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BIOPSY

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drmithila's picture
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 A biopsy is a medical test commonly performed by a surgeon or an interventional radiologist involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When only a sample of tissue is removed with preservation of the histological architecture of the tissue’s cells, the procedure is called an incisional biopsy or core biopsy. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy.

Conditions identified with biopsies

[Cancer

Lung biopsy in a case of suspected lung cancer under control of computer tomography.
When cancer is suspected, a variety of biopsy techniques can be applied. An excisional biopsy is an attempt to remove an entire lesion. When the specimen is evaluated, in addition to diagnosis, the amount of uninvolved tissue around the lesion, the surgical margin of the specimen is examined to see if the disease has spread beyond the area biopsied. "Clear margins" or "negative margins" means that no disease was found at the edges of the biopsy specimen. "Positive margins" means that disease was found, and a wider excision may be needed, depending on the diagnosis.
When intact removal is not indicated for a variety of reasons, a wedge of tissue may be taken in an incisional biopsy. In some cases, a sample can be collected by devices that "bite" a sample. A variety of sizes of needle can collect tissue in the lumen (core biopsy). Smaller diameter needles collect cells and cell clusters, fine needle aspiration biopsy.[3]
Pathologic examination of a biopsy can determine whether a lesion is benign or malignant, and can help differentiate between different types of cancer. In contrast to a biopsy that merely samples a lesion, a larger excisional specimen called a resection may come to a pathologist, typically from a surgeon attempting to eradicate a known lesion from a patient. For example, a pathologist would examine a mastectomy specimen, even if a previous nonexcisional breast biopsy had already established the diagnosis of breast cancer. Examination of the full mastectomy specimen would confirm the exact nature of the cancer (subclassification of tumor and histologic "grading") and reveal the extent of its spread (pathologic "staging").
[edit]Precancerous conditions
For easily detected and accessed sites, any suspicious lesions may be assessed. Originally, this was skin or superficial masses. X-ray, then later CT, MRI, and ultrasound along with endoscopy extended the range.
[edit]Inflammatory conditions
This section requires expansion.
A biopsy of the temporal arteries is often performed for suspected vasculitis. In inflammatory bowel disease (Crohn's disease and ulcerative colitis), frequent biopsies are taken to assess the activity of disease and to assess changes that precede malignancy.[4]
Biopsy specimens are often taken from part of a lesion when the cause of a disease is uncertain or its extent or exact character is in doubt. Vasculitis, for instance, is usually diagnosed on biopsy.
Kidney disease: Biopsy and fluorescence microscopy are key in the diagnosis of alterations of renal function. The immunofluorescence plays vital role in the diagnosis of Crescentic glomerulonephritis.
Infectious disease: Lymph node enlargement may be due to a variety of infectious or autoimmune diseases.
Metabolic disease: Some conditions affect the whole body, but certain sites are selectively biopsied because they are easily accessed. Amyloidosis is a condition where degraded proteins accumulate in body tissues. In order to make the diagnosis, the gingival.
Transplantation: Biopsies of transplanted organs are performed in order to determine that they are not being rejected or that the disease that necessitated transplant has not recurred.
Fertility: A testicular biopsy is used for evaluating the fertility of men and find out the cause of a possible infertility, e.g. when sperm quality is low, but hormone levels still are within normal ranges.[5]
[edit]Biopsied sites

Location Description
Bone marrow biopsy Since blood cells are formed in the bone marrow, a bone marrow biopsy is employed in the diagnosis of abnormalities of blood cells when the diagnosis cannot be made from the peripheral blood alone. In malignancies of blood cells (leukemia and lymphoma) a bone marrow biopsy is used in staging the disease. The procedure involves taking a core of trabecular bone using a trephine, and then aspirating material.
Gastrointestinal tract Flexible endoscopy enables access to the upper and lower gastrointestinal tract, such that biopsy of the esophagus, stomach and duodenum via the mouth and the rectum, colon and terminal ileum are commonplace. A variety of biopsy instruments may be introduced through the endoscope and the visualized site biopsied. Until recently, the majority of the small intestine could not be visualized for biopsy. The double-balloon “push-pull” technique allows visualization and biopsy of the entire gastrointestinal tract.[6]
Needle core biopsies or aspirates of the pancreas may be made through the duodenum or stomach.[7]
Lung biopsy Biopsies of the lung can be performed in a variety of ways depending on the location.
Liver biopsy In hepatitis, most biopsies are not used for diagnosis, which can be made by other means. Rather, it is used to determine response to therapy which can be assessed by reduction of inflammation and progression of disease by the degree of fibrosis or, ultimately, cirrhosis.
In Wilson's disease, the biopsy is used to determine the quantitative copper level.
Prostate biopsy Forms include transrectal biopsy and transurethral biopsy
Nervous system biopsy Forms include brain biopsy, nerve biopsy, and meningeal biopsy
Urogenital biopsies Forms include renal biopsy, endometrial biopsy and cervical conization
Other Other sites include breast biopsy, lymph node biopsy, muscle biopsy, and skin biopsy
 

