Biopsy 3. Histological examination

Content

Existing laboratory research methods significantly facilitate diagnosis, allow the patient to promptly initiate intensive care, and speed up the recovery process. One of such informative diagnostics in a hospital setting is a biopsy, during which it is possible to determine the nature of pathogenic neoplasms - benign or malignant. Histological examination of biopsy material, as an invasive technique, is carried out by knowledgeable specialists solely for medical reasons.

What is a biopsy

Essentially, this is the collection of biological material for further examination under a microscope. The main goal of the invasive technique is to timely detect the presence of cancer cells. Therefore, biopsy is often used in the complex diagnosis of cancer. In modern medicine, it is possible to actually obtain a biopsy from almost any internal organ, while at the same time removing the source of pathology.

Due to its pain, such laboratory analysis is performed exclusively under local anesthesia; preparatory and rehabilitation measures are required. A biopsy is an excellent opportunity to promptly diagnose a malignant neoplasm at an early stage in order to increase the patient’s chances of maintaining the viability of the affected organism.

Why do they take it?

A biopsy is prescribed for the timely and rapid detection of cancer cells and the pathological process accompanying their presence. Among the main advantages of this invasive technique performed in a hospital setting, doctors highlight:

high accuracy in determining tissue cytology;
reliable diagnosis at an early stage of pathology;
determining the extent of the upcoming operation in cancer patients.

What is the difference between histology and biopsy

This diagnostic method studies cells and their potential mutation under the influence of provoking factors. A biopsy is a mandatory component of diagnosing cancer and is necessary to take a tissue sample. This procedure is performed under general anesthesia using special medical instruments.

Histology is considered an official science that studies the structure and development of tissues of internal organs and body systems. The histologist, having received a sufficient fragment of tissue for examination, places it in an aqueous solution of formaldehyde or ethyl alcohol, and then stains the sections using special markers. There are several types of biopsy, histology is carried out in a standard sequence.

Species

In case of prolonged inflammation or suspected oncology, it is necessary to perform a biopsy to exclude or confirm the presence of an oncological process. It is first necessary to perform a general analysis of urine and blood to identify the inflammatory process, and implement instrumental diagnostic methods (ultrasound, CT, MRI). The collection of biological material can be carried out in several informative ways, the most common and popular among them are presented below:

Trephine biopsy. It is carried out using a thick needle, which in modern medicine is officially called a “trephine”.
Needle biopsy. The collection of biological material is carried out by puncturing the pathogenic neoplasm using a thin needle.
Incisional biopsy. The procedure is carried out during a full-fledged operation under local anesthesia or general anesthesia and involves the productive removal of only part of the tumor or affected organ.
Excisional biopsy. This is a large-scale procedure, during which a complete excision of an organ or malignant tumor is performed, followed by a rehabilitation period.
Stereotactic. This is a diagnosis carried out by preliminary scanning for the further construction of an individual scheme for the purpose of surgical intervention.
Brush biopsy. This is the so-called “brush method”, which involves the use of a catheter with a special brush for collecting biopsy material (located at the end of the catheter, as if cutting off the biopsy material).
Loop. Pathogenic tissues are excised using a special loop (electric or radio wave), in this way a biopsy sample is taken for further research.
Liquid. This is an innovative technology for identifying tumor markers in liquid biopsy, blood from a vein, and lymph. The method is progressive, but very expensive, and is not carried out in all clinics.
Transthoracic. The method is implemented with the participation of a tomograph (for more careful control) and is necessary for collecting biological fluid mainly from the lungs.
Fine needle aspiration. With such a biopsy, the biopsy material is forcibly pumped out using a special needle to conduct exclusively cytological examination (less informative than histology).
Radio wave. A gentle and absolutely safe technique, which is carried out using special equipment - Surgitron in a hospital setting. Does not require long-term rehabilitation.
Preskalennaya. This biopsy is used to diagnose the lungs and consists of taking a biopsy sample from the supraclavicular lymph nodes and lipid tissues. The session is carried out with the participation of a local anesthetic.
Open. Officially, it is a surgical procedure, and tissue collection for examination can be done from an open area. It also has a closed diagnostic form, which is more common in practice.
Core. Soft tissue sampling is performed using a special trephine with a harpoon system.

How they do it

The features and duration of the procedure itself completely depend on the nature of the pathology and the location of the suspected focus of the pathology. Diagnostics must be monitored by a tomograph or ultrasound machine, and must be carried out by a competent specialist in a given direction. Below are described options for such a microscopic examination depending on the organ that was rapidly affected in the body.

In gynecology

This procedure is appropriate for extensive pathologies not only of the external genitalia, but also of the uterine cavity, its cervix, endometrium and vagina, and ovaries. Such laboratory research is especially relevant for precancerous conditions and suspected progressive oncology. The gynecologist recommends undergoing the following types of biopsy strictly for medical reasons:

Sighting. All actions of the specialist are strictly controlled by extended hysteroscopy or colposcopy.
Laparoscopic. More often, the technique is used to take biological material from the affected ovaries.
Incisional. Involves careful excision of affected tissue using a classic scalpel.
Aspiration. In this case, the biopsy can be obtained using a vacuum method using a special syringe.
Endometrial. Carrying out a pipel biopsy is possible with the assistance of a special curette.

