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A biopsy is a procedure that involves taking a tissue sample (e.g. an organ) or a piece of skin for a specialized laboratory test. Due to its high effectiveness in terms of diagnosis, it is very popular.
A biopsy is a medical procedure that involves taking a small sample of tissue so that it can be examined under a microscope. The tissue sample can be taken from anywhere on the body or in the body, including: skin, stomach, kidneys, liver, and lungs. The term biopsy is often used to refer to both the collection of the sample and the tissue sample itself.
Biopsies often help diagnose or rule out:
- tumors,
- peptic ulcers – ulcers affecting the digestive system,
- hepatitis,
- kidney disease
- endometriosis – the cells that normally line the uterus are found elsewhere in the body
- specific infections.
Also read: Biopsy without anesthesia. What’s next for young patients?
Indications for a biopsy
There are several basic indications for a biopsy. The first is the suspicion of a neoplastic lesion detected, for example, in the course of ultrasound or computed tomography. Secondly, a biopsy is also performed if there is swelling or infiltration. However, sometimes a biopsy is also ordered after blood tests that indicate suspected anemia or hepatitis.
Read: Safer perfusion computed tomography
Depending on the type of biopsy you are dealing with, it may be performed on an outpatient basis or may require a visit to the hospital. Before each procedure of this type, you should ask your doctor about it. This will allow you to prepare in terms of the time and possibly the things you need to take to the hospital with you.
Before the biopsy, you should also provide the doctor with all information about your health, and above all about whether you are taking medications that thin the blood and affect its clotting. These are the basic contraindications for such a procedure as a biopsy. They may affect the safety of sampling for testing.
Read: They cut because they want to earn – that is, the abuse of a surgical biopsy
Although imaging tests are helpful in detecting changes and / or areas of abnormalities, they cannot distinguish cancer cells from non-cancerous cells by themselves. For most cancers, the only way to make a definitive diagnosis is through a biopsy. Here are the types of biopsy:
- fine needle biopsy (FNA),
- core needle biopsy,
- percutaneous biopsy,
- endoscopic biopsy,
- surgical biopsy,
- brush biopsy,
- stereotaxic biopsy.
Fine needle biopsy (FNA) – is a simple and quick procedure. It is done to collect a sample of cells or fluid from a cyst or nodule so that the cells can be examined under a microscope. A local anesthetic is usually not required to perform a fine needle biopsy as the procedure should not be painful. Minor needle biopsies can be performed on palpable nodules (nodules that can be felt) or on non-palpable nodules that are detected by ultrasound or x-ray.
After cleaning the skin, a lump is examined at the needle entry point. If you feel a lump, your doctor or surgeon will touch it to align it with the needle. If the lump cannot be felt, imaging may be necessary to find the exact location.
This can be done with ultrasound where the surgeon will observe the needle on an ultrasound monitor and guide it to the area, or with a stereotaxic mammograph (for the breast) which uses two mammograms at different angles and a computer to create the exact coordinates.
Core needle biopsy – takes place under anesthesia and uses a thicker needle that allows you to take a section of the place where the cells are located next to the advanced tumor.
Percutaneous biopsy – this type of test is the most frequently performed procedure. It is divided into fine-needle and core-needle biopsy. The first one involves puncturing the examined area with a thin needle while remaining under the control of eyesight, ultrasound or a CT scanner. It does not require anesthesia and is used to detect, among others, thyroid nodules, liver disease, breast tumors, kidney and prostate problems, and problems with the heart muscle.
Endoscopic biopsy in turn, it is a procedure of collecting a fragment of a lesion within the digestive system, performed during colonoscopy or gastroscopy with the use of small forceps.
Surgical biopsy – during a surgical biopsy, the surgeon cuts the skin to gain access to the suspicious area of cells. Examples of surgical biopsy procedures include surgery to remove a breast lump for a possible diagnosis of breast cancer and surgery to remove a lymph node for a possible diagnosis of lymphoma.
Surgical biopsy procedures can be used to remove some of the abnormal area of cells (incision biopsy) or a surgical biopsy, which can be used to remove the entire area of abnormal cells (excision biopsy).