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drmithila's picture
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BIOPSY

 The word biopsy originates from the Greek terms bios
(life) and opsis (vision): vision of life. A biopsy consists of
the obtainment of tissue from a living organism with the
purpose of examining it under the microscope in order to
establish a diagnosis based on the sample (1).
The technique allows us to establish the histological characteristics of suspect lesions, their differentiation, extent
or spread, and to adopt an adequate treatment strategy.
Biopsies establish evolutive control of disease processes, and
are able to document healing or relapse. In turn, the biopsy
findings are of irrefutable legal medical value (2,3).
A biopsy is indicated in application to any lip or oral
mucosal lesions following the exclusion of local irritants
(of traumatic or inflammatory origin), when the lesions in
question are seen to persist for more than two weeks, and
may be suggestive of malignancy (1,4). In general, lesions
appearing in the oral mucosa should be explored and evaluated for the possible presence of local irritative factors. If
such factors are identified, they must be eliminated, after
which an observation period of approximately 15-20 days is
indicated. After this period of time, and if the lesions persist, histopathological study is required to discard possible
malignancy (3). Such a study is also indicated in the case
of radiotransparent bone lesions presenting radiological
features suggestive of malignancy - even when such features constitute casual findings in the course of a routine
radiological study.
All maxillary cysts, and particularly keratocysts, must also
be processed for histological studyA biopsy is also indicated in the case of bone lesions accompanied by pain, sensitivity alterations or other symptoms, and in application to bone lesions showing important
changes or rapid expansion as evidenced by successive
radiological evaluations.
A biopsy is also required of those oral mucosal surfaces
that show important and persistent color changes (becoming very white, red or pigmented) or changes in appearance
(cracking, proliferation or ulceration), with deep-lying hard
masses detected upon palpation.
Likewise, evaluation is required of premalignant mucosal
lesions or states such as lichen planus or leukoplakia, in
persistent atrophic-erosive areas (4).
A biopsy is also very useful for the detection of certain systemic illnesses requiring histological confirmation in order
to establish the definitive diagnosis, e.g., lupus, amyloidosis,
scleroderma, or Sjögren’s syndrome - which can be confirmed by an oral tissue biopsy. As an example, confirmation
of Sjögren’s syndrome requires the obtainment of a sample
of the lesser salivary glands of the lips (1,3,4).
A biopsy is also used as complement in the diagnosis of
certain disorders of infectious origin, such as lesions suggestive of syphilis or tuberculosis, based on an oral sample
- though prior confirmation of the positivity of tests specific
of such disease processes is required.
Another indication for biopsy is confirmation of the diagnosis of blister lesions, in mucocutaneous diseases affecting
the oral mucosa, such as vulgar pemphigus or cicatricial
pemphigoid.
Benign tumors, with the exception of those of a vascular
nature, are to be removed, sending the entire sample for
histopathological study to determine the histological origin
of the lesion, after establishing a tentative diagnosis (4).
On the other hand, a biopsy is contraindicated in veryseriously ill patients, in those subjects with some systemic
disorder that may worsen, or where secondary complications
may develop (4).
Likewise, a biopsy should be avoided in the case of lesions
located in very deep regions or in areas of difficult access
where the surgical technique proves complicated or hazardous, with the risk of damage to neighboring structures. In
such cases the patient should be referred to a specialist. The
same considerations apply in the case of suspected vascular
lesions such as hemangiomas, due to the risk of massive and
persistent bleeding (1,5).
Biopsy is not advised in the case of multiple neurofibromas,
due to the risk of neurosarcomatous transformation, or in
tumors of the greater salivary glands. Such biopsies must
be performed by specialized surgeons, in order to avoid
damaging nearby anatomical structures and causing the
spread of tumor cells, as this would adversely affect the
prognosis (1).
In turn, a biopsy would be needless in application to banal
irritative lesions or normal anatomical variants such as
physiological gingival pigmentation, geographic tongue,
linea alba, lingual indentations, protuberances, exostosis,
etc

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DrPatel's picture
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BIOPSY

What is a Biopsy?