This procedure in gynecology is an informative diagnostic method that helps to identify a malignant neoplasm at an early stage, initiate effective treatment in a timely manner, and improve the prognosis. With progressive pregnancy, it is advisable to abandon such diagnostic methods, especially in the first and third trimesters; it is first important to study other medical contraindications.

Blood biopsy

Such laboratory testing is considered mandatory if leukemia is suspected. In addition, bone marrow tissue is collected for splenomegaly, iron deficiency anemia, and thrombocytopenia. The procedure is performed under local anesthesia or general anesthesia, performed by aspiration or trepanobiopsy. It is important to avoid medical errors, otherwise the patient may suffer significantly.

Intestines

This is the most common method of laboratory research of the intestines, esophagus, stomach, duodenum and other elements of the digestive system, which is carried out with the participation of puncture, loop, trepanation, pinching, incisional, scarification technology, necessarily in a hospital setting. Preliminary pain relief and a subsequent rehabilitation period are necessary.

In this way, it is possible to determine changes in the tissues of the gastrointestinal mucosa and promptly recognize the presence of cancer cells. In the stage of relapse of a chronic disease of the digestive system, it is better not to conduct the study in order to avoid gastric bleeding or other potential complications. Laboratory testing is prescribed only on the recommendation of the attending physician; there are contraindications.

Hearts

This is a complex procedure that, if there is a medical error, can cost the patient his life. A biopsy is used if serious diseases such as myocarditis, cardiomyopathy, or ventricular arrhythmia of unknown etiology are suspected. Due to rejection of a transplanted heart, such diagnostics are also necessary to monitor sustainable positive dynamics.

More often, modern cardiologists recommend conducting a right ventricular examination, accessing the source of pathology through the jugular vein on the right, the subclavian or femoral vein. To increase the chances of success of such a manipulation, during the collection of biological material, fluoroscopy and ECG are used, and the process is monitored on the monitor. The essence of the technique is that a special catheter is advanced to the myocardium, which has special tweezers for “biting off” biological material. To exclude thrombosis, medicine is administered into the body through a catheter.

Skin

Invasive examination of the epidermis is necessary if skin cancer or tuberculosis, lupus erythematosus, or psoriasis are suspected. An excisional biopsy is performed by shaving off the affected tissue in a column for further microscopic examination. If a minor area of skin is deliberately damaged, after completion of the session it must be treated with ethyl or formic alcohol. With large amounts of damage to the dermis, it may even be necessary to apply sutures in compliance with all aseptic rules.

If the focus of the pathology is concentrated on the head, it is necessary to examine a 2-4 mm area of skin, after which a suture will be applied. It can be removed a week after the operation, but for skin diseases this biopsy method is the most informative and reliable. It is not recommended to collect biological material in case of visible inflammation, open wounds and suppuration. There are other contraindications, so an individual consultation with a specialist is first required.

Bone tissue

This session is necessary to detect cancer and is an additional diagnostic method. In such a clinical picture, it is recommended to perform a percutaneous puncture with a thick or thin needle, depending on medical indications, or by a radical surgical method. After receiving the first results, there may be an urgent need to re-examine a similar biopsy.

Eye

If the development of retinoblastoma is suspected, an urgent biopsy is necessary. Action is required immediately, since such a malignant neoplasm very often progresses in childhood and can cause blindness and death for the clinical patient. Histology helps to give a real assessment of the pathological process and reliably determine its extent and predict the clinical outcome. In such a clinical picture, the oncologist recommends performing an aspiration biopsy using vacuum extraction.

FGDS with biopsy

To understand what we are talking about, you need to decipher the abbreviation FGDS. This is fibrogastroduodenoscopy, which is an instrumental examination of the esophagus, stomach and duodenum using a fiber-optic endoscope. When carrying out such a procedure, the doctor gets a real idea of the source of the pathology, and moreover, he can visually examine the condition of the affected digestive system - tissues and mucous membranes.

A biopsy is performed under local anesthesia, so it is an absolutely painless diagnostic method. This is especially important for patients at risk of gag reflex. A distinctive feature of this diagnosis is the ability to detect Helecobacter pylori infection and the degree of damage to the digestive system and mucous membranes.

Material research methods

After the biological material is obtained, it can be examined in detail under a microscope to promptly identify the nature of the pathological process. The most common and popular research methods and their brief descriptions are presented below:

Histological examination. In this case, sections of tissue taken from the body (exclusively from the surface or contents of the pathology site) come under observation. Using a special tool, biological material must be cut into strips of 3 micrometers, after which sections of such “strips” must be stained to detect cancer cells. Then the prepared material is examined under a microscope to determine the presence of cancer cells dangerous to health in the structure.
Cytological examination. This technique has a fundamental difference, which lies in the study of cells, not affected tissues. The method is less informative, and is used if an insufficient amount of biological material was taken for histological examination. More often, cytology is performed after a fine-needle (aspiration) biopsy, taking swabs and smears, which also causes discomfort when collecting biological material.

