biopsy

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Key Terms: Contrast agent, Excision, Incision, Platelets.

Definition

Biopsy is a diagnostic procedure in which a piece of tissue and/or cells are removed to be examined under a microscope by a pathologist.

Purpose

Biopsies are performed to determine the presence of cancer cells, establish tumor grading, and provide more information for treatment.

Precautions

Most biopsies should not be done on patients with blood clotting problems. If the patient has a low blood platelet count, a platelet transfusion can be given as a temporary relief measure, and a biopsy can then be performed. The physician should be notified of any bleeding problems—as well as any allergies, current medications, or pregnancy—well in advance.

Patients receiving IV sedation for a biopsy procedure will continue to feel drowsy for several hours, and should refrain from cooking, driving, or operating any equipment that requires careful attention. A ride home from the clinic should be arranged in advance.

Description

There are several different types of biopsies, and the decision on which one is most effective depends on where the tumor is located and the general health of the patient. Four common categories of biopsy are fine needle aspiration, core needle biopsy, excisional biopsy, and incisional biopsy.

Fine Needle Aspiration Biopsy

Fine needle aspiration biopsy, also known as suction biopsy or needle aspiration biopsy, involves applying negative pressure through the use of a syringe and hollow, hypodermic needle. This type of biopsy is often used as a diagnostic procedure on neck and thyroid masses. It results in the removal of tissue that is fragmented into cells, as opposed to one sample of undamaged tissue. Fine needle aspiration biopsy is a frequently performed procedure that results in minimum discomfort and is less costly than many other types of biopsy.

Core Needle Biopsy

Core needle biopsy, also known as wide-core needle biopsy or cutting core biopsy, involves the use of a large-bore needle and is the simplest method of pathologic diagnosis of cancer. It results in minimal disturbance of surrounding tissues and a solid, intact sample. Tumors located in the liver and breast are commonly biopsied with this technique.

Incisional Biopsy

This refers to the removal of part of the tumor from the larger tumor mass. An incisional biopsy is employed for tumors located deep within the body and after an initial needle biopsy has failed to supply enough tissue for diagnosis. Biopsies of this type are the preferred technique for diagnosing soft tissue cancers and osteosarcomas.

Excisional Biopsy

Also known as surgical biopsy, the excisional biopsy entails the surgical removal of the entire tumor mass and is a diagnostic technique that simultaneously serves as a treatment. For example, a lumpectomy removes the entire primary tumor mass associated with breast cancer. Excisional biopsy is also useful for diagnosing and removing surface tumors of the skin, such as those associated with squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.

Preparation

Many biopsies can be performed in the doctor's office or in the hospital on an outpatient basis. Most do not require much special preparation on the part the patient, but patients should ask their physician for special instructions. Prior to the procedure, most require the use of anesthesia. Prior to and during a biopsy, special imaging techniques may be employed to assist in locating the tumor and guidance of biopsy procedures using a needle. Such imaging techniques include computed tomography scan (CT guided biopsy), fluoroscopy, magnetic resonance imaging (MRI), nuclear medicine scan, and ultrasound (ultrasound guided biopsy). Patients who undergo imaging scans may be injected with or asked to drink a contrast agent (dye) prior to biopsy.

Fine Needle Aspiration Biopsy

Some routine blood work (blood counts, clotting profile) should be completed two weeks prior to biopsy.

Patients may be asked not to eat for a specified time before the procedure. Those taking blood thinners (anticoagulants) or aspirin should talk to their physicians about whether they should discontinue using them prior to biopsy.

Core Needle Biopsy

Women undergoing breast biopsy should not wear talcum powder, deodorant, lotion, or perfume under their arms or on their breasts on the day of the procedure (since these may cause image artifacts or other problems). A comfortable two-piece garment should be worn. Patients may be asked not to eat for a specified time before the procedure. Those taking blood thinners or aspirin should talk to their physicians about whether they should discontinue using them prior to core needle biopsy.

Incisional Biopsy

Patients should follow instructions provided by their doctor and give notification of any allergies. Those expecting general anesthesia should not eat or drink for at least 8 hours before an incisional biopsy. Patients should also bathe thoroughly before the procedure and allow time to rest afterward.

Excisional Biopsy

Patients may be asked to: sign a consent form allowing the physician to perform this test; refrain from eating or drinking for at least 8 hours prior to surgery; and arrange for a ride home from the hospital (most patients can go home on the same day as the surgery). Those taking insulin, aspirin, non-steroidal anti-inflammatory drugs, or any medicines that affect blood clotting should notify their doctor well before the procedure.

Aftercare

Fine Needle Aspiration Biopsy

After the biopsy, patients should be able to drive home, return to work, or perform any other routine activity. This biopsy does not affect medication schedules.

