Biopsy is a specialized diagnostic method that is used to collect tissue material from lesions suspected of a disease process or cancer. The collected cells and tissue structure are assessed by a specialist pathologist using a light microscope. What are the indications and contraindications for the examination? How does the biopsy work?

Biopsyis a diagnostic test which consists in collecting material for microscopic examination. The biopsy may be fine-needle, coarse-needle, segmental (when a section of the changed tissue is surgically removed), scratch (when the tissue is scraped with a special spoon) or drill (using a special punch) used in bone examination. There is also an open biopsy - surgical. It is an operation during which material for examination is collected.

Contents:

  1. Biopsy: indications
  2. Biopsy: contraindications
  3. Biopsy: preparation for the procedure
  4. Biopsy: complications
  5. Biopsy: types

Biopsy: indications

A biopsy is ordered by a doctor who, in a physical or imaging examination (eg ultrasound), revealed an unclear, disturbing change. These are usually various types of nodules and tumors, cysts, enlarged lymph nodes, skin changes or changes in the mucous membranes. Fine needle aspiration biopsy (FNAB) is most often performed when a doctor suspects the presence of lesions in organs such as the thyroid gland, prostate gland, nipple, bone marrow or lungs.

Biopsy: contraindications

There are few contraindications for biopsy as a diagnostic method. The only conditions that absolutely prevent the procedure from being performed include the patient's lack of consent. Relative contraindications for biopsy include the lack of cooperation with the patient, uncontrolled blood coagulation disorders, hemorrhagic diathesis, and the presence of purulent lesions on the skin at the site of the planned puncture.

Biopsy: preparation for the procedure

In all patients, prior to biopsy, the blood group, blood coagulation parameters (bleeding and clotting time, platelet count, prothrombin and kephalin-coalin time, as well as fibrinogen concentration) should be determined.

Biopsy: complications

Complications after the biopsyare rare, but the most frequently described are prolonged bleeding from the puncture site and the formation of a hematoma.

Biopsy: types

Fine Needle Aspiration (BAC)

Fine-needle aspiration biopsy is a diagnostic method, the essence of which is the collection of tissue-building cells for cytological examination. As the name suggests, it is made with a thin needle, about 0.5-0.6 mm in diameter. It is worth noting that this is not a test method on the basis of which a diagnosis of a disease, especially cancer, can be made. It is used as a preliminary method before more advanced diagnostic techniques. The result of fine-needle biopsy should be confirmed by histopathological examination of a specimen suspected of a proliferative process, before the introduction of treatment. The test may be performed on an outpatient basis.

  • Mileage BAC

After a thorough examination of the patient, the doctor must precisely locate the lesion that he or she wants to undergo diagnostics. When it is not available on palpation, the doctor often decides to use imaging diagnostic methods - ultrasound (ultrasound) or computed tomography (CT) and / or endoscopic examinations to accurately determine the injection site.

Ultrasound guided fine-needle aspiration biopsy is called fine-needle aspiration biopsy (FNAB). Using a sterile, disposable needle placed on the syringe, the tumor is punctured and the plunger of the syringe is pulled (aspiration is performed - hence the name) to collect the material for microscopic examination.

The test usually takes several seconds. After collecting the material, the punctured area should be pressed with a sterile gauze for several minutes in order to prevent the formation of a hematoma.

The obtained content is placed on a laboratory glass slide, cytological smears are made, fixed, for example in alcohol, or left to dry in the air and stained with specialized reagents. The specialist pathologist is responsible for the assessment of the obtained material.

Superficial lesions are usually punctured without local anesthesia, deeper lesions require additional anesthesia to ensure patient comfort during the examination. The waiting time for the biopsy result is approximately 7-14 business days.

  • Indications BAC

BAC is most often used in the diagnosis of tumors available for palpation, located in the mammary gland, lymph nodes, thyroid gland or salivary glands.

A doctor who has imaging methods such as CT or ultrasound canperform BAC under their control. It is then possible to puncture the lesions suspected to be cancerous located in deeper organs, such as the lungs, liver or mediastinal lymph nodes.

  • BAC biopsy - limitations

Fine needle aspiration biopsy is a diagnostic method that enables the cytological evaluation of cells. On the basis of it, the doctor is not able to describe the structure and structure of the entire tissue of the lesion.

It happens that the amount of material collected for the test is insufficient, and the test is non-diagnostic and should be repeated.

  • BAC: complications

Due to the fact that a very fine needle is used to collect the material, and usually under ultrasound guidance, complications after performing a fine-needle aspiration biopsy are very rare.

Core needle biopsy

Core-needle biopsy differs significantly from the fine-needle aspiration biopsy in terms of the material obtained during the examination. During a biopsy with a thick needle, a piece of tissue in the shape of a cylinder is obtained, which is then subjected to histopathological examination.

The doctor assesses the structure and structure of the entire tissue taken. However, during BAC, only a cell smear is obtained, which allows cytological evaluation of individual cells, but the tissue structure is not visible. On its basis, it is possible to diagnose neoplastic disease and its exact type and stage.

  • Core needle biopsy: course

The procedure of collecting material for the coarse-needle biopsy is analogous to the BAC, but a much thicker needle is used, therefore local anesthetics are usually used before starting the test.

The obtained material resembles a cylinder about 1 cm long and with a base diameter of about 1.5-4 mm (depending on the diameter of the needle used).

The pathologist fixes, stains and cuts the obtained tissue fragment with the use of specialized equipment, and then examines the structure and tissue structure of the acquired lesion.

Surgical biopsy

Surgical, or open, biopsy is a diagnostic method used much less frequently than fine-needle aspiration or core-needle biopsy.

It should only be performed after appropriate imaging tests and a FNAB or a biopsy with a thick needle have been performed and it is still not possible to determine the nature of the tumor.

The procedure is performed in an operating theater under local or general anesthesia. Please note that the procedure iswith many complications, therefore it should not be used routinely.

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Research