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Diagnosing Diseases Through Biopsy Procedures

Biopsy Procedures In Diagnosing Diseases

Biopsy refers to the extraction of a small tissue sample from the body for assessment in the laboratory. The tissue is analyzed using a microscope to help in the diagnosis.

Biopsy tissue can be removed either by scraping the tissue, using special instruments called “scopes” inserted into the area from where the sample needs to be removed, or by using needles and syringes.

Why Is Biopsy Recommended?

Doctors recommend biopsy when an initial test shows some abnormality in an area of tissue. It may be a mass, tumor or just a skin lesion. It may be seen in a physical examination or internally by an imaging diagnostic tool. A biopsy can answer all those questions that these exams can not find. Some examples are:

  • A mammogram shows a mass or lump that indicates possibilities of breast cancer
  • A mole on the skin that changes its size, shape or color, an indicator of melanoma
  • In chronic hepatitis, to know if cirrhosis (liver damage) of the liver has happened.

Types Of Biopsy:

There are many types of biopsies used to make a disease diagnosis. In the sensitive areas of the body like skin, local anesthesia (numbness medicine) is given first.

Following are the types of biopsies:

  • Liver biopsy:

A liver biopsy is used to arrive at diagnoses of tumors, hepatitis, or liver cirrhosis. Biopsies are carried out on patients while they are lying on their left side with their hand on the head, and right arm extended. It’s important for the patient to hold and maintain this position. A local anesthetic is administered to numb the skin. A needle is introduced between the two ribs near the surface of the liver, and biopsy material is quickly obtained.

  • Endometrial biopsy:

This biopsy is obtained to assess the inner layer of the womb in situations when a woman has abnormal vaginal bleeding or has irregular periods. An endometrial biopsy may show polyp formations, hormone imbalances in the body, and the development of a tumor. An endometrial biopsy can be carried out via various methods.

  • Dilatation and curettage (D&C):

Dilatation and curettage is a normal gynecological procedure but is now being replaced by the most current practice of hysteroscopy. Dilatation and curettage is carried out with a short-term universal anesthesia. The cervix is opened slowly by inserting a series of rounded dilators, or sticks. These are initially small, but an increase in size until the cervix is adequately dilated to accept a curette. A curette is a very small device shaped like a rectangular spoon. It is used to obtain a sample from the inner lining of the womb.

  • Hysteroscopy:

Hysteroscopy is a procedure in which a fiber-optic tube is inserted into the cervix with a bright light at one end to get a precise view of the inner lining of the womb. A biopsy with direct vision can be done by passing forceps through the inside of the tube into the womb. It’s usually carried out with a local anesthetic, but some women may be advised to choose a universal anesthesia.

  • Prostate biopsy:

A prostate biopsy can be carried out where abnormality is established by a nurse or doctor, while carrying out a DRE (Digital Rectal Examination). A TRUS (Transrectal Ultrasound) of the prostate gland can be requested for examination if there is any abnormality identified on DRE, or if blood tests reveal high PSA (Prostate Specific Antigen). The process is carried out in a hospital, usually without the use of anesthetic.

The urologist or radiologist carrying out the process instructs the patient to avoid taking blood thinning agents such as Warfarin or Aspirin for a period of up to one week before the examination, to reduce the risk of bleeding. Antibiotics are administered to avoid the risk of infections.

During the biopsy, the patient lies on his side with knees curved and legs pulled up to the chest. If any abnormality spotted on the ultrasound scan, a biopsy is obtained immediately. Patients may feel sharp and short pains as the needles move around the prostate. Many small cylindrical samples (6-12 samples) will be obtained, with each quadrant of the gland giving four samples.

The process can also work without ultrasound guidance. To perform this, the doctor uses a finger to direct a single needle to the abnormal area, and obtains a series of biopsies. Following the process, patients may spot blood in the urine for several days and may feel irritation for a short period.