Core Needle Biopsy

Most patients can resume normal activities right after the biopsy. If there is excessive redness, pain, or drainage from the puncture site, patients should call their doctor immediately.

Incisional Biopsy

After recovering from anesthesia, the patient will be observed for a few hours before returning home. During this time, an analysis may come back from the lab and the doctor may explain the nature of the abnormality. This analysis is the result of only one test and will not be 100% accurate. In about two days, lab testing should be complete. Patients should call their doctor immediately if there is drainage from the wound or a fever develops.

Excisional Biopsy

Depending on the invasiveness of the procedure, the patient may receive varied instructions for aftercare. The incision site should be kept clean, dry, and free of lotion, medication, or ointments. The patient may be required to remain in a certain position until sufficient time has passed to warrant the release of the patient from medical care. For example, patients are required to remain on their right side for approximately four hours to allow for healing to occur after a liver punch biopsy. Some patients, however, may be able to return to normal activities on the same day. Those who develop a fever, or notice bleeding, drainage, strong pain, or redness and warmth at the biopsy site should contact their doctor immediately.

Risks

Although most biopsies end with success, there are a certain number of risks to keep in mind. For example, complications can arise if other organs are nicked during a biopsy using a long needle. As with any procedure, there is a slight risk of allergic reaction to anesthesia. To be well informed, patients should consult with their physician about the risks prior to undergoing the procedure.

Fine Needle Aspiration Biopsy

This biopsy poses no significant risks. Some minor bleeding may occur and some patients report a mild, dull, and throbbing sensation in the area of the biopsy, which usually subsides within 30 to 60 minutes. The risk of infection exists any time the skin is penetrated, but is extremely rare with this procedure. The error rate of diagnosis, however, is substantially higher than that of other biopsy procedures; major surgical resections should not be undertaken solely on the basis of the evidence of aspiration biopsy.

Core Needle Biopsy

A lumpy scar called a keloid may form in the area of puncture. Infection and bleeding may also occur at or under the biopsy site; however, this risk is uncommon. Core needle biopsy, like fine needle aspiration, only removes samples of a mass and not the entire area of concern. Therefore, it is possible that a more serious diagnosis may be missed by limiting the sampling of an abnormality.

Incisional Biopsy

A keloid may form in the incision area. In rare cases, infection and bleeding may occur.

Excisional Biopsy

Some patients may experience infection, bleeding, or bruising around the biopsy site. The physician should be consulted about any risks that may be related to a patient's medical history.

Normal Results

The tissue sample obtained from the biopsy needs to be prepared for examination by a pathologist, and results usually are reported to the patient within a few days of the procedure. Normal (negative) results indicate that no malignancy is present.

Abnormal Results

Abnormal results indicate that a malignancy or other abnormality is present. In some cases, results are indeterminate and patients are subject to further diagnostic procedures.

Resources

Books

Bast, Robert C., et al. Cancer Medicine. 5th ed. Hamilton, ON: B.C. Decker Inc., 2000.

Other

"An Alternative to Excisional Breast Biopsy: Core Needle Breast Biopsy." Washington Radiology Associates. [cited June 25, 2001]. .

Harvard Health Online. [cited June 25, 2001]. .

National Cancer Institute. [cited June 25, 2001]. .

Questions to Ask the Doctor

• Why is this particular type of biopsy being performed?
• Is there another type of biopsy that can be used?
• What are the risks associated with the biopsy?
• What level of discomfort is expected?
• Are there any special preparations associated with the biopsy?
• Are there any aftercare requirements?
• When are the results expected?
• Should a return visit be scheduled?

—Sally C. McFarlane-Parrott

A piece of tissue taken from a patient during life to establish a precise diagnosis so that the most appropriate treatment can be initiated. Usually a thin section of the specimen on a glass slide is examined by a pathologist under a microscope, but if the specimen is small and soft it may be more appropriate to make a smear on the slide. On occasion the biopsy may require to be examined biochemically. Biopsies may also be taken, for example, from chorionic villi (the projections of fetal tissue around the early embryo after it is embedded in the womb) for chromosomal analysis when a hereditary disorder is suspected.

The technique of biopsy is vital in all branches of medicine. Various methods are used. The simplest is a scraping from an accessible site such as the skin, or from a mucous membrane, such as in the mouth or the cervix of the womb. One of the commonest is a needle biopsy when a small sample is sucked out into some type of syringe through a needle of a calibre appropriate to the consistency of the tissue. This method is applicable to obtaining tissue from the breast, kidney, liver, brain, or heart.

