Biopsy 3. Histological examination

Content

Existing methods of laboratory research significantly facilitate diagnosis, allow the patient to proceed to intensive care in a timely manner, 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 exclusively for medical reasons.

What is a biopsy

In fact, 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, a biopsy is often used in the complex diagnosis of oncological diseases. In modern medicine, it is possible to obtain a biopsy from almost any internal organ, while simultaneously removing the focus of pathology.

Such a laboratory analysis, due to its pain, is performed exclusively under local anesthesia; preparatory and rehabilitation measures are required. A biopsy is an excellent opportunity to timely 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 take

A biopsy is prescribed for the timely and rapid detection of cancer cells and the accompanying pathological process. Among the main advantages of such an invasive technique, carried out in a hospital, doctors distinguish:

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

What is the difference between histology and biopsy

This diagnostic method deals with the study of cells and their potential mutation under the influence of provoking factors. A biopsy is a mandatory component of the diagnosis of oncological diseases, and is necessary to take a tissue sample. This procedure is performed under anesthesia with the participation of 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 piece of tissue for examination, places it in an aqueous solution of formaldehyde or ethyl alcohol, then stains the sections using special markers. There are several types of biopsy, histology is performed in a standard sequence.

Kinds

With prolonged inflammation or suspicion of oncology, it is necessary to conduct a biopsy, excluding or confirming the presence of an oncological process. First, it is required to perform a general analysis of urine and blood to identify the inflammatory process, to implement instrumental diagnostic methods (ultrasound, CT, MRI). The sampling of biological material can be carried out in several informative ways, the most common and popular among them are presented below:

Trepan biopsy. It is carried out with the participation of a thick needle, which in modern medicine is officially called a "trephine".
Needle biopsy. The sampling of biological material is carried out by the method of puncturing a pathogenic neoplasm with the participation of a thin-field needle.
incisional biopsy. The procedure is carried out during a full-fledged operation under local anesthesia or general anesthesia, it provides for the productive removal of only part of the tumor or the affected organ.
Excisional biopsy. This is a large-scale procedure, during which a complete excision of an organ or a malignant tumor is performed, followed by a rehabilitation period.
Stereotactic. This is a diagnosis carried out by the method of 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 to collect a biopsy (located at the end of the catheter, as if cutting off the biopsy).
Loopback. Pathogenic tissues are excised using a special loop (electric or radio wave), in this way a biopsy is taken for further research.
Liquid. This is an innovative technology for detecting tumor markers in a liquid biopsy, blood from a vein, and lymph. The method is progressive, but very expensive, not carried out in all clinics.
Transthoracic. The method is implemented with the participation of a tomograph (for more thorough control), it is necessary for taking biological fluid mainly from the lungs.
Fine needle aspiration. With such a biopsy, the biopsy specimen is forced to be pumped out using a special needle for exclusively cytological examination (less informative than histology).
Radio wave. A gentle and absolutely safe technique, which is carried out with the help of special equipment - Surgitron in a hospital. Does not require long rehabilitation.
Preskalennaya. Such a biopsy is involved in the diagnosis of the lungs, it consists in taking a biopsy 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 intervention, and tissue sampling for research can be performed from an open area. It also has a closed form of diagnosis, which is more common in practice.
Core. Soft tissue sampling is performed using a special trephine with a harpoon system.

How do they do

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

In gynecology

Carrying out this procedure is appropriate for extensive pathologies not only of the external genital organs, but also of the uterine cavity, its cervix, endometrium and vagina, and ovaries. Such a laboratory study is especially relevant for precancerous conditions and suspected progressive oncology. The gynecologist recommends undergoing such types of biopsy strictly for medical reasons:

Sighting. All actions of a 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. It provides for a careful excision of the affected tissues with a classic scalpel.
Aspiration. In this case, a biopsy specimen can be obtained by the vacuum method using a special syringe.
Endometrial. Pipel biopsy is possible with the help of a special curette.

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

Blood biopsy

Such a laboratory study is considered mandatory if leukemia is suspected. In addition, bone marrow tissue is taken 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 greatly.

Intestine

This is the most common method of laboratory examination of the intestines, esophagus, stomach, duodenum and other elements of the digestive system, which is carried out with the participation of puncture, loop, trepanation, pinch, incisional, scarification technology, necessarily in a hospital. Preliminary anesthesia is necessary, followed by a rehabilitation period.

