Systematic "Head-to-Head" Comparison of Scalp Biopsy Techniques for Alopecia Diagnosis: Diagnostic Adequacy, Efficiency, and Resource Utilization.

BACKGROUND

Alopecia can significantly affect a patient's quality of life, underscoring the clinical importance of the optimal scalp biopsy technique. As histopathology remains the gold standard, selecting the most efficient and resource-conscious biopsy processing technique is essential for delivering high-value care. The optimal processing technique remains controversial. Seven distinct methods reported between 1984 and 2022 exist, but comprehensive head-to-head comparative studies assessing resource utilization have yet to be conducted. This study extends prior comparative investigations by systematically evaluating seven scalp biopsy processing techniques to identify the most efficient and diagnostically adequate method, addressing critical gaps in histopathologic workflows to advance value-based patient care.

METHODS

Eighty standard 4 mm punch biopsies were performed and processed for seven alopecia biopsy techniques-Diagonal, Frishberg, Headington, HoVert, St. John's (two biopsy specimens), Thompson and Tosti, and Tyler-to assess diagnostic adequacy (i.e., full visualization of the folliculosebaceous unit in upfront slides), resource consumption, and histotechnologist time.

RESULTS

Diagnostic adequacy was reliably achieved using the Diagonal, HoVert, St. John's, and Tyler methods. The Tyler method required the least amount of time (< 15 min) and fewest materials (one paraffin block and two slides) compared to the other techniques that yielded diagnostically adequate slides.

CONCLUSIONS

Our study demonstrates that the Tyler method is the most efficient and resource-sparing technique for diagnostic adequacy in alopecia biopsies, supporting its adoption as a high-value care initiative. These results underscore the potential to enhance laboratory efficiency, optimize diagnostic precision, and promote cost-effective practices in pathology laboratories.