In other situations a lesion is biopsied by a surgeon either at an operation undertaken just for that purpose, or in the course of an exploratory procedure. Often only part of the lesion being investigated is taken at operation — an incisional biopsy, but if the lesion is small, such as an ulcer, a pigmented spot on the skin, or a lymph node it may be removed in its entirety: an excision biopsy. Procedures of this type involve the use of a scalpel. Other instruments may be appropriate: a curette is used to take scrapings from the inner lining of the womb (the endometrium) ; small biopsies may be obtained by endoscopy — from the lungs during bronchoscopy, or from the lining of the stomach or colon. Occasionally specially designed instruments are used, in the form of ‘punches’ or ‘brushes’.

One of the commonest reasons for undertaking a biopsy is to establish whether a tumour is malignant or benign. A common example of this is the investigation of a lump in a woman's breast. In such circumstances the pathologist often undertakes an immediate microscopical examination while the patient is still in the operating theatre, the surgeon waiting for the result before deciding how extensive an operation is required. This is also a common procedure during operations for tumours of the brain, or for cancers in other sites when lymph nodes need to be examined to establish whether or not they have been invaded by malignant cells.

Apart from the assessment of malignancy, biopsies are taken to examine organs such as the liver or kidneys for evidence of intrinsic disease, or to look for any signs of rejection of a transplanted organ such as a kidney or a heart.

Needle biopsies of skeletal muscles are often taken because of the problems frequently encountered in distinguishing clinically among conditions caused by disease in the muscle itself (myositis, muscular dystrophy) and those secondary to an abnormality in its nerve supply.

Healthy individuals are not always exempt — for example they may be recruited as volunteers for muscle biopsy. Enthusiasm for competitive sport and interest in the health-promoting effects of exercise in recent decades have provided an increasing incentive (and funds) for improving knowledge about skeletal muscle and the effects upon it of various training and dietary regimes. Needle biopsy of muscles has become a standard component of investigations in major research laboratories for sport and exercise science.

— J. Hume Adams

See also cancer; muscle; neoplasm; transplantation.

Removal and examination, usually microscopic, of tissue from the living body. Biopsies are usually done to determine whether a tumor is malignant or benign; however, a biopsy may be a useful diagnostic aid in other disease processes such as infections.

• aspiration b. — biopsy in which tissue is obtained by application of suction through a needle attached to a syringe.
• bite b. — instrumental removal of a fragment of tissue.
• bone marrow b. — obtaining a sample of bone marrow, usually by needle aspiration, from a long bone, rib or sternum, for cytological examination.

  Needle aspiration of bone marrow. By permission from Ettinger SJ, Feldman E, Textbook of Veterinary Internal Medicine, Saunders, 2004

• brush b. — removal of cells and tissue fragments using a brush with stiff bristles (introduced through an endoscope). Effective in obtaining tissue samples from inaccessible places such as the renal pelvis.
• closed b. — one carried out without access through an open incision such as a laparotomy. An example is a percutaneous, fine needle aspirate.
• cone b. — biopsy in which an inverted cone of tissue is excised, as from the uterine cervix.
• cytological b. — obtaining specimens of cells by various methods including irrigation of a hollow tube.
• b. dart — an alternative to immobilization of large and wild animals; a dart which cuts a skin bipsy, then falls out. Limited to use for superficial lesions.
• endoscopic b. — removal of tissue by appropriate instruments through an endoscope.
• excisional b. — biopsy of tissue removed from the body by surgical cutting.
• exploratory b. — a combination of exploratory surgery to determine size and location of a lesion and the taking of a biopsy.
• fine needle b. — see needle biopsy (below).
• hepatic b. — may be by transperitoneal incision, more commonly by percutaneous needle or trocar and cannula technique.
• incisional b. — biopsy of a selected portion of a lesion.
• needle b. — biopsy in which tissue is obtained by puncture of a tumor, the tissue within the lumen of the needle being detached by rotation, and the needle withdrawn.
• punch b. — see punch biopsy.
• Robson–Heggers b. — a procedure for the collection of a piece of tissue from an infected wound in order to determine the extent and the nature of the infection.
• sternal b. — biopsy of bone marrow of the sternum removed by puncture or trephining (see also sternal puncture).
• surface b. — sample of cells scraped from the surface of a lesion or obtained by impression smears.
• surgical b. — one obtained during a surgical procedure.
• synovial b. — by a needle biopsy technique or through an arthrotomy incision using special forceps for a bite biopsy.
• total b. — obtained by removal of the entire lesion. May be for therapeutic as well as diagnostic purposes.
• ultrasound-guided b. — use of ultrasonography to guide the passage of a needle or biopsy instrument into an internal organ or lesion.

The removal of a tissue specimen or other material from the living body for microscopic examination to aid in establishing a diagnosis.