A biopsy is often recommended following a consultation on the clinic.

It is a simple procedure that provides tissue for the histopathologists to discover the presence, cause or extent of a disease.

The procedure is carried out under local anæsthetic, that is, you will be awake and have an injection to numb up the tissue in question. You will have stitches at the biopsy site that dissolve over the next 10 – 14 days. You can expect some discomfort and possibly swelling afterwards. These will settle over the next few days.

The whole process should take less than 30 minutes.

There are two types of biopsy:

Excisional Biopsy

Where the biopsy aims to remove an area completely. This is usually only appropriate for small lumps or swellings.

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DrPatel's picture
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BIOPSY

Incisional Biopsy

Occasionally, only a small piece of an abnormal area is removed to confirm a diagnosis.

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DrPatel's picture
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BIOPSY

How is it done?

A local anæsthetic injection is used to numb the area which
takes a couple of minutes to work. After this injection, the
procedure should be painless. The biopsy usually leaves a
small hole that often requires stitching. In the majority of
cases the stitches used are dissolvable and take around
two weeks to disappear.

All together, this procedure usually takes around 15 - 20
minutes from start to finish.

Before Your Appointment

No special precautions have to be taken before your
biopsy. Make sure you take your medications as normal.

Please eat and drink as normal prior to your appointment
and DO NOT miss meals.

After Your Appointment

Following the procedure, the doctor will instruct you on how
to keep yourself comfortable over the next few days.

The biopsied area will be sore and any discomfort can be
controlled by pain-killers such as paracetamol or ibuprofen.

You will be able to eat and drink as normal immediately
after the biopsy but avoid anything too hot for the first 24
hours. Try not to either spit out or rinse out the mouth and
do not do any physical exertion for the next 24 hours as
this can make the swelling worse or dislodge the blood
clot at the site of operation encouraging more bleeding.

Use either a hot salty mouthwash or an antiseptic
mouthwash such as Corsodyl, for the next few days,
starting 24 hours after the procedure. This should lessen
the chance of infection at the biopsy site and hasten the
biopsy site’s healing.

Results

If the lump or bump that is being biopsied looks to be a
well-recognised or common lump or bump, we won’t
necessarily review you on clinic but will send the biopsy
results to you.

In other cases, you will normally be given a review
appointment for the biopsy results to be discussed
approximately 3 – 4 weeks after the biopsy.

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BIOPSY

 

 

 

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Drsumitra's picture
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BIOPSY

