FINALS | Biopsy

• Biopsy


  Excision and examination of tissue from a living subject for diagnostic purposes
• Biopsy


  • Could be therapeutic
  • Careful handling of the tissue is mandatory for sarcoma, and immediate touch preparation for lymphoma
• Ruge and Joham Vert in Berlin introduced surgical biopsy as an essential tool for diagnosis


  1870

  
• Emarch put forward an argument that confirmations should be made before surgeries for malignancies


  1889
• (YEAR) Study of exfoliated cells from female genital tract by Papanicolaou

  1941
• Papanicolaou's study was adapted to study cells from other body systems
• Indications for biopsy in surgery

  • Any lesion that persists for more than 2 weeks with no apparent etiologic basis
  • Any inflammatory lesion that does not respond to local treatment after 10 to 14 days
  • Persistent hyperkeratotic changes in surface tissues
  • Any persistent tumescence, either visible or palpable beneath relatively normal tissue
  • Evaluation and monitoring of tissue rejection after transplantation – kidney and liver
• Aspiration biopsy


  The use of a needle and syringe to penetrate a lesion for aspiration of its contents
• Indications for aspiration biopsy

  • To determine the presents of fluid within a lesion
  • To ascertain the type of fluid within a lesion
  • When exploration of an intraosseous lesion is indicated

  
• Aspiration biopsy procedure

  1. Outpatient procedure

  2. Infiltrate the site with local anesthesia

  3. 22G needle attached to a 10 ml syringe

  4. Place the needle in the mass

  5. Apply suction while the needle is in and move back and forth within the mass

  6. Release the suction and withdraw needle once cellular aspirate is seen

  7. Cellular material is then expressed unto the microscope slide

  8. Air dry or fix with 95% ethanol
• Core needle biopsy


  • Skin cleansing + LA
  • Small skin incision, bigger needle
  • Lesion approach at an angle of 45 degrees
  • Stabilize the lesion and introduce the needle via the skin until it abuts against the lesion
  • Fully mechanical biopsy gun is fired
  • Tissue fixed in formalin
  • Bleeding usually not a problem, apply pressure

  
• Core needle


  • Incision covered by an occlusive dressing
  • Sensitivity of 80-90%
• Exfoliative cytology


  • Widely used, especially for the diagnosis of malignant conditions and sites as the cervix, uterus, vagina, and the bronchial but also in urine and CSF and in fluid aspirated from the pleural and peritoneal cavities
  • Smears made from suspected metastasis
• Excisional biopsy


  • Complete removal of lesion provides the most reliable biopsy
  • Permits the pathologist to examine all of the suspicious tissue
  • Performed under local anesthesia before treatment is planned, but may be done using frozen section
  • Includes 2-3 mm perimeter of normal tissue
  • Certainly benign lesions
• Incisional biopsy


  • Removal of part of a lesion for histological examination
  • Preferred for large situated tumours that cannot be excised
  • Removal of small piece of tumour
  • Significant tumour remains
• Bite biopsy


  • Biopsy in which small pieces of tumor are removed with special forceps
  • Endoscopic biopsy is example of this type
• Cutaneous biopsy


  Removed from the skin lesion
• Punch biopsy


  • It is larger than 2 millimetre
  • Stained with H and E
  • Gross lesion assessment is very limited
• Shave biopsy


  Always present orientation problems and should be reserve for secretions requiring only histopathologic diagnostic
• Wedge biopsy


  • Size should be thicker than 3 to 4 mm
  • If EM is used, it should be less than 1 mm thin
• Marginal excision


  It refers to excisional or shell out and is a procedure in which the lesion is not entered but removed
• Endoscopic biopsy


  Gastroscopic or colonoscopic through ERCP or cystoscopic, arthroscopic
• Frozen section biopsy


  • Done whenever report is needed at the earliest time. Here, an unfixed fresh tissue is frozen using carbon dioxide in a metal and sections are made and stained
  • Disadvantages: Technically difficult, Difficult to get accurate results
  • Advantages: Quick and surgeons can decide the further steps to follow immediately
• Stereotatic biopsy


  • This uses image intensifier to enhance the accuracy of the site of the biopsy
  • Radiological images of the site of the lesion, the location, the size and shape, the depth, and other characteristics are employed in order to increase the accuracy of the procedure
  • This involves ultrasound, CT-scan, MRI, and mammography