How long to wait for the result

If we talk about histological examination, the reliability of laboratory research is 90%. There may be errors and inaccuracies, but this depends on the morphologist who did not perform the sampling correctly, or use obviously healthy tissue for diagnosis. Therefore, it is advisable not to save on this procedure, but to seek help exclusively from a competent specialist.

It is important to clarify that the histological examination is final, i.e., based on its results, the doctor prescribes the final treatment. If the answer is positive, an intensive therapy regimen is selected individually; if negative, repeat biopsies are performed to clarify the diagnosis. Cytological examination, due to its less informative content, is an intermediate “link” of diagnosis. Also considered mandatory. If the result is positive, this is the basis for an invasive histological examination.

Results

When performing a histological examination, the result will be obtained after 4–14 days. When a quick response is needed, the biological material is immediately frozen after collection and sections are made and then stained. In such a clinical picture, the result will be obtained after 40–60 minutes, but the procedure itself requires high professionalism on the part of a competent specialist. If the disease is confirmed, the doctor prescribes treatment, and whether it will be medicinal or surgical depends entirely on the medical indications and the specifics of the body.

As for cytological examination, this is a faster, but less informative diagnostic method. The result can be obtained 1–3 days after the collection of biological material. If it is positive, it is necessary to start oncology treatment in a timely manner. If negative, it would be a good idea to perform a repeat biopsy. This is explained by the fact that doctors do not exclude errors and inaccuracies. The consequences for the body become fatal. Additionally, histology, gastroscopy (especially if the gastrointestinal tract is affected) and colonoscopy may be required.

Care after collection

After the biopsy, the patient needs complete rest, which includes bed rest for at least the first day after the procedure, proper nutrition and emotional balance. At the site where the biopsy is taken, the patient feels some pain, which becomes less and less pronounced every day. This is a normal phenomenon, since some tissues and cells were deliberately injured by a medical instrument. Further postoperative measures depend on the type of procedure and the characteristics of the affected organism. So:

If a puncture was performed, there is no need for additional sutures and bandages. If the pain increases, the doctor recommends taking an analgesic or using an ointment with an analgesic effect externally.
When making incisions to collect biological material, a suture may be required, which can be removed after 4 to 8 days without serious consequences for the patient’s health. Additionally, you will have to apply bandages and be sure to follow the rules of personal hygiene.

The recovery period should proceed under strict medical supervision. If the pain intensifies, purulent discharge or pronounced signs of inflammation appear, a secondary infection cannot be ruled out. Such anomalies can equally occur during biopsy of the bladder, breast, pancreas or thyroid gland, and other internal organs. In any case, action must be taken immediately, otherwise the health consequences could be fatal.

Complications

Since such a surgical procedure is associated with a violation of the integrity of the skin, doctors do not rule out the addition of a secondary infection with subsequent inflammation and suppuration. This is the most dangerous consequence for health, which can even result in blood poisoning, exacerbation of other unpleasant diseases with periodic recurrence. So a temporary scar of different sizes at the site of direct biopsy sampling is not the only problem of an aesthetic nature; potential complications that are no longer dangerous to health may be as follows:

excessive bleeding at the sampling site;
acute pain syndrome in the diagnostic area;
internal discomfort after completion of the session;
inflammatory process with high body temperature;
injury to the organ being examined (especially if a biopsy forceps is used);
infection of the organ being examined;
septic shock;
blood poisoning;
suppuration at the puncture site;
spread of bacterial infection with fatal outcome.

The results of histopathological examination allow the doctor not only to confirm or exclude prostate cancer, but also to establish the extent of cancer, the stage of the malignant process, choose treatment tactics and assess the prognosis of the disease. It is important for the urologist to know the exact location and extent of the pathological process. This information can help in deciding the extent of prostate surgery or in determining the biopsy site for repeat site-specific biopsy.

Pathological aspects: number, location and length of prostate tissue columns Numerous studies conducted in the USA and Europe confirm the fact that sextant prostate biopsy often gives false negative results. According to the recommendations of the European Association of Urology, a biopsy is currently performed from at least 8 points, and additional tissue columns are collected from hypoechoic zones detected during ultrasound examination, located on the periphery of the prostate gland. Thus, during a prostate biopsy, 10 tissue columns are obtained (sextant biopsy + 2 tissue columns from the peripheral zone of each side of the prostate gland).

The length and diameter of the tissue columns are important to ensure sufficient biopsy material for histopathological examination. The length and diameter of the tissue pieces directly depend on the type of needles used and the skills of the operating urologist, however, the minimum length of the tissue column should be 15 mm, and the diameter should be 2 mm.

The material obtained from the biopsy is sent to the laboratory for histopathological examination. According to the recommendations of the European Association of Urology, the obtained pieces of tissue from different parts of the prostate are sent to the laboratory in separate tubes.

The biopsy material undergoes special processing (fixation, cutting, staining), after which it is examined by a histologist under a microscope.