HOW tO PERFORM AN ORAL bIOPSY
The materials and instrumentation required to perform an
oral biopsy are not particularly sophisticated. The necessary
instruments are limited to those commonly employed in
surgery, such as a buccal mirror, exploratory probe, toothless
dissection forceps, mosquito forceps, scalpel handpiece and
number 15 blade, syringe for anesthesia, pressure forceps,
scissors, periostotome, separators, needle carriers and suture mounted needles. For bone biopsies we can use gubia
forceps, a chisel and mallet, a motor-driven handpiece with
drills, and curettes.
As to the required material, an ejector, gauze, sterile gloves
and a plastic or glass bottle containing 10% formalin solution is advised (3).
As with any surgical procedure, a biopsy requires due
sterilization of the instrumentation and disinfection of the
surgical field.
Most target lesions are found in soft tissues such as the
tongue, cheek mucosa or lips, or in more adhered regions
such as the palate and gums. Anaesthesia with a vasoconstrictor to minimize bleeding should not be applied in the
actual biopsy target zone but rather at a certain distance, to
avoid alterations. Thus, injection should be performed with
a separation of 3-4 mm, and at the four cardinal reference
points (top, bottom, left and right).
The specimen should be obtained by means of a clean
and deep cut, taking care in extraction to avoid tearing or
compression, as this could cause alterations. In excisional
biopsies, the lesion is to be palpated carefully, determining
its depth, and the incisions should slightly exceed the total
depth of the lesion. In incisional biopsies, any depth within
the lesion allowing the obtainment of sufficient material for
study is considered acceptable. The incision should include a
significant portion of the suspect tissue, though also a part
of adjacent normal tissue (19).
The wound margins are subjected to debridement, with
control of bleeding, and the lips of the wound are joined
with suture. When a sample of gingival tissue or palate is
obtained, and closure of the incision proves difficult, it can
be left to heal by second intention. Oxidized and regenerated
cellulose can be applied, together with gauze impregnated
with tranexamic acid, to avoid bleeding (8).
After obtaining the sample, washing with physiological
saline is indicated, followed by fixation. Sample processing begins once the specimen has been obtained, with the
purpose of allowing tissue study under magnification. The
steps comprise fixation, cutting into fragments or blocks,
embedding, sectioning, staining and examination. The most
common procedure is staining with hematoxylin-eosin, followed by examination under the light microscope (1).
Light microscopic studies generally involve the use of 10%
formaldehyde solution in water; the concentration must be
sufficient to ensure correct fixation of the tissue.
If prolonged storage of the specimens is contemplated, we
can use Bouin fixating medium, which remains stable over
time. The tissue sample is to be left in the fixating solution
for 2-10 hours, depending on its thickness. It is then washed
for 24 hours and finally immersed in 80º alcohol for posterior dehydration, clearance or embedding. The formula
for preparing Bouin medium is as follows: 1.4% picric acid
aqueous solution (150 ml), commercial formalin solution
(50 ml) and glacial acetic acid (19 ml)(3).
Other simple fixing fluids can also be used, such as picric acid,
acetic acid, chromic acid, potassium dichromate, mercury
chloride, cadmium chloride, osmium tetraoxide (osmic acid),
acetone or 70% alcohol - though the latter sharply dehydrates
the tissues, causing artifacts, complicating epithelial staining
and poorly fixing the connective tissue elements (3).
On the other hand, for electron microscopic preparations,
the specimen is immersed in 3% glutaraldehyde in the refrigerator for 24 hours, followed by transfer to a 0.1 M buffer
solution until study (3).
Oral cavity biopsies can give rise to complications, though in
most cases such problems can be minimized by making use
of a careful surgical technique. Bleeding may occur in the
first 24 hours after the procedure, as a result of clot disruption during the early healing period, or secondary to suture
loosening. Minor bleeding responds to local pressure application, while more important bleeding requires ligation,
cauterization or the closure of some bleeding point (11).
Dehiscences are infrequent, however. Such problems may
develop 5-8 days after biopsy. The implicated local factors comprise bleeding, infection, excess suture material
or excessively tightened sutures that tend to strangle local
vascularization (11).
On the other hand, infection is also rare and is attributable
to a deficient surgical technique. Treatment in such situations consists of drainage of the infectious material, and
antibiotic medication.
Another possible complication of oral biopsies is sensory
impairment. This type of problem may result from a defective surgical technique, and can be avoided. Sensory defects
are secondary to sensory nerve damage during the biopsy
procedure. The symptoms are paresthesia of variable intensity that can persist for hours or even several months,
depending on the magnitude of the damage caused (11).
The pathologist must be duly informed of the identifying
data of the biopsied lesion, i.e., its macroscopic appearance,
and the zone in which it is located.
The specimens obtained with oral biopsy procedures are
typically small, and the risk of artifacts is considerable.
These artifacts, which are sometimes seen under the microscope, may pose a problem for establishing a correct
histopathological diagnosis.
Biopsy artifacts are due to defective sampling techniques,
problems during transport, or incorrect processing of the
tissue in the laboratory.
A small sample usually consists of a narrow strip of delicate
mucosa, which tends to fold onto itself during fixation.
When this happens, the junction between the epithelial and
connective tissue components is usually lost - particularly
if the specimen lacks an underlying submucosal or muscle
tissue layer.
On one hand, when the tissue is removed with excessive
force, the epithelium and connective component may suffer
important damage. The forceps used to grasp the specimen
may perforate the latter, leaving gaps and creating compression zones around the tissue (20-22).
On the other hand, the heat generated by an electroscalpel
gives rise to alterations such as tissue protein coagulation
- resulting in an amorphous epithelial and connective tissue
appearance. In such situations the epithelial cells become
fusiform and hyperchromatic (18,21). Some authors recommend combination of an electroscalpel and conventional
scalpel. The technique in this case consists of application of
the conventional scalpel for incision around the target lesion,
with use of the electroscalpel to complete tissue removal.
This approach affords increased hemostasia and reduces
the amount of heat generated. However, the electroscalpel
is generally not advised, and when it is used, a marginal
incision should be made at a good distance from the tissue
sampling zone, in order to avoid heat-induced changes in
the target area.