In this way, it is possible to determine the change in the tissues of the mucous membrane of the digestive tract, to recognize the presence of cancer cells in a timely manner. In the stage of recurrence of a chronic disease of the digestive system, it is better not to conduct a study in order to avoid gastric bleeding or other potential complications. Laboratory research is prescribed only on the recommendation of the attending physician, there are contraindications.

hearts

This is a complex procedure that, if a medical error can cost the patient his life. Use a biopsy for suspected serious diseases such as myocarditis, cardiomyopathy, ventricular arrhythmia of unknown etiology. Due to the rejection of the transplanted heart, such diagnostics are also needed to control stable positive dynamics.

More often, modern cardiology recommends conducting a right ventricular examination, accessing the focus of pathology through the jugular vein on the right, subclavian or femoral vein. To increase the chances of success of such a manipulation, fluoroscopy and ECG are used during the taking of biological material, 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 injected into the body through a catheter.

Skin

An invasive examination of the epidermis is necessary for suspected skin cancer or tuberculosis, lupus erythematosus, psoriasis. An excisional biopsy is performed by shaving the affected tissues with a column for the purpose of their further microscopic examination. If a small area of the skin is deliberately damaged, after the session is completed, it must be treated with ethyl or formic alcohol. With large amounts of damage to the dermis, suturing may even be required in compliance with all asepsis rules.

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

bone tissue

The indicated session is necessary for the detection of oncological diseases, it is an additional diagnostic method. In such a clinical picture, it is indicated to carry out 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 you suspect the development of retinoblastoma, an urgent biopsy is necessary. Action is required immediately, since such a malignant neoplasm very often progresses in childhood, can cause blindness and death for a clinical patient. Histology helps to give a real assessment of the pathological process and reliably determine its extent, predict the clinical outcome. In such a clinical picture, the oncologist recommends an aspiration biopsy technique using vacuum extraction.

FGDS with biopsy

To understand what will be discussed, it is required to make such a decoding of the FGDS abbreviation. This is fibrogastroduodenoscopy, which is an instrumental study of the esophagus, stomach and duodenum with the involvement of a fiber optic endoscope. When carrying out such a procedure, the doctor gets a real idea of the focus of the pathology, moreover, he can visually examine the state of the affected digestive system - tissues and mucous membranes.

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

Material research methods

After the biological material is obtained, it can be followed by a detailed study under a microscope to timely identify the nature of the pathological process. The most common and popular research methods and their brief description are presented below:

Histological examination. In this case, tissue sections taken from the body (exclusively from the surface or contents of the pathology focus) are under observation. Using a special tool, the biological material must be cut into strips of 3 micrometers, after which, in order to detect cancer cells, it is necessary to stain the sections of such “strips”. Then the prepared material is examined under a microscope to determine the presence of cancer cells hazardous to health in the structure.
Cytological study. This technique has a fundamental difference, which consists in the study of not affected tissues, but cells. The method is less informative, but 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 swabs, which also causes discomfort when taking 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 it depends on the morphologist who did not correctly take the sample, or use obviously healthy tissues 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, individually selects an intensive care regimen; if negative, repeat biopsies are performed to clarify the diagnosis. Cytological examination, due to less information content, is an intermediate "link" in diagnosis. It is 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 to 14 days. When a quick response is needed, the biological material is immediately frozen after sampling, sections are made with their subsequent staining. 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 what it will be - medication or surgery, depends entirely on medical indications, the specifics of the body.

As for the cytological examination, this is a faster, but less informative diagnostic method. The result can be obtained after 1 - 3 days from the moment of sampling of biological material. If it is positive, it is necessary to start oncology treatment in a timely manner. If negative, it will not be superfluous to perform a second biopsy. This is explained by the fact that doctors do not exclude errors, inaccuracies. The consequences for the body become fatal. Additionally, histology, gastroscopy (especially with damage to the digestive tract) and colonoscopy may be required.

Care after the fence

After a 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 of the biopsy, the patient feels some soreness, which is less and less pronounced every day. This is a normal phenomenon, since part of the tissues and cells were deliberately injured by a medical instrument. Further postoperative measures depend on the type of procedure, the characteristics of the affected organism. So:

If a puncture was performed, additional suturing and bandaging is not necessary. With an increase in pain, the doctor recommends drinking an analgesic or using an ointment with an anesthetic effect externally.
When making incisions to take biological material, it may be necessary to apply a suture, which is removed after 4 to 8 days without serious consequences for the patient's health. Additionally, you will have to apply bandages, 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 is not excluded. Such anomalies can equally occur with a biopsy of the bladder, mammary, pancreas or thyroid gland, and other internal organs. In any case, action is required immediately, otherwise the health consequences can be fatal.