The results of a prostate biopsy must be unequivocal, i.e. crisp and clear and concise. It follows that the histopathological nomenclature of prostate lesions should be unified. Terms and phrases such as “glandular atypia,” “possibly malignant,” or “possibly benign” are not acceptable when interpreting histopathologic findings. The completeness and sufficiency of the biopsy material is of great importance for an adequate histopathological examination. An ineligible sample is one that contains little prostatic epithelial tissue. Columns of tissue in which there is a sufficient number of prostatic epithelial structures can be accurately distinguished from malignant. It is also necessary to know that some benign neoplasms can mimic prostate carcinoma. Taking into account the above, the European Association of Urology has adopted the following diagnostic terms used to interpret the results of prostate biopsy:

Benign neoplasm/ absence of cancer: this includes pathological findings such as fibromuscular and glandular hyperplasia, various forms of atrophy, such as foci of chronic (lymphocytic) inflammation.
Acute inflammation, a negative result for the presence of a malignant neoplasm - characterized by damage to the glandular structures, and may explain the increased level of prostate-specific antigen in the patient.
Chronic granulomatous inflammation, negative for malignancy: characterized by xanthogranulomatous inflammation. This condition can cause a persistent increase in prostate-specific antigen levels and give a false-positive result on digital rectal examination. As a rule, granulomatous inflammation of prostate tissue is associated with a history of BCG therapy for bladder cancer (intravesical therapy with bacillus Calmette-Guérin - a weakened strain of Mycobacterium tuberculosis).
Adenosis/atypical adenomatous hyperplasia, a negative result for the presence of a malignant neoplasm - as a rule, this is a rare finding in the peripheral zone of the prostate, characterized by a cluster of small acini surrounded by single basal cells.
Prostatic intraepithelial neoplasia(PIN). PIN can be diagnosed only by histological examination, has no specific clinical manifestations, and does not cause an increase in the level of prostate-specific antigen. Initially, low-grade and high-grade PIN were distinguished; currently, it is customary to distinguish only high-grade PIN, since the diagnosis of low-grade PIN does not have prognostic value for assessing the risk of prostate cancer with a repeat biopsy.

Diagnosis	Prostate cancer risk
Low degree PTS
Benign neoplasm

High PTS, negative result for the presence of adenocarcinoma. High-grade PIN diagnosed by extended prostate biopsy (>8 tissue cores) is not associated with an increased risk of prostate cancer and does not require a repeat biopsy. A repeat biopsy is recommended 2-3 years after the initial prostate biopsy.

	Prostate cancer risk
	High PTS	Benign neoplasm
Sextant
Extended

High grade PIN with atypical glands, with suspected adenocarcinoma. Requires a repeat extended prostate biopsy.
Focus of atypical glands/nodule with suspected adenocarcinoma. This diagnosis is made when a histologist under a microscope sees dubious, unclear signs of cancer and cannot confidently say that it is adenocarcinoma. Such a histopathological picture can be given by various lesions of the prostate gland, for example, a benign neoplasm simulating cancer (atrophy, basal cell hyperplasia), atypia caused by an inflammatory process, etc. A node suspected of cancer is detected in 0.7-23.4% of biopsies, and The risk of prostate cancer with a repeat biopsy is 41%.

If a diagnosis of adenocarcinoma is established, then the histopathological type of tumor (small acinar, papillary, etc.) must be indicated; it will also be important for the clinician to know how many positive tissue columns were detected during the study and their location. The histologist must indicate in millimeters the extent and percentage (%) of the tumor in each tissue column, which will allow assessing the prevalence of the malignant process, choosing treatment tactics and determining the prognosis. According to the European Association of Urology, the extent and percentage of tumor detected in the biopsy material have the same prognostic value.

Gleason score

It is recommended to use the Gleason score to interpret the results of prostate biopsy. The Gleason score is intended for staging prostate adenocarcinoma based on histopathological examination. The advantage of the Gleason index is that it is widely used throughout the world and has high accuracy and prognostic value, allowing one to assess how aggressive a malignant neoplasm is. Prostate cancer cells can be highly, moderately and poorly differentiated. Cellular differentiation is a term that refers to how different cancer cells are from normal cells when examined microscopically. Highly differentiated cancer cells are cells that are morphologically practically indistinguishable from normal cells. Tumors consisting of such cells are not prone to rapid growth and metastasis. Poorly differentiated cells appear abnormal under a microscope, and tumors made from such cells tend to grow rapidly and metastasize early.

During histopathological examination, the pathologist evaluates the tissue columns using a 5-point system from 1 to 5. The lowest score of 1 indicates the least aggressive tumor, and 5 indicates the most aggressive. The Gleason index is obtained by adding the scores of the two most common altered prostate tissues by volume.