With this type of biopsy, local anesthesia may be given to numb the area of the biopsy. Some surgical biopsy procedures require general anesthesia. You may also need to stay in hospital for follow-up after surgery.
Brush biopsy – otherwise known as a brush swab, exfoliation swab, exfoliative biopsy. This type of biopsy involves collecting cellular (cytological) material using a special device that looks like a brush. It is used in situations when it is not possible to take a sample with forceps, e.g. from the bile ducts, bronchi, cervix.
Stereotactic biopsy – it is a type of fine-needle or core-needle biopsy performed under the control of a radiological examination. It consists in performing two projections of a radiological examination, which allows for spatial location (stereotaxia) of the lesion and precise insertion of a biopsy needle in it.
Liquid biopsy is a simple and non-invasive alternative to surgical biopsy. It allows you to obtain a wide range of information about the tumor with a simple blood sample. Tumor DNA traces in the blood may give clues as to which treatment is most likely to be effective in a particular patient.
A liquid biopsy test that can detect epidermal growth factor receptor (EGFR) gene mutations that occur in 10-35% of non-small cell lung cancer (NSCLC) patients will help doctors choose the right treatment for the right patient at the right time. Much of the early liquid biopsy research looked at lung, breast and prostate cancer, but this technology is expected to affect all types of cancer.
The non-invasive nature of liquid biopsies, which only require 5 milliliters of blood, means they are much easier to tolerate and the procedure is faster than a surgical biopsy. After the blood sample is collected, it is “centrifuged” to obtain 2 milliliters of plasma that can be analyzed for tumor DNA.
Tolerance and comfort are the main stimuli for patients. The greatest benefit is the potential of liquid biopsy to detect disease progression or treatment resistance long before clinical symptoms develop. Most cancers have many genetic mutations. Tissue samples taken for biopsy may not show all mutations, while liquid biopsies offer a better chance of detecting these genetic changes.
If you want to know more, read the “Holy Grail” of oncologists discovered. A simple blood test will help detect 10 types of cancer
Bone marrow biopsy – a bone marrow biopsy is usually performed if your doctor notices any abnormalities in the production of blood cells. Analysis of a bone marrow sample may reveal the cause of this problem.
This type of biopsy is also used to diagnose:
- unexplained anemia (lack of red blood cells)
- conditions of blood cells where too little or too many types of blood cells are produced, such as leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, pancytopenia and polycythemia
- iron deficiency,
- hematopoietic tissue tumors (leukemia, lymphoma),
- tumors that have spread to the bone marrow
- fever of unknown origin.
During a bone marrow biopsy, your doctor takes a bone marrow sample from the back of your hip bone with a long needle. In some cases, your doctor may perform a bone marrow biopsy from other bones in your body. Local anesthesia is given prior to the bone marrow biopsy to minimize any discomfort during the procedure.
See: What is the role of bone marrow?
Ovarian biopsy is the only method that determines whether the tumor that has formed on the ovary is malignant or benign. There are several types of biopsy. The following are most often used in the diagnosis of ovarian cancer:
- fine-needle aspiration biopsy (FNAB) – this test involves puncturing the organ under examination with a thin needle, which is inserted into the body cavities under ultrasound guidance under local anesthesia. The biopsy is usually preceded by other imaging tests (computed tomography, magnetic resonance imaging) in order to more accurately locate the tumor,
- open biopsy – this type of biopsy is done during surgery. The doctor can decide whether it is necessary to excise the entire tumor (excision biopsy) or if it is sufficient to excise only a part of the lesion (biopsy).
See Ovarian Cancer, The Silent Killer
Neoplastic diseases can appear at any age. For this reason, it is very important to perform the tests on a regular basis. We recommend a package of selected cancer markers for women to assess the risk of developing the disease.
A kidney biopsy is a procedure used to obtain a segment of kidney tissue, usually with a needle or other surgical tool. The two main types of kidney biopsy are percutaneous and laparoscopic / open biopsy. Percutaneous kidney biopsy is usually performed in patients who require simultaneous liver and kidney biopsy.
The indications for a kidney biopsy are:
- unknown cause of high proteinuria, hematuria, acute renal failure,
- systemic diseases (e.g. lupus erythematosus, vasculitis),
- primary glomerulonephritis,
- secondary glomerulonephritis,
- nephrotic syndrome.
