Abiopsy is amedical test commonly performed by asurgeon,an interventional radiologist, or aninterventional cardiologist. The process involves the extraction ofsamplecells ortissues for examination to determine the presence or extent of a disease. The tissue is thenfixed, dehydrated, embedded, sectioned, stained and mounted[1] before it is generally examined under amicroscope by apathologist; it may also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called anexcisional biopsy. Anincisional biopsy orcore biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. 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 aneedle aspiration biopsy. Biopsies are most commonly performed for insight into possiblecancerous or inflammatory conditions.
TheArab physicianAbulcasis (1013–1107) developed one of the earliest diagnostic biopsies. He used a needle to puncture thethyroid and then characterized many types ofgoiter.[2][3]
Lung biopsy in a case of suspected lung cancer under guidance ofcomputed tomography.
When cancer is suspected, a variety of biopsy techniques can be applied. Anexcisional 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, thesurgical 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.[citation needed]
When intact removal is not indicated for a variety of reasons, a wedge of tissue may be taken in anincisional biopsy. In some cases, a sample can be collected by devices that "bite" a sample. A variety of sizes of needles can collect tissue in the lumen (core biopsy). Smaller diameter needles collect cells and cell clusters,fine needle aspiration biopsy.[6]
Pathologic examination of a biopsy can determine whether a lesion isbenign ormalignant, 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 amastectomy 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").
There are two types of liquid biopsy (which is not really a biopsy as they are blood tests that do not require a biopsy of tissue): circulating tumor cell assays or cell-free circulating tumor DNA tests.[7] These methods provide a non-invasive alternative to repeat invasive biopsies to monitor cancer treatment,[8] test available drugs against the circulating tumor cells,[9] evaluate the mutations in cancer and plan individualized treatments. In addition, because cancer is a heterogeneous genetic disease, and excisional biopsies provide only a snapshot in time of some of the rapid, dynamic genetic changes occurring in tumors, liquid biopsies provide some advantages over tissue biopsy-based genomic testing.[10] In addition, excisional biopsies are invasive, cannot be used repeatedly, and are ineffective in understanding the dynamics of tumor progression and metastasis.[11][12] By detecting, quantifying and characterisation vital circulating tumor cells or genomic alterations in CTCs and cell-free DNA in blood, liquid biopsy can provide real-time information on the stage of tumor progression, treatment effectiveness, and cancer metastasis risk.[13] This technological development could make it possible to diagnose and manage cancer from repeated blood tests rather than from a traditional biopsy.[13][14][15][16]
Circulating tumor cell tests are already available but not covered by insurance yet atmaintrac and under development by many pharmaceutical companies. Those tests analyzecirculating tumor cells (CTCs)[14][17] Analysis of individual CTCs demonstrated a high level of heterogeneity seen at the single cell level[18] for both protein expression and protein localization and the CTCs reflected both the primary biopsy and the changes seen in the metastatic sites.[citation needed]
Analysis of cell-free circulating tumor DNA (cfDNA) has an advantage over circulating tumor cells assays in that there is approximately 100 times more cell-free DNA than there is DNA in circulating tumor cells.[7] These tests analyze fragments of tumor-cell DNA that are continuously shed by tumors into the bloodstream. Companies offering cfDNA next generation sequencing testing include Personal Genome Diagnostics andGuardant Health.[10] These tests are moving into widespread use when a tissue biopsy has insufficient material for DNA testing or when it is not safe to do an invasive biopsy procedure, according to a recent report of results on over 15,000 advanced cancer patients sequenced with the Guardant Health test.[19]
A 2014 study of the blood of 846 patients with 15 different types of cancer in 24 institutions was able to detect the presence of cancer DNA in the body. They found tumor DNA in the blood of more than 80 percent of patients with metastatic cancers and about 47 percent of those with localized tumors. The test does not indicate the tumor site(s) or other information about the tumor. The test did not produce false positives.[20]
Such tests may also be useful to assess whether malignant cells remain in patients whose tumors have been surgically removed.[21] Up to 30 percent are expected to relapse because some tumor cells remain.[22] Initial studies identified about half the patients who later relapsed, again without false positives.[20]
Another potential use is to track the specific DNA mutations driving a tumor. Many new cancer medications block specific molecular processes. Such tests could allow easier targeting of therapy to tumors.[20]
For easily detected and accessed sites, any suspicious lesions may be assessed. Originally, this was skin or superficial masses.X-ray, then laterCT,MRI, andultrasound along withendoscopy extended the range.[citation needed]
Biopsy specimens are often taken from part of alesion 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. 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. To make the diagnosis, thegingival.
Transplantation: Biopsies oftransplanted organs are performed in order to determine that they are not beingrejected or that the disease that necessitated the transplant has not recurred.
Fertility: A testicular biopsy is used for evaluating the fertility of men and find out the cause of a possibleinfertility, e.g. whensperm quality is low, but hormone levels still are within normal ranges.[24][failed verification]
Abone biopsy is a procedure in which bone samples are removed to find out ifcancer orinfection or other abnormal cells are present. A bone biopsy involves the outer layers of bone, unlike a bone marrow biopsy, which involves the innermost part of the bone. Bone biopsy should as rule be done after all necessary imagings performed.Jamshidi needle has replaced the open-biopsy andfine-needle aspiration
Sinceblood cells form in thebone marrow, abone-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 andlymphoma) a bone-marrow biopsy is used in staging the disease. The procedure involves taking a core oftrabecular bone using atrephine, and then aspirating material.