Thus, the result of assessing the biopsy material according to the Gleason score may look like this:

3+4=7 or 4+5=9 or 5+4=9

It is necessary to understand that the sequence of numbers is of great importance and can influence the choice and outcome of treatment. The first digit indicates the prevailing score, i.e. changes in prostate tissue corresponding to this score occupy more than 51% of the volume of morphological material. The second score characterizes changes in prostate tissue, occupying from 5% to 50% of the biopsy material. The European Association of Urology recommends not to include in the Gleason index a score that characterizes the tumor area of less than 5%. It is now clear that the sum of 4+5=9 and 5+4=9 have different meanings, and patients with a Gleason score of 4+3=7 have a more aggressive tumor.

Thus, the Gleason index varies from 2 to 10:

A Gleason score of 2 to 6 means a slow-growing, well-differentiated tumor that is not prone to rapid growth and early metastasis.
A Gleason index of more than 7 characterizes moderately differentiated adenocarcinoma.
A Gleason score of 8-10 indicates a poorly differentiated tumor characterized by rapid growth and early metastasis.

A Gleason index of less than 4 is not indicated in the prostate biopsy report.

Less commonly, the following tumor staging scale can be used:

GX: stage cannot be set

G1: well-differentiated normal tumor cells (Gleason score 2 to 4)

G2: moderately differentiated normal tumor cells (Gleason score 5 to 7)

G3: poorly differentiated tumor cells (Gleason score 8-10).

Immunohistochemical study

Immunohistochemistry is not a routine research method and is used if differential diagnosis is necessary. Thus, immunohistochemical examination is used:

In the differential diagnosis of adenocarcinoma and benign neoplasm simulating cancer.
In the differential diagnosis of poorly differentiated adenocarcinoma and transitional cell carcinoma or colon cancer, etc.

The results of a prostate biopsy are presented by a histologist in a special histological examination report. The European Association of Urology has developed a special summary table, which must be filled out by a doctor when drawing up a conclusion on a histopathological examination of biopsy material. If a malignant neoplasm is detected, the following information is indicated in the table:

Histopathological type of adenocarcinoma
Gleason index
Localization and extent of tumor
The status of the surgical margin (the margin can be positive or negative) influences the likelihood of biochemical tumor recurrence
The presence of extraprostratic spread, its degree and localization.
In addition, the presence of lymphovascular or perineural invasion is indicated.

For pathomorphological staging of the tumor process it is used TNM system(T-tumor – primary tumor process; N – nodes – involvement of lymph nodes, M – metastasis – presence of metastases). A simplified TNM system for staging prostate cancer can be represented as follows:

T1 – the tumor is not detected by digital rectal examination or imaging studies (ultrasonography, computed tomography), but histological examination of the biopsy material reveals cancer cells;

T2 – the tumor is detected by digital examination and can occupy from one lobe of the prostate to involve both lobes of the prostate in the pathological process;

T3 – tumor invades the prostate capsule and/or seminal vesicles

T4 – the tumor has spread to nearby tissues (but not the seminal vesicles)

N – regional lymph nodes

N0 – regional lymph nodes are not affected

N1 – the tumor process involves one regional lymph node, a node with a diameter of no more than 2 cm

N2 – the tumor has spread to one or more lymph nodes, the nodes reach sizes from 2 to 5 cm.

N3 – the tumor process affects regional lymph nodes that reach a size of more than 5 cm.

M – distant metastases

M0 – the tumor process does not spread beyond the regional lymph nodes

M1 – the presence of metastases in non-regional lymph nodes, bones, lungs, liver or brain.

Thus, the results of prostate biopsy obtained from histopathological examination allow:

Confirm or exclude the diagnosis of prostate cancer
Decide whether to schedule a repeat prostate biopsy
In the case of a diagnosis of adenocarcinoma, determine the localization, extent and stage of the tumor process and choose treatment tactics
Make a prognosis for the disease, etc.

A biopsy is a diagnostic procedure in which a piece of tissue or organ is removed for subsequent microscopic examination. .

If cancer is suspected, a biopsy is required. since without it the diagnosis is not considered definitively established.

A biopsy is also performed for some non-oncological processes. For example, with autoimmune thyroiditis, some types of hepatitis, Crohn's disease, etc.

In this situation, it is an additional research method and is carried out when data from non-invasive diagnostic methods (CT, MRI, ultrasound, etc.) are not enough to make a diagnosis

Types of biopsy

Depending on the method of collecting material, there are the following types of biopsy:

excisional – excision of the entire tumor or organ;
incisional – excision of part of a tumor or organ;
puncture – percutaneous sampling of a tissue fragment with a hollow needle.
washes and smears.

Excisional and incisional biopsy

These types of biopsies are quite painful, so they are performed under anesthesia or local anesthesia in an operating room (the exception is a biopsy under endoscope guidance), and they require suturing. Excisional biopsy often performed not only for diagnostic purposes, but also for treatment purposes, incisional- for diagnostic purposes only. Sometimes during surgery for cancer it is necessary to urgently perform an incisional biopsy to clarify the scope of the operation.

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Needle biopsy

A minimally invasive method is a puncture biopsy. Its principle is that a hollow needle is inserted into the pathological formation or organ that needs to be examined. Pieces of tissue through which the needle passed get into it. After the needle is removed, these areas are sent for examination. If you need to examine an organ that is located deeply (that is, it cannot be seen and “palpated”), then the puncture is done under ultrasound or X-ray control.