  • Skin biopsy:

When changes in the skin occur, further assessment is needed, and a biopsy may be helpful. About one hour prior to the examination, a local anesthetic is injected or applied as a topical cream to the area of concern.

Skin biopsy procedures comprise of the following:

  • Shave Biopsy: The physician uses a tool that is similar to a razor to scrape the surface of the skin.
  • Incisional Biopsy: The doctor uses a scalpel to separate a small area of skin. It depends on the amount of area of skin removed, to decide for application of stitches.
  • Punch Biopsy: The doctor uses a small circular tool to separate a small section of your skin’s deep layers
  • Excisional Biopsy: The doctor removes the whole lump or mass. There is a greater chance of stitches required for excisional biopsy.    

A special device removes a skin sample. The procedure involves the removal of a cylindrical piece of the skin by creating a series of small holes. The skin is then stitched together. The procedure does not leave a big scar, and the skin appears just as normal as it was before the procedure.

Based on the outcome of the biopsy, the entire skin lesion may be removed completely.

  • Bone marrow biopsy:

Biopsy of bone marrow is important for many diseases that may include diseases of the blood, the lymphatic system, and bone marrow. The Iliac crest is a point on the upper part of the hip. The area from which the biopsy is commonly obtained, although it may also be obtained from the sternum (the bone of the breast).

A local anesthetic is first given. It is followed by pushing a strong needle into the bone marrow (central part of the bone that is soft), through the skin and into the outer part of the bone. Some of the bone marrow is extracted using a syringe.

  • Breast biopsy:

A breast biopsy is usually done during a clinical examination, mammography, or ultrasound to determine whether a lump in the breast is cancerous. The biopsy establishes whether the tumor is malignant or benign.

Fine-needle aspiration (FNA) is a method that uses a hypodermic needle to extract the sample after piercing the skin. It can be done under an X-ray, or with ultrasound guidance. Based on the test result, the entire lump may be removed.

  • Small intestine biopsy:

It is always difficult to observe the jejunum (central part of small intestine) using an endoscope. In such cases, a sample can be obtained from the central part by using a biopsy capsule.

The capsule is connected to a thin tube. The capsule is swallowed by the patient and is followed by an X-ray to allow for confirmation when the capsule has reached the jejunum.

When the capsule has reached the correct area, partial pressure is created in the tube with a syringe. The capsule extracts some small samples of the mucous membrane. The capsule is then withdrawn and the biopsy examination performed in the laboratory.

A condition in the bowel referred to as celiac disease can best be investigated using this procedure.

  • Kidney biopsy:

A renal, or kidney biopsy, is important in examining inflammation or tumors affecting the organ. Kidneys are found below the diaphragm on either side of the upper abdomen, in the back.

A hollow needle is usually used in a kidney biopsy. The needle is pushed into the tissue of the kidney from behind, through anesthetized muscles and skin, to get a small sample. The patient is advised to hold his or her breath during the procedure, so the kidney does not move.

Biopsy Analysis And Outcomes:

After collection of the tissue sample by the doctor, it is sent to the pathologist in the laboratory. In some cases, the doctor who did the biopsy may analyze the sample himself. Now after that the sample may be preserved in a refrigerator to be cut into thin slices. Then the sample is placed on a glass slide to examine under the microscope.

The results predict if the cells are cancerous, its type and where cancer originated. It is done by looking at the size, shape and internal activity of the cell.

The time of the results varies. In some cases, it takes minutes for the results to come. Whereas, in case of higher accurate conclusions it may take weeks to conclude the results.

Conclusion:

A biopsy is an advanced diagnostic procedure that is done after the initial physical examination of the body or any abnormality seen in imaging procedures like ultrasound. It has various types to diagnose problems in the different parts of the body. It is a good procedure for detecting the stage of cancers.

 

References:

  1. Biopsy and its types
  2. What is a biopsy and its types
  3. Introduction of biopsy
  4. How a biopsy is performed