• Procedures - biopsy: removal of small piece of tissue for microscopic examination and diagnosis, esp. for cancer

Biopsy
Intervention
Brain biopsy
ICD-10-PCS	0?D???X (without force), 0?B???X (with force)
MeSH	D001706
OPS-301 code:	1-40...1-49 (without incision) 1-50...1-58 (with incision)

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.

Contents 1 Etymology 2 History 3 Conditions identified with biopsies 3.1 Cancer 3.2 Precancerous conditions 3.3 Inflammatory conditions 4 Biopsied sites 5 Analysis of biopsied material 6 See also 7 References 8 External links

Etymology

Biopsy is of Greek origin, coming from the words bio, meaning life, and opsia, meaning to see.

French dermatologist Ernest Besnier introduced the word “biopsy” to the medical community in 1879.^[1]

History

This section requires expansion.

One of the earliest diagnostic biopsies was developed by the Arab physician Abulcasim (1013–1107). A needle was used to puncture a goiter, and the material issuing was characterized.^{[2][verification needed]}

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").

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.

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]

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

Analysis of biopsied material

After the biopsy is performed, the sample of tissue that was removed from the patient is sent to the pathology laboratory. A pathologist is a physician who specializes in diagnosing diseases (such as cancer) by examining tissue under a microscope. When the laboratory (see Histology) receives the biopsy sample, the tissue is processed and an extremely thin slice of tissue is removed from the sample and attached to a glass slide. Any remaining tissue is saved for use in later studies, if required. The slide with the tissue attached is treated with dyes that stain the tissue, which allows the individual cells in the tissue to be seen more clearly. The slide is then given to the pathologist, who examines the tissue under a microscope, looking for any abnormal findings. The pathologist then prepares a report that lists any abnormal or important findings from the biopsy. This report is sent to the physician who originally performed the biopsy on the patient.

See also

• Interventional radiology

References

1. ^ "Biopsy: its history, current and future outlook". PubMed.gov.
2. ^ Anderson, J. B.; Webb, A.J. "Fine-Needle Aspiration Biopsy and the Diagnosis of Thyroid Cancer", British Journal of Surgery 74:292-6, 1987.
3. ^ Sausville, Edward A. and Longo, Dan L. "Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy", Harrison's Principles of Internal Medicine, 16th Ed. Kaspar, Dennis L. et al., eds. p.446 (2005).
4. ^ Friedman, S. and Blumberg, R.S. "Inflammatory Bowel Disease", Harrison's Principles of Internal Medicine, 16th Ed. Kaspar, Dennis L. et al., eds. pp.1176-1789, 2005.
5. ^ Mens health - Testicular Biopsy
6. ^ Saibeni, S., Rondonotti, E., Iozzelli, A., Spina, L., Tontini, G.E., Cavallaro, F., Ciscato, C., de Franchis, R., Sardanelli, F., Vecchi, M. "Imaging of the Small Bowel in Crohn's Disease: A Review of Old and New Techniques", World Journal of Gastroenterology 13(24): 3279-87, 2007.
7. ^ Iglesias-Garcia, J., Dominguez-Munoz, E., Lozano-Leon, A., Abdulkader, I., Larino-Noia, J., Antunez, J., Forteza, J. "Impact of Endoscopic Ultrasound-Guided Fine Needle Biopsy for Diagnosis of Pancreatic Masses", World Journal of Gastroenterology 13(2): 289-93, 2007.

External links

• Mybiopsyinfo.com - What is a biopsy? How is a biopsy examination performed? This website gives you answers to these and many other questions.
• MyBiopsy.org - Information about biopsy results for patients. This site is created by pathologists, the physicians who diagnose cancer and other diseases by looking at biopsies under a microscope.
• RadiologyInfo - The radiology information resource for patients: Biopsy
• Fine needle aspiration biopsy on Wikisurgery
• Core needle (Trucut) biopsy on Wikisurgery

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - biopsi, vævsprøve

Nederlands (Dutch)
diagnostisch onderzoek van levend weefsel

Français (French)
n. - biopsie

Deutsch (German)
n. - Biopsie

Ελληνική (Greek)
n. - βιοψία

Italiano (Italian)
biopsia

Português (Portuguese)
n. - biópsia (f)

Русский (Russian)
биопсия

Español (Spanish)
n. - biopsia

Svenska (Swedish)
n. - biopsi

中文（简体）(Chinese (Simplified))
活组织检查, 活组织切片检查

中文（繁體）(Chinese (Traditional))
n. - 活組織檢查, 活組織切片檢查

한국어 (Korean)
n. - 생체 조직 절편 검사

日本語 (Japanese)
n. - 生検
v. - 生検を実施する

العربيه (Arabic)
‏(الاسم) فحص العينه الحيه‏

עברית (Hebrew)
n. - ‮בדיקה מן החי, ביופסיה‬

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