectioning protocol for prostate biopsies was developed for ultrasound-guided systematic sampling and predates lesion-targeted biopsy approaches. Multiparametrical MRI (mpMRI) has improved detection of clinically significant prostate carcinoma but has also increased biopsy volume, workload, costs and digital pathology requirements, including whole-slide imaging and artificial intelligence (AI) integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A retrospective institutional cost-yield analysis was performed on prostate biopsy cases at Beth Israel Deaconess Medical Center (2015\u20132022), comparing systematic 12-core biopsies with combined systematic and mpMRI-targeted biopsies. Case volume, tissue blocks and H&amp;E slides were analysed. Per-slide costs were calculated, and additional digital pathology and AI workflow costs were estimated using published data and vendor pricing. Case volume increased by 27% over 7 years, while combined systematic and mpMRI-targeted protocols increased tissue blocks and H&amp;E slides by 39%. The cost per H&amp;E slide was $7.18, with digital pathology and AI workflows adding an estimated $4.30\u20135.00 per slide. In systematic 12-core biopsies, third-level sectioning identified four additional low-volume carcinomas at a cost of $2283 per diagnosis. In combined biopsies, two additional carcinomas were detected exclusively on the third level, both Grade Group 1, with a cost of $27 657 per diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Routine three-level H&amp;E sectioning in combined systematic and mpMRI-targeted prostate biopsies demonstrated low incremental diagnostic yield and substantial additional processing cost. A two-level protocol with selective third-level sectioning may preserve detection of clinically significant carcinomas in this institutional cohort, while reducing workload and cost in the digital pathology era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2026-210815","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:20:31Z","timestamp":1780593631000},"page":"555-559","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic yield and cost of three-level H&amp;E sectioning in prostate biopsies"],"prefix":"10.1136","volume":"79","author":[{"given":"Ruth","family":"Gichinga","sequence":"first","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Lepe","sequence":"additional","affiliation":[{"name":"Pathology, Scripps Clinic Medical Group, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4543-2697","authenticated-orcid":false,"given":"Quinn","family":"Rainer","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-4792","authenticated-orcid":false,"given":"Laura C","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4499-5221","authenticated-orcid":false,"given":"Yue","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2026071702101069000_79.8.555.1","unstructured":"Cancer Statistics Data Visualizations Tool. CDC and NCI 2022."},{"key":"2026071702101069000_79.8.555.2","unstructured":"NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection. Version, 2021."},{"key":"2026071702101069000_79.8.555.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2017.11.001"},{"key":"2026071702101069000_79.8.555.4","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.acuro.2016.02.011","article-title":"Evolution of prostate biopsy techniques","volume":"40","author":"Sivaraman","year":"2016","journal-title":"Actas Urol Esp"},{"key":"2026071702101069000_79.8.555.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32401-1"},{"key":"2026071702101069000_79.8.555.6","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1056\/NEJMoa1801993","volume":"378","author":"Kasivisvanathan","year":"2018","journal-title":"PRECISION Trial N Engl J Med"},{"key":"2026071702101069000_79.8.555.7","unstructured":"Weinreb JC , Barentsz JO , Choyke PL , et al . PI-RADS Prostate Imaging \u2013 Reporting and Data System: 2019 Version 2.1. Reston, VA: American College of Radiology, 2019."},{"key":"2026071702101069000_79.8.555.8","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.urolonc.2024.05.012","article-title":"mpMRI in prostate cancer screening","volume":"43","author":"Launer","year":"2025","journal-title":"Urol Oncol"},{"key":"2026071702101069000_79.8.555.9","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/107.1.26"},{"key":"2026071702101069000_79.8.555.10","first-page":"833","article-title":"Adequate histologic sampling","volume":"122","author":"Lane","year":"1998","journal-title":"Arch Pathol Lab Med"},{"key":"2026071702101069000_79.8.555.11","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199903000-00002"},{"key":"2026071702101069000_79.8.555.12","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2013-0093-CP"},{"key":"2026071702101069000_79.8.555.13","unstructured":"Ardon O , Klein EA , Manzo A , et al . 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J Pathol Inform 2023."},{"key":"2026071702101069000_79.8.555.14","first-page":"158","article-title":"Financial projection for digital pathology implementation","volume":"138","author":"Ho","year":"2014","journal-title":"Arch Pathol Lab Med"},{"key":"2026071702101069000_79.8.555.15","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30739-9"},{"key":"2026071702101069000_79.8.555.16","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0508-1"}],"container-title":["Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jcp-2026-210815","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:10:23Z","timestamp":1784279423000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcp.bmj.com\/lookup\/doi\/10.1136\/jcp-2026-210815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":16,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,7,17]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/jcp-2026-210815"],"URL":"https:\/\/doi.org\/10.1136\/jcp-2026-210815","relation":{},"ISSN":["0021-9746","1472-4146"],"issn-type":[{"value":"0021-9746","type":"print"},{"value":"1472-4146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}