A biopsy of a transplanted kidney is often performed repeatedly if rejection or other cause of deterioration of function is suspected.
Read: The Basis of Kidney Cancer Diagnosis
A cervical biopsy is a surgical procedure in which a small amount of tissue is removed from the cervical canal. This procedure is performed when an abnormality is detected during a routine gynecological examination or after an abnormal result is obtained from a cervical smear.
These may be signs of infection with the human papillomavirus (HPV) or the presence of pre-cancerous cells. Certain types of HPV can be a significant risk factor for cervical cancer. Your gynecologist may order this type of biopsy, also to help diagnose genital warts and polyps (non-cancerous growths) on the cervix.
There are three types of cervical biopsy:
- punch biopsy – in this method, small pieces of tissue are removed from the cervix with a tool called a ‘biopsy forceps’
- conization – large fragments of tissue in the shape of a cone are cut out using a scalpel or laser. This type of biopsy is performed under general anesthesia,
- Cervical curettage (ECC) – involves the collection of cells from the cervical canal using a hand tool with a tip shaped like a small scapula or hook, called a curette.
The doctor decides which type of cervical biopsy is best for the patient.
Read: Cervical cancer – how to win with it?
A lung biopsy is a procedure in which samples of lung tissue (with a special biopsy needle or during surgery) are taken to determine if there is lung disease or cancer. A lung biopsy can be performed using the closed or open method. Closed methods are performed through the skin or through the trachea (windpipe). An open biopsy is performed in an operating room under general anesthesia.
The types of lung biopsy include:
- needle biopsy – after administering local anesthesia, the doctor uses a needle that it is guided through the chest wall into the suspected area by means of computed tomography (computed tomography or computed tomography) or fluoroscopy (a type of x-ray ‘film’) to obtain a tissue sample. This type of biopsy may also be referred to as a closed, transthoracic, or percutaneous (through the skin) biopsy.
- bronchial biopsy – this type of biopsy is done with a fiber optic bronchoscope (a long, thin tube with a telescope with a closer focus at the end for viewing) through the main airways of the lungs (bronchoscopy).
- thoracoscopic biopsy – after administration of general anesthesia, the endoscope is inserted through the chest wall into the chest cavity. Various types of biopsy tools can be inserted through the endoscope to obtain lung tissue for examination. This procedure can be called video assisted thoracic surgery (VATS) biopsy. In addition to obtaining tissue for a biopsy, therapeutic procedures such as removal of a lump or other tissue damage may be performed.
The editors recommend: Lung cancer – the killer of Poles
Pancreatic biopsy is an invasive diagnostic method that is performed only when all other diagnostic measures have failed to identify a pancreatic tumor. Due to the advances in modern imaging techniques, fine needle biopsy of the pancreas under ultrasound, computed tomography or endosonography has become a reliable method for the diagnosis of ductal adenocarcinoma or any of the other rare pancreatic neoplasms with high sensitivity and specificity.
Complications are rare, especially with endosonographic biopsy. A new indication for biopsy is to show some markers or gene mutations that are needed to start special therapies.
Read: Pancreatic cancer – what are its symptoms?
After the biopsy, you shouldn’t overextend yourself. When taking organ samples, it is also recommended to stay lying down for several hours, which is why the patient often stays in the hospital or clinic.
Biopsy – possible complications
A biopsy is a test that is well tolerated by patients, although in rare cases it may cause specific complications. They include bleeding or damage to organs located within the punctured site.
Biopsy – interpretation of the results
After the physician obtains a tissue sample, it is then sent to the histopathology lab for analysis. The sample can be chemically treated or frozen and prepared for examination under the microscope.
The results help your doctor determine if there are cancer cells in a given sample. If the cells are cancerous, the biopsy results can help determine the type of cancer.
A biopsy also helps the doctor determine how aggressive the cancer is – the stage of the cancer. The grade is sometimes expressed as, a number on a scale of 1 to 4 and is determined by the appearance of the cancer cells under the microscope.
Low-grade (Grade 1) tumors are generally the least aggressive, and higher-grade (Grade 4) tumors are generally the most aggressive. This information can help you determine your exact treatment.