For greater accuracy and to reduce trauma, a biopsy can be done under the control of ultrasound, endoscope, or x-ray.

In practice, two types of puncture biopsy are used:

fine-needle (aspiration, classic);
thick needle (cutting, trephine biopsy).

The advantage of a puncture biopsy is that this procedure is minimally painful. It is done without general or local anesthesia.

Why is a core needle biopsy performed?

In some cases, a local anesthetic is injected into the skin puncture site. But this type of biopsy also has its disadvantages. Firstly, the needle may not penetrate the pathological formation. Secondly, the material remaining in the needle cavity may not be sufficient for examination.

These factors significantly reduce the reliability of the method. The doctor’s experience and the quality of the equipment under whose control the manipulation is performed can compensate for the first drawback. To compensate for the second, modified techniques are used, in particular, core biopsy.

Core needle biopsies use threaded needles that are screwed into tissue like a screw. In this case, tissue areas that are much larger in volume remain in the needle cavity than with a fine-needle biopsy.

Biopsy guns make the procedure much easier for both the doctor and the patient.

This is the name of the devices that are used for fine-needle aspiration biopsy of various organs: pancreas, thyroid and prostate glands, liver, kidney, etc. A sterile needle is attached to the gun, consisting of a trephine (a tube with a very sharp edge) and a harpoon.

When fired, the trephine cuts tissue with great speed, and the harpoon fixes the tissue in the tube. As a result, a large column of material ends up in the needle cavity, which is sent for microscopic examination.

Taking swabs and swabs

In fact, taking smears and swabs is not a type of biopsy, but they, like biopsies, are used to determine the type of tissue and cells. Fingerprints are taken from accessible research objects. Thus, taking smears for atypical cells is widely used in gynecology for early diagnosis of cervical cancer.

To obtain swabs, the lumen of a hollow organ is washed with saline; for example, during bronchoscopy, swabs from the bronchi can be obtained. Fluid from a cyst (for example, breast cysts if breast cancer is suspected) or any body cavity, for example, pleural effusion, ascitic fluid, etc., can also be examined for malignant cells.

Study of the obtained material

Depending on the purpose of the biopsy and the amount of tissue obtained, the following is carried out:

histological examination of the material;
cytological examination of the material.

Histological examination examines tissue sections under a microscope..

To do this, pieces of tissue obtained from a biopsy are placed in a fixing liquid (formalin, ethanol, Bouin's fluid) to compact their structure, and then filled with paraffin. After hardening, they are cut into thin layers with a thickness of 3 micrometers using a microtome (a very sharp cutting tool). The sections are placed on a glass slide, paraffin is removed from them and stained with a special substance. After this, the drug is sent for microscopic examination.

In a cytological study, it is not the tissue that is studied, but the cells.

This type of microscopic examination is considered less precise, but requires less material. In addition, the preparation of a cytological preparation does not require lengthy preparation and special equipment.

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Cytological examination is usually carried out after aspiration biopsy, swabs and smears.. It is used to urgently solve diagnostic problems during surgery (establishing the nature of the tumor process, identifying tumor growth into surrounding tissues and metastases, the presence of tumor cells at the edges of the surgical incision, etc.), as well as when biopsy of a tissue area for histological examination is impossible or undesirable (for example, if melanoma is suspected).

Living cells are visible here - an experienced diagnostician quickly distinguishes leukemic (let's say) leukocytes and other atypical elements.

The significance of this method is great when it is necessary to analyze calcified and bone tissues, loose, crumbling masses and very small foci that are not suitable for histological examination.

When biopsy of tumors, it is most rational to carry out both histological and cytological examination of the biopsy specimen. But the results of histological examination are still decisive for establishing a diagnosis of cancer.

Reliability of biopsy results

The reliability of histological examination exceeds 90%. Its positive result serves as the basis for making a final diagnosis and prescribing a treatment regimen, including surgery for cancer.

If a tumor is suspected, it is better to do a biopsy in specialized government medical institutions, where experienced doctors and experienced pathologists work. This will significantly reduce the likelihood of a diagnostic error. If the result of the histological examination is negative, but the doctor has good reason to believe that the patient still has cancer, repeat biopsies are performed.

Cytological examination is a screening (intermediate) diagnostic method. Its results largely depend on the amount of material and its preservation, as well as on how precisely it is taken. If the result of a cytological examination is positive, then this serves as the basis for a more complex histological examination.

A negative result does not reject the suspected diagnosis of cancer.

“You need to get a biopsy” - many have heard this phrase from their attending physician. But why is it needed, what does this procedure provide and how is it carried out?

Concept

A biopsy is a diagnostic study that involves taking biomaterial from a suspicious area of the body, for example, a lump, a tumor formation, a long-term non-healing wound, etc.

This technique is considered the most effective and reliable among all those used in the diagnosis of oncological pathologies.