Complications

Since such a surgical procedure is associated with a violation of the integrity of the skin, doctors do not exclude the addition of a secondary infection, followed by inflammation and suppuration. This is the most dangerous consequence for health, which can even turn into 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 can be as follows:

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

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

Pathological aspects: number, location and length of prostate tissue columns Numerous studies conducted in the US and Europe confirm the fact that sextant biopsy of the prostate often gives false negative results. According to the recommendations of the European Association of Urology, a biopsy is currently being performed from at least 8 points, additionally, tissue columns are taken from the hypoechoic zones detected during ultrasound examination, located on the periphery of the prostate gland. Thus, with a biopsy of the prostate, 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 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 resulting pieces of tissue from different parts of the prostate are sent to the laboratory in separate test tubes.

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

The results of a prostate biopsy should be unambiguous, ie. clear and concise and concise. It follows that the histopathological nomenclature of prostate lesions should be unified. Terms and phrases such as "glandular atypia", "possibly malignant", or "it is possible that the process is benign" are not allowed when interpreting the results of histopathological examination. Of great importance for an adequate histopathological examination is the completeness and sufficiency of the biopsy material. A specimen that contains little prostatic epithelial tissue is considered non-compliant. Columns of tissue, in which a sufficient amount of prostatic epithelial structures, can be distinguished with high accuracy from malignant. It is also necessary to be aware that some benign neoplasms can mimic prostate carcinoma. Given the above, the European Association of Urology has adopted the following diagnostic terms used to interpret the results of a prostate biopsy:

benign neoplasm/absence of cancer: this includes such pathological findings as fibromuscular and glandular hyperplasia, various forms of atrophy, such as foci of chronic (lymphocytic) inflammation.
Acute inflammation, a negative result of the presence of a malignant neoplasm - is characterized by damage to the glandular structures, and may explain the elevated 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 a rectal digital examination. As a rule, granulomatous inflammation of the prostate tissues is associated with a history of BCG therapy for bladder cancer (intravesical therapy with Bacillus Calmette-Guerin, 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 an accumulation 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, but now it is accepted to distinguish only high-grade PIN, since the diagnosis of low-grade PIN has no predictive value for assessing the risk of prostate cancer on repeat biopsy.

Diagnosis	risk of prostate cancer
low grade PIN
benign neoplasm

high-grade PIN, negative for adenocarcinoma. High-grade PIN diagnosed on extended prostate biopsy (>8 tissue columns) is not associated with an increased risk of prostate cancer and does not warrant a repeat biopsy. A repeat biopsy is recommended 2-3 years after the primary prostate biopsy.

	risk of prostate cancer
	high-grade PIN	benign neoplasm
Sextant
Extended

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

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

Gleason scale

To interpret the results of prostate biopsy, it is recommended to use the Gleason index. The Gleason score is intended for staging prostate adenocarcinoma based on the results of histopathological examination. The advantage of the Gleason index is that it is widely used throughout the world and has high accuracy and predictive value, it allows you to assess how aggressive a malignant neoplasm is. Prostate cancer cells can be highly, moderately or poorly differentiated. Cellular differentiation is the term used to describe how different cancer cells are from normal cells when viewed microscopically. Highly differentiated cancer cells - cells morphologically practically do not differ from normal cells. Tumors consisting of such cells are not prone to rapid growth and metastasis. Poorly differentiated cells look abnormal under a microscope, and tumors from such cells are prone to rapid growth and early metastasis.

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

Thus, the result of assessing the biopsy material on the Gleason scale may look like this:

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

It must be understood 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 the tissues of the prostate, occupying from 5% to 50% of the biopsy material. The European Association of Urology recommended not to include in the Gleason index a score that characterizes a tumor site 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 neoplasm.

Thus, the Gleason index ranges from 2 to 10:

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

A Gleason index 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 Index 2 to 4)

G2: Moderately differentiated normal tumor cells (Gleason Index 5 to 7)

G3: poorly differentiated tumor cells (8-10 on the Gleason scale).

Immunohistochemical study

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

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

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

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

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

T1 - the tumor is not detected during rectal digital examination or imaging methods of research (ultrasoundography, computed tomography), but cancer cells are detected during histological examination of the biopsy material;

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

T3 - tumor invades prostate capsule and/or seminal vesicles

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

N - regional lymph nodes

N0 - regional lymph nodes are not affected

N1 - the tumor process captures one regional lymph node, the node is no more than 2 cm in diameter

N2 - The tumor has spread to one or more lymph nodes, the nodes are 2 to 5 cm in size.

