Generality
A biopsy, or bioptic examination, is a medical procedure, usually having a diagnostic purpose, which involves the collection and subsequent analysis in the laboratory, under the microscope, of a sample of suspicious cells, whether they are part of an organ or an internal tissue or a portion of skin.
There are various types of biopsy: skin biopsy, needle biopsy, endoscopic biopsy, excisional biopsy and perioperative biopsy.
Today, thanks also to medical advances, biopsy procedures are linear, safe and low risk for the patient
In general, the results of a biopsy are available within a few days.
What is a biopsy?
A biopsy, or bioptic examination, is a medical procedure, generally with diagnostic purposes, which consists in collecting a sample of cells from a suspect tissue or organ and in its subsequent analysis in the laboratory, using a microscope.
Thanks to advances in medicine, sampling tools and techniques are currently available that allow the collection of cellular samples from any region of the human body, be it the skin or an internal organ located in a rather delicate position.
WHO IS ITS EXECUTIVE FOR?
Generally, during a biopsy, to take care of collecting the cell sample, he is a surgeon or an interventional radiologist, while he is a doctor specializing in pathological histology when he is in charge of the laboratory tests.
ORIGIN OF THE NAME
The term biopsy has Greek origins and derives from the union between the word "bios" (βίος), which means "life", and the word "opsis" (ὄψις), which means "vision".
Therefore, based on what has just been stated, the literal meaning of biopsy is "vision of life".
The use of such a term is explained by the fact that laboratory analyzes consist in the observation, under a microscope, of a sample of living cells.
The merit of having introduced the use of the word "biopsy" into scientific language belongs to the French dermatologist Ernest Besnier . It was the year 1879.
uses
In general, doctors resort to a biopsy in the presence of important morbid conditions, for which there are still some doubts or uncertainties regarding the characteristics, causes, gravity, etc.
Among the conditions that usually justify the use of a biopsy are:
- Tumors (or neoplasms ). In these situations, a biopsy allows doctors to study in detail the cellular and molecular characteristics of the malignant tissue forming the tumor mass.From a biopsy on a tumor two important parameters emerge that give a fairly precise idea of the severity of the condition in place: staging (or stage) and grade.
The most common tumor biopsies are those performed for breast tumors, skin tumors (melanoma, etc.), for tumors of the gastro-intestinal tract, etc.
- Inflammations of extremely important internal organs, such as the liver or kidneys. Through a biopsy, doctors are able to trace the causes and severity of hepatitis (inflammation of the liver), nephritis (inflammation of one or both kidneys), etc.
- Serious infectious diseases affecting internal organs, such as the lungs.
Infections that may necessitate a biopsy are severe pneumonia, tuberculosis, etc. - Non-tumor type skin diseases .
- All those conditions in which a particular organ or group of organs has suffered a decline in their functional capacity (eg, renal failure, liver failure, etc.). In these circumstances, a biopsy is used above all to trace the precise triggering causes.
Types
There are various types of biopsy . To distinguish each type of bioptic examination is the instrumentation used for the collection of the cell sample.
Going into more detail, the types of biopsy available today are:
- Skin biopsy, also known as punch biopsy or punch excision ;
- The needle biopsy ;
- Endoscopic biopsy ;
- The excisional biopsy ;
- Perioperative biopsy .
The use of one type of biopsy, rather than another, depends on where the cell sample is to be collected. In fact, there are tissues and organs of the human body that lend themselves better only to some types of bioptic examination (if not to a single typology).
Procedure
In this chapter, the procedures of the various types of existing biopsies will be addressed.
CUTANEOUS BIOPSY
As can be easily understood, the skin biopsy is indicated to study the characteristics of diseases affecting the skin.
For its execution, the doctors use a special surgical instrument, a sort of circular scalpel, capable of producing holes on the skin and removing the anatomical area corresponding to the area of application.
In general, the use of skin biopsy requires the injection of a local anesthetic (local anesthesia), at the level of the sampling area.
Core Biopsy
The needle biopsy is a type of biopsy which, for the collection of the cellular sample, involves the use of a needle of variable size; needle that the doctor puts under the skin, in the organ or tissue to be analyzed.
Very often, to identify the precise point of the sampling, those who perform this type of biopsy make use of real-time images resulting from instrumental procedures, such as an ultrasound scan, a CT scan or an MRI scan.
If the needle provided for the collection of the cell sample has a considerable size, the needle biopsy involves the use of local anesthesia, since, otherwise (ie without anesthesia), it could be very painful for the patient.
Special cases
- Needle biopsy for a breast lump. The doctor inserts the needle at the nodule and takes a small sample of cells for further analysis.
In general, if the nodule gives rise to particular concerns, the needle used for the collection is of considerable size, as there is a need to analyze a cellular sample of a certain extension.
Conversely, if the nodule is a liquid-filled cyst (therefore not very worrying), the needle provided for the collection can also be small.
- Needle biopsy on internal organs. For such a needle biopsy, the needle must be of considerable size, as samples of cells from organs such as the liver or kidneys are being studied.
In general, to correctly perform the sampling, the doctor uses the images of an ultrasound scan or a CT scan and - an absolutely not to be overlooked aspect - requires the patient to "hold his breath" for a few seconds, when the needle insertion and subsequent withdrawal.