Breast biopsy is often performed to assess or diagnosebreast cancer, and can be performed by various methods such as fine needle aspirate (FNA), core needle biopsy (CNB), or surgical removal.[25]
Endovascular endothelial cells
A micro-3D-printed device adapted for endovascular techniques has been shown to harvest endothelial cells for transcriptomic analysis.[26]
Flexibleendoscopy enables access to the upper and lowergastrointestinal tract, such that biopsy of theesophagus,stomach andduodenum via the mouth and therectum,colon and terminalileum are commonplace. A variety of biopsy instruments, such as thebioptome, may be introduced through the endoscope and the visualized site biopsied.[27] 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.[28]
Needle core biopsies or aspirates of the pancreas may be made through the duodenum or stomach.[29]
Inhepatitis, most biopsies are not used for diagnosis, which generally occurs 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 offibrosis or, ultimately,cirrhosis.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of cystic lesions, followed by liquid cell analysis, has been used as a diagnostic tool for differentiating benign, potentially malignant, and malignant pancreatic cysts.[30][31] 'Through-the-needle' cytologic brushes have been developed for increasing the cellular content in the aspirates.[32][33][34][35]
After the biopsy is performed, the sample of tissue that was removed from the patient is sent to thepathologylaboratory. Apathologist specializes in diagnosingdiseases (such ascancer) by examining tissue under amicroscope. When the laboratory (seeHistology) receives the biopsy sample, the tissue is processed and an extremely thin slice oftissue is removed from the sample and attached to a glass slide. Any remaining tissue is saved for use in later studies, if required.[citation needed]
The slide with the tissue attached is treated with dyes that stain the tissue, which allows the individualcells 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 thesurgeon who originally performed the biopsy on the patient.[citation needed]
^Anderson & Webb (1987) cite Abulcasim Chalaf Ben Abbas El-Zahrawi. Altasrif Vol 30. Translated by Geradus Cremonensis in the 12th century. Bibliotheque Nationale, f. lat 2127.
^Zerbino DD (1994). "Biopsy: Its history, current and future outlook".Likars'ka Sprava / Ministerstvo Okhorony Zdorov'ia Ukrainy (3–4):1–9.PMID7975522.
^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).
^Pachmann, K.; Stein, E.; Spitz, G.; Schill, E.; Pachmann, U. (2009-12-15). "Chemosensitivity Testing of Circulating Epithelial Cells (CETC) in Breast Cancer Patients and Correlation to Clinical Outcome".Poster Session Abstracts.69 (24_Supplement). American Association for Cancer Research: 2044.doi:10.1158/0008-5472.sabcs-09-2044.
^Carl, S; Camara, O; Plaschke-Schluetter, A; Kroll, T; Pachmann, K. (2010-12-15). "Abstract P3-10-37: Molecular Analysis of Single Circulating Tumor Cells for Characterization of the Targets of Systemic Breast Cancer Therapy as Chance to Individualize Therapy".Poster Session Abstracts.70 (24_Supplement). American Association for Cancer Research: P3–10–37.doi:10.1158/0008-5472.sabcs10-p3-10-37.
^Pachmann, Katharina; Camara, Oumar; Kavallaris, Andreas; Krauspe, Sabine; Malarski, Nele; Gajda, Mieczyslaw; Kroll, Torsten; Jörke, Cornelia; Hammer, Ulrike (2008-03-10). "Monitoring the Response of Circulating Epithelial Tumor Cells to Adjuvant Chemotherapy in Breast Cancer Allows Detection of Patients at Risk of Early Relapse".Journal of Clinical Oncology.26 (8):1208–1215.doi:10.1200/jco.2007.13.6523.ISSN0732-183X.PMID18323545.S2CID20074388.
^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.
^Niederhuber, John E.; Armitage, James O.; Doroshow, James H.; Kastan, Michael B.; Tepper, Joel E. (2013-09-12).Abeloff's clinical oncology (Fifth ed.). Philadelphia, Pennsylvania.ISBN978-1-4557-2881-7.OCLC857585932.{{cite book}}: CS1 maint: location missing publisher (link)
^Marques, F., Schliemann, I., Wijngaart, W. van der, Arnelo, U., Roxhed, N., Baldaque-Silva, F. (2023), "New through-the-needle brush for pancreatic cysts assessment: a randomized control trial",Igie, Elsevier BV,doi:10.1016/j.igie.2023.08.006,S2CID261406528
^Muniraj, Thiruvengadam; Aslanian, Harry R. (2018). "Devices for endoscopic ultrasound-guided tissue acquisition".Techniques in Gastrointestinal Endoscopy.20 (1). Elsevier BV:2–9.doi:10.1016/j.tgie.2018.01.003.ISSN1096-2883.
Mybiopsyinfo.com - What is a biopsy? How is a biopsy examination performed? This website gives you answers to these and many other questions.
MyBiopsy.orgArchived 2018-09-25 at theWayback Machine - Links to a video. 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