N3 - the tumor process affects regional lymph nodes, which reach sizes 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 a prostate biopsy obtained during histopathological examination allow:

Confirm or rule out a diagnosis of prostate cancer
Decide on the appointment of a second biopsy of the prostate
In case of a diagnosis of adenocarcinoma, determine the localization, extent and stage of the tumor process and choose the tactics of treatment
Make a prognosis of the disease, etc.

A biopsy is a diagnostic procedure during which a piece of tissue or an organ is taken for subsequent microscopic examination. .

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

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

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

Types of biopsy

According to the method of sampling, there are the following types of biopsy:

excisional - excision of the entire neoplasm or organ;
incisional - excision of a part of a neoplasm or organ;
puncture - percutaneous sampling of a tissue fragment with a hollow needle.
washouts and smears.

Excisional and incisional biopsy

These types of biopsies are quite painful, so they are performed under anesthesia or local anesthesia in the operating room (with the exception of an endoscope-guided biopsy), and after them suturing is required. Excisional biopsy often performed not only for the purpose of diagnosis, but also for the purpose of treatment, incisional- for diagnostic purposes only. Sometimes during surgery for cancer, an urgent incisional biopsy is necessary to clarify the extent of the operation.

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Needle biopsy

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

For greater accuracy and reduced injury, a biopsy can be done under the control of ultrasound, endoscope, x-ray.

In practice, two types of puncture biopsy are used:

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

The advantage of a puncture biopsy is that this procedure is not painful. It is done without general and local anesthesia.

Why is a core biopsy performed?

In some cases, a local anesthetic is injected into the skin puncture site. But this type of biopsy has its drawbacks. Firstly, the needle may not enter the pathological formation. Secondly, the material remaining in the needle cavity may not be enough for research.

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

For core needle biopsy, threaded needles are used, which are screwed into the tissue like a screw. In this case, tissue areas remain in the needle cavity, which are much larger in volume than with a fine-needle biopsy.

Manipulation for both the doctor and the patient is greatly facilitated by biopsy guns.

This is the name of the devices that are used for fine-needle aspiration biopsy of various organs: pancreas, thyroid and prostate, 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 at great speed, and the harpoon fixes the tissue in the tube. As a result, a large column of material appears in the cavity of the needle, which is sent for microscopic examination.

Taking swabs and swabs

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

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

Study of the received 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 under a microscope examines tissue sections.

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

In a cytological study, not tissue, but cells are studied.

This type of microscopic examination is considered less accurate, but it requires less material. In addition, the preparation of a cytological preparation does not require long-term preparation and special equipment.

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

Live cells are visible here - an experienced diagnostician quickly distinguishes leukemia (for example) leukocytes and other atypical elements.

The value 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. But the results of histological examination are still decisive for establishing the diagnosis of oncological disease.

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.

A biopsy if a tumor is suspected is best done in specialized state medical institutions, where experienced doctors and experienced pathologists work. This will greatly reduce the chance 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, repeated biopsies are performed.

Cytological examination is a method of screening (intermediate) diagnosis. 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 rule out a suspected cancer diagnosis.

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

concept

A biopsy is a diagnostic study that involves the sampling of biomaterial from a suspicious area of \u200b\u200bthe body, for example, compaction, 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 the microscopic examination of the biopsy, it is possible to accurately determine the cytology of tissues, which provides complete information about the disease, its degree, etc.
The use of a biopsy allows you 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 pathology tissues. For a detailed diagnosis, a biopsy study is supplemented with X-ray water, immunological analysis, endoscopy, etc.

Kinds

Biomaterial sampling can be done in different ways.

- a technique for obtaining a biopsy using a special thick needle (trephine).
excisional biopsy - a type of diagnosis in which the 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 fine needle.
Incisional. Removal affects only a certain part of the organ or tumor and is carried out in the process of 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 the pre-scan.
Brush biopsy- a variant of the diagnostic procedure using a catheter, inside which a string with a brush is inserted, collecting a biopsy. This method is also called the brush method.
Fine needle aspiration biopsy- a minimally invasive method in which the material is taken using a special syringe that sucks the biomaterial from the tissues. The method is applicable only for cytological analysis, since only the cellular composition of the biopsy is determined.
Loopback biopsy - a biopsy is taken by excising pathological tissues. The desired biomaterial is cut off by a special loop (electrical or thermal).
Transthoracic biopsy is an invasive diagnostic method used to obtain biomaterial from the lungs. It is carried out through the chest in an open or puncture way. Manipulations are carried out under the supervision of a videothoracoscope or computed tomography.
Liquid biopsy is the latest technology for detecting 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, does not cause complications.
open- this type of biopsy is carried out using open access to the tissues, the sample of which needs to be obtained.
Preskalennaya biopsy - a retroclavicular study in which the biopsy is taken from the supraclavicular lymph nodes and lipid tissues at the angle of the jugular and subclavian veins. The technique is used to detect pulmonary pathologies.