Photo of breast biopsy

Thanks to a microscopic examination of the biopsy, it is possible to accurately determine the cytology of the tissue, which provides complete information about the disease, its degree, etc.
The use of a biopsy makes it possible to identify the pathological process at its earliest stage, which helps to avoid many complications.
In addition, this diagnosis allows you to determine the extent of the upcoming operation in cancer patients.

The main task of a biopsy is to determine the nature and nature of pathological tissue. For detailed diagnostics, biopsy examination is supplemented with water x-ray techniques, immunological analysis, endoscopy, etc.

Species

Biomaterial can be collected in different ways.

– a technique for obtaining a biopsy using a special thick needle (trephine).
Excision biopsy is a type of diagnosis in which an entire organ or tumor is removed during surgery. It is considered a large-scale type of biopsy.
puncture– This biopsy technique involves obtaining the necessary samples by puncture with a thin needle.
Incisional. Removal affects only a certain part of the organ or tumor and is carried out during a full-fledged surgical operation.
Stereotactic– a minimally invasive diagnostic method, the essence of which is to build a specialized access scheme to a specific suspicious area. Access coordinates are calculated based on a preliminary scan.
Brush biopsy– a variant of the diagnostic procedure using a catheter, inside of which a string with a brush is built in, collecting biopsy material. This method is also called brush method.
Fine needle aspiration biopsy– a minimally invasive method in which material is collected using a special syringe that sucks out biomaterial from tissues. The method is applicable only for cytological analysis, since only the cellular composition of the biopsy is determined.
Loop biopsy – a biopsy sample is taken by excision of pathological tissue. The required biomaterial is cut off with a special loop (electric or thermal).
Transthoracic biopsy is an invasive diagnostic method used to obtain biomaterial from the lungs. It is carried out through the chest using an open or puncture method. Manipulations are carried out under the supervision of a video thoracoscope or computed tomograph.
Liquid biopsy is the latest technology for identifying tumor markers in liquid biopsy, blood, lymph, etc.
Radio wave. The procedure is carried out using specialized equipment - the Surgitron apparatus. The technique is gentle and does not cause complications.
Open– this type of biopsy is carried out using open access to the tissues whose sample needs to be obtained.
Preskalennaya biopsy is a retroclavicular study in which a biopsy sample is taken from the supraclavicular lymph nodes and lipid tissues at the angle of the jugular and subclavian veins. The technique is used to identify pulmonary pathologies.

Why is a biopsy done?

A biopsy is indicated in cases where, after other diagnostic procedures, the results obtained are not sufficient to make an accurate diagnosis.

Typically, a biopsy is prescribed upon detection to determine the nature and type of tissue of the formation.

This diagnostic procedure is today successfully used to diagnose many pathological conditions, even non-oncological ones, since in addition to malignancy, the method allows one to determine the degree of spread and severity, stage of development, etc.

The main indication is to study the nature of the tumor, however, a biopsy is often prescribed to monitor the ongoing oncology treatment.

Today, a biopsy can be obtained from almost any area of the body, and the biopsy procedure can perform not only a diagnostic, but also a therapeutic mission, when the pathological focus is removed in the process of obtaining biomaterial.

Contraindications

Despite all the usefulness and highly informative nature of the technique, biopsy has its contraindications:

The presence of blood pathologies and problems associated with blood clotting;
Intolerance to certain drugs;
Chronic myocardial failure;
If there are alternative non-invasive diagnostic options that have similar information content;
If the patient refuses to undergo such a procedure in writing.

Material research methods

The resulting biomaterial or biopsy specimen is subjected to further examination using microscopic technologies. Typically, biological tissues are sent for cytological or histological diagnosis.

Histological

Sending a biopsy sample for histology involves conducting a microscopic examination of tissue sections, which are placed in a specialized solution, then in paraffin, after which staining and sections are carried out.

Staining is necessary so that cells and their areas are better distinguished during microscopic examination, on the basis of which the doctor draws up a conclusion. The patient receives results in 4-14 days.

Sometimes histological examination needs to be carried out urgently. Then the biomaterial is taken during the operation, the biopsy sample is frozen, and then sections are made and stained according to a similar scheme. The duration of such analysis is no more than 40 minutes.

Doctors have a fairly short period of time to determine the type of tumor and make decisions on the extent and methods of surgical treatment. Therefore, in such situations, urgent histology is practiced.

Cytological

If histology was based on the study of tissue sections, it involves a detailed study of cellular structures. A similar technique is used if it is not possible to obtain a piece of tissue.

Such diagnostics are carried out mainly to determine the nature of a particular formation - benign, malignant, inflammatory, reactive, precancerous, etc.

The resulting biopsy is used to make a smear on glass, and then conduct a microscopic examination.

Although cytological diagnosis is considered simpler and faster, histology is still more reliable and accurate.

Preparation

Before the biopsy, the patient must undergo laboratory testing of blood and urine for the presence of various types of infections and inflammatory processes. In addition, magnetic resonance, ultrasound, and x-ray diagnostics are performed.

The doctor studies the picture of the disease and finds out whether the patient is taking medications.

