biopsy

• Biopsy


  A procedure that involves removing a piece of tissue or a sample cell from the body so that it can be analyzed in a laboratory to determine whether one has cancer/malignancy or some other condition, and to know the extent of the disease

  
• Cancer


  A genetic disorder caused by DNA mutations, most of which are either induced by exposure to mutagens or occur spontaneously as part of aging. Cancers frequently show epigenetic changes, such as focal increases in DNA methylation and alterations in histone modifications, which may themselves stem from acquired mutations in genes that regulate such modifications.
• Neoplasia


  New growth
• Neoplastic cells


  Transformed cells that continue to replicate, apparently oblivious to the regulatory influences that control normal cells. Neoplasms enjoy a degree of autonomy and tend to increase in size regardless of their local environment, though they depend on the host for their nutrition and blood supply.
• Benign tumors


  • Fibroma
  • Chondroma
• Benign epithelial tumors


  Have more varied and complex nomenclature
• Malignant neoplasms


  • Sarcomas (arising in solid mesenchymal tissues or their derivatives)
  • Leukemias or lymphomas (arising from the mesenchymal cells of the blood)
  • Carcinomas (arising from the epithelia of the body, regardless of the tissue of origin)
• Benign tumors by tissue of origin


  • Surface epithelium: Papilloma/Adenoma
  • Solid glandular epithelium: Adenoma
  • Fibrous: Fibroma
  • Bone: Osteoma
  • Cartilage: Chondroma
  • Fat: Lipoma
  • Smooth muscle: Leiomyoma
  • Skeletal muscle: Rhabdomyoma
  • Blood vessel: Hemangioma
• Malignant tumors by tissue of origin


  • Surface epithelium: Carcinoma
  • Solid glandular epithelium: Adenocarcinoma
  • Fibrous: Fibrosarcoma
  • Bone: Osteosarcoma
  • Cartilage: Chondrosarcoma
  • Fat: Liposarcoma
  • Smooth muscle: Leiomyosarcoma
  • Skeletal muscle: Rhabdomyosarcoma
  • Blood vessel: Hemangiosarcoma
• Adenomas


  Benign tumors of epithelial cell origin, in epithelial glands or ducts
• Sarcomas


  Malignant tumors arising from mesenchymal tissue
• Carcinomas


  Malignant tumors derived from any of the 3 germ layers
• Adenocarcinoma


  A malignant lesion in which the neoplastic epithelial cells grow in glandular patterns
• Lymphomas


  Derived from solid lymphoid tissue
• Leukemias


  Derived from hematopoietic elements
• Biopsy specimen processing


  1. Specimen sent to histopathology lab in formalin

  2. Specimen logged in logbook

  3. Specimen checked for fixative and label match

  4. Gross examination by pathologist

  5. Specimen preparation (fixation, decalcification, processing)

  6. Sectioning, staining, and microscopic examination
• Types of biopsy


  • Surgical/Excisional biopsy
  • Incisional biopsy (bone marrow, endoscopic, needle, cone, punch)
  • Fine-needle aspiration biopsy (FNAB)
  • Core needle biopsy (CNB)
  • Vacuum-assisted biopsy
  • Image-guided biopsy

  
• Fine needle aspiration biopsy (FNAB)


  Uses a very thin needle to withdraw a small amount of tissue from the suspicious area for microscopic examination

  
• Core needle biopsy (CNB)

  Uses a larger needle with a cutting tip to draw a column of tissue out of a suspicious area

  
• Needle biopsy can be used on tumors that the doctor can feel through the skin, or on suspicious areas that can't be felt using imaging guidance

  
• Local anesthesia is used for needle biopsies to minimize pain

  
• Core needle biopsy (CNB)

  A larger needle with a cutting tip is used to draw a column of tissue out of a suspicious area

  
• Core needle biopsy (CNB)


  1. Needle is put in 3 to 6 times to get the samples or cores

  2. More likely to give a definite result because more tissue is taken to be looked at

  
• Core needle biopsy (CNB)


  • Can cause some bruising but usually does not leave scars inside or outside the breast
  • Doctor guides the needle into the abnormal area while feeling (palpitating) the lump
  • If the abnormal area is too small to be felt, a radiologist or other doctor may use a stereotactic instrument or ultrasound to guide the needle to the target area

  
• Punch biopsy


  • Primary technique for obtaining diagnostic full-thickness skin specimens
  • Involves the use of a circular blade that is rotated down through the epidermis and dermis, and into the subcutaneous fat, yielding a 3- to 4- mm cylindrical core of tissue sample

  
• Shave biopsy


  Small fragments of tissue are "shaved" from a surface (usually skin)

  
• Curettings


  Tissue is scooped or spooned to remove tissue or growths from body cavity such as endometrium or cervical canal

  
• Bone marrow biopsy


  • Doctor draws a sample of bone marrow out of the back of your hipbone using a long needle
  • May biopsy marrow from other bones in your body
  • Used to diagnose a variety of blood problems - both noncancerous and cancerous, including blood cancers, such as leukemia, lymphoma, and multiple myeloma
• Bone marrow biopsy


  You receive a local anesthetic before the procedure in order to minimize discomfort
• Endoscopic biopsy


  • Doctor uses a thin, flexible tube with a light on the end to see structures inside your body and takes a small sample of tissue to be analyzed
  • Tubes can be inserted through your mouth, rectum, urinary tract, or a small incision in your skin

  
• Endoscopic biopsy


  • Cystoscopy to collect tissue from the inside of your bladder
  • Bronchoscopy to get tissue from inside your lung
  • Colonoscopy to collect tissue from inside your colon
• Endoscopic biopsy


  Depending on the type of endoscopic biopsy you undergo, you may receive a sedative or anesthetic before the procedure
• Image-guided biopsy


  • Combines an imaging procedure, such as X-ray, CT scan, MRI, or ultrasound, with a needle biopsy
  • Allows your doctor to access suspicious areas that can't be felt through the skin

  
• Vacuum-assisted biopsy


  1. A suction device increases the amount of fluid and cells that are extracted through the needle

  2. Can reduce the number of times the needle must be inserted to collect an adequate sample

  
• Lymph node biopsy


  Removes all or part of the lymph node to be looked at under a microscope for signs of infection or a disease, such as cancer
• Types of lymph node biopsies


  • Fine-needle aspiration
  • Open (excisional) biopsy
  • Sentinel lymph node (SLN) biopsy

  
• Fine-needle aspiration


  A long thin needle is inserted into a lymph node to remove a sample of cells or tissue

  
• Open (excisional) biopsy


  A small cut is made in the skin and one or more lymph nodes are taken

  
• Sentinel lymph node (SLN) biopsy


  The so-called sentinel lymph node is the first one to receive lymphatic fluid draining from a cancer site, and can predict whether cancer is likely to be found in the rest of the lymphatic system without removing all of the nearby nodes
• Bone marrow aspirates are more sensitive than trephine biopsy sections for the detection of hemosiderin when the biopsy specimens are decalcified in formic acid