Why is a biopsy done?

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

Usually, a biopsy is prescribed when detected to determine the nature and type of tissue formation.

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

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

Today, it is possible to obtain a biopsy 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 a biomaterial.

Contraindications

Despite all the usefulness and highly informative technique, a biopsy has its own contraindications:

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

Material research methods

The resulting biomaterial or biopsy is subjected to further research, which takes place using microscopic technologies. Usually, biological tissues are sent for cytological or histological diagnostics.

Histological

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

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

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

Doctors have a rather short period of time to determine the type of tumor, decide on the volume and methods of surgical treatment. Therefore, in such situations, urgent histology is practiced.

Cytological

If histology was based on the study of tissue sections, then 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 a diagnosis is carried out mainly in order to determine the nature of a particular formation - benign, malignant, inflammatory, reactive, precancerous, etc.

The resulting biopsy specimen is smeared on glass, and then microscopic examination is carried out.

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

Preparation

Before a biopsy, the patient must undergo a laboratory study of blood and urine for the presence of various infections and inflammatory processes. In addition, magnetic resonance, ultrasound, X-ray diagnostics are carried out.

The doctor examines the picture of the disease and finds out whether the patient is taking medication.

It is very important to tell the doctor about the presence of pathologies of the blood coagulation system and allergies to drugs. If the procedure is planned to be carried out under anesthesia, then you can not eat and drink liquid for 8 hours before the biopsy is taken.

How is a biopsy done in certain organs and tissues?

Biomaterial sampling is carried out using general or local anesthesia, so the procedure is usually not accompanied by painful sensations.

The patient is placed on the couch or operating table in the position required by the specialist. Then proceed to the process of obtaining a biopsy. The total duration of the process is often several minutes, and with invasive methods it can be up to half an hour.

In gynecology

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

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

Used in gynecology:

Incisional biopsy - when scalpel excision of tissue is performed;
Targeted biopsy - when all manipulations are controlled by extended hysteroscopy or colposcopy;
Aspiration - when the biomaterial is obtained by aspiration;
Laparoscopic biopsy - in this way, a biopsy is usually taken from the ovaries.

An endometrial biopsy is performed by means of a pipel biopsy, in which a special curette is used.

Intestines

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

Puncture;
Petlev;
Trepanation - when the biopsy is taken using a sharp hollow tube;
Shchipkov;
incisional;
Scarifying - when a biopsy is scraped off.

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

Pancreas

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

Indications for pancreatic biopsy is the need to determine the morphological changes in pancreatic cells in the presence 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 of the muscle and muscle fascia will help determine the disease.

In addition, this procedure is carried out in case of suspicion of the development of periarteritis nodosa, dermatopolymyositis, eosinophilic ascites, etc. Such a diagnosis is used with needles or in an open way.

Heart

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

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

A catheter (biopt) is inserted into the vein, which is brought to the required site where the sample is to be obtained. On the bioptom, special tweezers are opened, which bite off a small piece of tissue. During the procedure, a special medication is given through the catheter to prevent thrombosis.

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 tweezers. A 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 biopsy of the bone marrow is performed in the case of malignant tumor pathologies of the blood like.

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

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

Eyes

Examination of the tissues of the eye is necessary, in the presence of a tumor formation of a malignant origin. These tumors are common in children.

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

Bone

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

Oral cavity

Biopsy examination of the oral cavity involves obtaining a biopsy from the larynx, tonsils, salivary glands, throat and gums. Such a diagnosis is 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. With a scalpel, he takes a part and the whole tumor. The whole procedure takes about a quarter of an hour. Soreness is observed when an anesthetic is injected, and there is no pain when taking a biopsy.

Analysis results

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

Consequences

The most common consequence of such a diagnosis is rapidly passing bleeding and soreness at the site of the biopsy.

Moderately weak pain is experienced by about a third of patients after a biopsy.

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

Care after the procedure

With severe pain syndrome, analgesics can be used. Care of the puncture site or suture (depending on the type of procedure) may vary somewhat, but the bandage can be removed only a day after the biopsy, then you can take a shower.