It is very important to tell your doctor about the presence of pathologies of the blood clotting system and allergies to medications. If the procedure is planned to be carried out under anesthesia, then you should not eat or drink liquid 8 hours before taking the biopsy sample.

How is a biopsy done in certain organs and tissues?

The biomaterial is collected using general or local anesthesia, so the procedure is usually not accompanied by painful sensations.

The patient is placed on a couch or operating table in the position required by the specialist. After which they begin the process of obtaining a biopsy sample. The total duration of the process is often several minutes, and with invasive methods it can reach half an hour.

In gynecology

The indication for biopsy in gynecological practice is the diagnosis of pathologies of the vagina, ovaries, and external organs of the reproductive system.

Such a diagnostic technique is decisive in the detection of precancerous, background and malignant formations.

In gynecology they use:

Incisional biopsy - when tissue is excised with a scalpel;
Targeted biopsy - when all manipulations are controlled by extended hysteroscopy or colposcopy;
Aspiration – when the biomaterial is obtained by aspiration;
Laparoscopic biopsy - this method usually takes a biopsy sample from the ovaries.

Endometrial biopsy is performed using a pipette biopsy, which uses a special curette.

Intestines

A biopsy of the small and large intestines is performed in various ways:

puncture;
Petlev;
Trepanation - when a biopsy is taken using a sharp hollow tube;
Shchipkov;
Incisional;
Scarification - when the biopsy is scraped.

The specific choice of method is determined by the nature and location of the area being examined, but most often they resort to colonoscopy with biopsy.

Pancreas

Biopsy material from the pancreas is obtained in several ways: fine needle aspiration, laparoscopic, transduodental, intraoperative, etc.

Indications for a pancreatic biopsy are the need to determine morphological changes in pancreatic cells, if present, and to identify other pathological processes.

Muscles

If a doctor suspects that a patient has developed systemic connective tissue pathologies, which are usually accompanied by muscle damage, a biopsy examination of the muscle and muscle fascia will help determine the disease.

In addition, this procedure is performed if there is a suspicion of the development of periarteritis nodosa, dermatopolymyositis, eosinophilic ascites, etc. Such diagnostics are used using needles or in the open way.

Heart

Biopsy diagnosis of the myocardium helps to detect and confirm pathologies such as myocarditis, cardiomyopathy, ventricular arrhythmia of unknown etiology, as well as to identify processes of transplanted organ rejection.

According to statistics, a right ventricular biopsy is more often performed, with access to the organ through the right jugular vein, femoral or subclavian vein. All manipulations are controlled by fluoroscopy and ECG.

A catheter (bioptome) is inserted into the vein and guided to the desired area where the sample is to be obtained. On the bioptome, special tweezers open and bite off a small piece of tissue. To prevent thrombosis, a special medicine is pumped through the catheter during the procedure.

Bladder

Bladder biopsy in men and women is performed in two ways: cold and TUR biopsy.

The cold method involves transurethral cytoscopic penetration and biopsy sampling with special forceps. TUR biopsy involves removing the entire tumor down to healthy tissue. The purpose of such a biopsy is to remove all visible formations from the bladder walls and make an accurate diagnosis.

Blood

A bone marrow biopsy is performed in the case of malignant tumor pathologies of the blood such as.

Also, a biopsy examination of bone marrow tissue is indicated for iron deficiency, splenomegaly, thrombocytopenia and anemia.

Using a needle, the doctor removes a certain amount of red bone marrow and a small bone tissue sample. Sometimes the study is limited to obtaining only a bone tissue sample. The procedure is performed by aspiration or trepanobiopsy.

Eyes

Examination of eye tissue is necessary if there is a tumor of malignant origin. Such tumors are often found in children.

A biopsy helps to obtain a complete picture of the pathology and determine the extent of the tumor process. In the process of diagnosing retinoblastoma, the technique of aspiration biopsy using vacuum extraction is used.

Bone tissue

A bone biopsy is performed to identify either infectious processes. Typically, such manipulations are performed percutaneously by puncture, with a thick or thin needle or surgically.

Oral cavity

An oral biopsy involves obtaining biopsies from the larynx, tonsils, salivary glands, throat and gums. Such diagnostics are prescribed when pathological formations of the jaw bones are detected or to determine salivary glandular pathologies, etc.

The procedure is usually performed by a facial surgeon. He uses a scalpel to remove part and the entire tumor. The whole procedure takes about a quarter of an hour. Pain is observed when an anesthetic is injected, but there is no pain when a biopsy is taken.

Analysis results

The results of biopsy diagnostics are considered normal if the patient does not have cellular changes in the tissues being examined.

Consequences

The most common consequence of such a diagnosis is rapid bleeding and pain at the site of biopsy sampling.

About a third of patients experience moderate to mild pain after a biopsy.

Serious complications after a biopsy usually do not occur, although in rare cases, fatal consequences of the biopsy occur (1 in 10,000 cases).

Post-procedure care

For severe pain, analgesics can be used. Caring for the puncture site or suture (depending on the type of procedure) may vary slightly, but you can remove the bandage only one day after the biopsy, at which time you can take a shower.