- Needle biopsy on bone marrow. This kind of needle biopsy involves the use of a considerable and quite long needle, as the bone marrow resides inside the bones (so it is in depth).
In general, the area of collection is at the level of the iliac crest.
In order for the patient to feel no pain, the doctor injects a local anesthetic (at the point of collection) and a sedative to help him relax.
ENDOSCOPIC BIOPSY
Endoscopic biopsy is a type of biopsy used by doctors when they experience some problem in the organ or a series of organs accessible from the outside (esophagus, stomach, intestine, trachea, bronchial tree, bladder, etc.).
Figure: biopsy endoscope
The procedure involves the use of an endoscope, that is an instrument of tubular shape, flexible and equipped at the same end with a camera and a cutting element for collecting the sample.
To take the cell sample, the examiner puts the endoscope through the external opening or leads it to the desired location.
During an endoscopic biopsy, the administration of local anesthetics depends on the anatomical site of investigation: so uncomfortable and particularly sensitive sites require the use of anesthesia, while less sensitive anatomical areas can also exclude anesthetic practice.
ESCISSIONAL BIOPSY
Excisional biopsy is a type of biopsy that involves the removal of a large cell sample.
Doctors resort to excisional biopsy when they want to analyze entire abnormal structures, such as breast lumps, thyroid nodules, etc.
In general, to prevent the patient from feeling pain or discomfort, it is essential to resort to anesthesia : this practice can be local, for withdrawals in areas that are easily accessible and not very sensitive, or general, for withdrawals in delicate, sensitive and inaccessible areas.
PERIOPERATIVE BIOPSY
The perioperative biopsy is that biopsy exam that takes place just before surgery.
Its purpose is to clarify once and for all how and if it is actually the case to proceed with the operation of surgery.
Clearly, laboratory tests must be immediate and the results must be available to the operating surgeon within a few minutes.
Perioperative biopsy usually involves the use of general anesthesia .
LABORATORY ANALYSIS
Laboratory analysis consists of the observation of various cellular features, including: morphology, size, growth capacity, appearance of the nucleus, appearance of the cytoplasm, shape and number of various intracellular organelles, l appearance of the cell membrane, etc.
In some situations, they also foresee the realization of some genetic tests, to understand what is the chromosomal outfit and the genetic structure of the abnormal cells.
Post-procedural phase
In general, any biopsy performed under local anesthesia consists of a fairly simple and linear procedure, which does not require the patient's hospitalization but only a hospital stay of a few hours.
The situation changes widely, when the biopsy exam requires the use of general anesthesia: in these situations, the patient is admitted, so that the patient can fully recover his sensory faculties, his ability to pay attention, etc. .
POST-BIOPSY SENSATIONS
After a biopsy under local anesthesia, it is rare but possible for the patient to feel slight pain or discomfort at the point of withdrawal.
Biopsies that have a greater tendency to be painful are those that involve important organs such as, for example, the liver or bone marrow.
Usually, pain remedies, recommended by doctors, consist of administering painkillers, including ibuprofen or paracetamol.
risks
Thanks to modern sampling techniques, the risks of a biopsy are currently very limited.
Among the possible adverse effects, the danger of haemorrhage deserves special mention: blood loss is rarely serious and only in very few cases does it require a blood transfusion.
For women: the biopsy of a female genital organ (for example the cervix uteri) could lead to blood loss at the vaginal level. It is a temporary phenomenon, which in a short time resolves spontaneously.
Examples
Among the best known examples of biopsy, they deserve a quote:
- Breast biopsy . It is indicated to study the precise nature of nodules or suspected tumors on one of the two breasts.
- Renal biopsy . The doctors prescribe its execution to trace the causes of a state of renal failure with still some question marks and to analyze the characteristics of kidney neoplasms.
- Liver biopsy . It is very useful to understand the causes and to analyze the characteristics of serious liver diseases, such as cirrhosis.
- Bone biopsy . Doctors prescribe it when they suspect the presence of: a generalized bone disease (for example Paget's disease), a malignant bone tumor (for example Ewing's sarcoma), an osteomyelitis (ie an infection of the bones or bone marrow bone) and, finally, long-lasting bone pain whose causes are unknown.
- Lung biopsy . It is indicated in all those suspected cases of: pulmonary fibrosis, interstitial disease, sarcoidosis and lung cancer.
Moreover, it is useful to clarify the progress of a serious pneumonia and the causes of pulmonary disorders, which the classical imaging techniques have not yet brought to light.
- Prostate biopsy (or prostatic biopsy ). Doctors appeal to you when, on the basis of other diagnostic tests, they suspect prostate cancer.
- Bone marrow biopsy . It is indicated in the presence of suspected leukemia, a cancer of the blood.
- Skin biopsy . It is useful when doctors suspect some skin cancer (melanoma, basal cell carcinoma, squamous cell carcinoma, etc.)
Results
In general, if the collection of the cell sample is appropriate, a biopsy can provide information of fundamental importance, which no other diagnostic procedure can guarantee.
Usually (except, for example, there are no special needs), the results of a biopsy are available within a few days.
