Biopsy
Professor
Khalid Kareem Rajab Al-Mafrachi
Consultant Surgeon
A biopsy is a procedure to remove a piece of tissue or
a sample of cells from patient body so that it can be
analyzed in a laboratory.
A doctor should recommend a biopsy when an initial
test suggests an area of tissue in the body isn't
normal.( The suspicious area may be noticed during
a physical examination or internally on an imaging
test.) for diagnosis or asses the management
While imaging tests, such as X-rays, are helpful in
detecting masses or areas of abnormality, they
alone can't differentiate cancerous cells from
noncancerous cells. For the majority of cancers,
the only way to make a definitive diagnosis is to
perform a biopsy to collect cells for closer
examination.
Here's a look at the various types of biopsy
procedures used to make a cancer diagnosis.
?Why Are Biopsies Done
Biopsies are most often done to look for cancer.
But biopsies can help identify many other
conditions.
• Diagnosis: e.g. differentiated malignancy from
benign condition, chronic infection TB, non-
specific inflammatory bowel diseases.
• Treatment: follow up in the management like
response or effect of treatment.
A biopsy might be recommended whenever there
is an important medical question the biopsy could
help answer. Here are just a few examples:
A mammogram shows a lump or mass,
indicating the possibility of breast cancer.
A mole on the skin has changed shape recently
and melanoma is possible.
A person has chronic hepatitis and it's important
to know if cirrhosis is present.
In some cases, a biopsy of normal-appearing
tissue may be done. This can help check
for cancer spread or rejection of a transplanted
organ.
In most cases, a biopsy is done to diagnose a
problem or to help determine the best therapy
option.
:Types of biopsies
1. Needle biopsies.
2. Surgical biopsy (open Incisional, Excisional
biopsy) or laparoscopic or endoscopic.
3. Skin biopsy
Needle biopsies; the most common biopsies
Core needle biopsies use medium-sized needle to extract a column of
tissue, in the same way that core samples are taken from the earth.
Fine needle biopsies use a thin needle that is attached to a syringe,
allowing fluids and cells to be drawn out.
Image-guided biopsies are guided with imaging procedures — such
as U/S, X-ray or CT scans — so your doctor can access specific areas
and helps a doctor direct the needle into the lesion, such as the lung, liver,
or other organs.
Vacuum-assisted biopsies use suction from a vacuum to collect cells.
FNAB under U/S for Thyroid nodule
:Surgical biopsies
A. Open biopsy
1- Incisional biopsy
2- Excisional biopsy
B. Laparoscopic or endoscopic.
If the cells in question can't be accessed with other biopsy
procedures or if other biopsy results have been
inconclusive, your doctor may recommend a surgical
biopsy.
During a surgical biopsy, a surgeon makes an incision in
your skin to access the suspicious area of cells. Examples
of surgical biopsy procedures include surgery to remove a
breast lump for a possible breast cancer diagnosis and
surgery to remove a lymph node for a possible lymphoma
.diagnosis
Surgical biopsy procedures can be used to remove part of an
abnormal area of cells (incisional biopsy). Or surgical
biopsy may be used to remove an entire area of abnormal
cells (excisional biopsy).
You may receive local anesthetics to numb the area of the
biopsy. Some surgical biopsy procedures require general
anesthetics to make you unconscious during the procedure.
You may also be required to stay in the hospital for
observation after the procedure.
Upper GIT Endoscopy
Skin biopsy
Shave biopsy. During a shave biopsy, the doctor uses a tool similar
to a razor to scrape the surface of diseased skin.
Punch biopsy. During a punch biopsy, the doctor uses a circular
tool to remove a small section of your skin's deeper layers.
Incisional biopsy. During an incisional biopsy, the doctor uses a
scalpel to remove a small area of skin. Whether you receive stitches to
close the biopsy site depends on the amount of skin removed.
Excisional biopsy. During an excisional biopsy, the doctor
removes an entire lump or an entire area of abnormal skin. You'll likely
receive stitches to close the biopsy site. You receive a local anesthetic
to numb the biopsy site before the procedure.
Punch biopsy
Biopsy analysis and results
After we obtains a tissue sample, it's sent to a laboratory for
analysis. The sample may be chemically treated or frozen and
sliced into very thin sections. The sections are placed on glass
slides, stained to enhance contrast and studied under a microscope.
The results help us determine whether the cells are cancerous. If the
cells are cancerous, the biopsy results can tell your doctor where
the cancer originated — the type of cancer.
How to prepare for a biopsy
Biopsies may require some preparation on the part of the
patient such as bowel prep, clear liquid diet, or nothing
by mouth. Your doctor will instruct you on what to do
before the procedure.
As always before a medical procedure, tell your doctor
what medications and supplements you take. You may
need to stop taking certain drugs before a biopsy, such as
aspirin or nonsteroidal anti-inflammatory medications.
Following up after a biopsy
After the tissue sample is taken, your doctors will need to analyze
it. In some cases, this analysis can be done at the time of
procedure. More often, however, the sample will need to be sent
to a laboratory for testing. The results can take anywhere from a
few days to a few weeks.
Once the results arrive, your doctor may call you to share the
results, or ask you to come in for a follow-up appointment to
discuss the next steps.
If the results showed signs of cancer, the doctor should be able to
tell the cancer’s type and level of aggression from your biopsy. If
the biopsy was done for a reason other than cancer, the lab report
should be able to guide the doctor in diagnosing and treating that
condition.
If the results are negative but the doctor’s suspicion is still high
either for cancer or other conditions, we may need another biopsy or
a different type of biopsy.
Thank You