 

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Drsumitra's picture
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BIOPSY

 ). Freezing during transport should also be avoided, since
cytoplasmic condensation has been described, secondary to
cell dehydration as a result of freezing. Interstitial vacuoles
form, together with vacuoles within the cell cytoplasm, due
to ice crystal formation (22).
Ficarra et al. (21) recommended the following protocol
to avoid possible artifacts during the surgical procedure:
Firstly, good clinical judgment is required for selecting
the best area for biopsy. Sufficient tissue must then be obtained with care, avoiding sample compression or traction.
The sample thus obtained must be fixed immediately. The
fixation bottle must be labeled with water-proof tape, and
using a pencil for writing. Each specimen is to be placed in
a separate bottle or container, with due identification of the
different zones involved.
Posteriorly, the pathology laboratory will issue a report,
identifying the material and providing details (macroscopic
identification), a description of the study made, the final
histopathological diagnosis, and other comments (3).
The pathologist thus may prepare the report in three different ways: certainty diagnosis, incompatibility diagnosis,
or orientative diagnosis.
The certainty diagnosis is a true histopathological diagnosis.
This diagnosis is stated when the findings are pathognomonic of a given type of lesion. If possible, tumor disease
should specify tumor extension to the resection margins,
including depth and infiltration, and the histological malignancy grade.
On the other hand, a diagnostic incompatibility report
is issued when no lesions typical of a given disease entity
have been observed. In these situations we must check that
sampling and processing have been correct in both amount
and location. In some cases there may be a previous test
yielding a negative diagnosis, and the biopsy specimen in
these cases serves to check the possible presence of positive
lesions (24).
In contrast, the diagnosis in some cases is merely orientativeand must be interpreted in close correlation to the clinical
data and the findings of other complementary tests. In such
cases the diagnosis is said to be compatible or suggestive of
a concrete disease entity.
Finally, in some cases the pathologist is unable to draw any
conclusions, and the resulting report is of a merely descriptive nature (1

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drmithila's picture
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BIOPSY

Researchers are constantly finding new ways to figure out what makes us human beings tick, and one of the newer methods makes you want to spit -- literally. Saliva is full of analytes and biomarkers that create a biological journal of exposure to chemicals and disease, and genetic variability. However, the collection of oral fluid has always proved cumbersome, with researchers depending on swabs or collection cups.
A new tool developed by the Johns Hopkins University School of Nursing (JHUSON) Center for Interdisciplinary Salivary Bioscience Research (CISBR) in collaboration with SalivaBio, LLC, will improve the ease of oral fluid collection, while maintaining the integrity of the biospecimen.
"Our studies show that swabs used to collect saliva can retain analytes, cause interference with assays, result in inaccurate estimates of saliva flow rates, and may even produce inaccurate assay results," notes Douglas A. Granger, PhD, Director of CISBR and professor of Medicine, Nursing, and Public Health at Hopkins.
The new Whole Saliva Collection Device -- available for use in February -- is a small, polypropylene collection tube with an integral adapter that comes individually wrapped in a clean, foil pouch with ready-to-go instructions, and is a universal fit with common cyro vials. "It's not rocket science," Granger says, "it's a practical solution that will enable saliva analytes to be integrated effectively into basic and clinical studies and consumer applications."

 

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BIOPSY

CDx Diagnostics has released data that support the company's WATS3D (wide-area transepithelial sample biopsy with 3D analysis) as an additional surveillance tool to increase detection of dysplasia and Barrett's esophagus.

The WATS3D biopsy collects a wide-area, disaggregated tissue specimen of the thickness of the suspect epithelium, according to the company. The tissue specimen is then subjected to computer-assisted 3D analysis to pinpoint potentially abnormal cells for presentation to a pathologist.

 

The retrospective, multicenter study, led by Seth A. Gross, MD, of the New York University (NYU) School of Medicine and NYU Langone Medical Center, found that WATS3D increased detection yield of Barrett's esophagus by 20% (p < 0.05). In three sites that had more than 30 WATS3D tests performed or had onsite assistance, the increased detection yield of Barrett's esophagus was an average of 46% (p < 0.05, n = 75).

Esophageal cancer is now the fastest growing form of cancer in the U.S. Early detection is particularly difficult because dysplasia in Barrett's esophagus is often inconspicuous, flat, and patchy in distribution.

 

 

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