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BIOPSY

A biopsy is the examination of tissue remove from a lesion and by extension the term is also
used to convey the removal of the tissue.
Biopsy is the removal of tissue for examination, microscopic analysis, chemical analysis, and
bacterial analysis or a combination of all four. The term is used most frequently to indicate
removal of tissue from a living subject for analysis.
TYPES OF BIOPSIES
I. Needle Biopsy
Needle biopsy is a general term that's often used to describe inserting a special needle through
the skin to collect cells from a suspicious area. Also known as a percutaneous tissue biopsy.
A needle biopsy is often used on suspicious areas that can feel through skin, such as breast
lumps and enlarged lymph nodes. When combined with an imaging procedure, needle biopsy
can be used to collect cells from an area that can't be felt through the skin.
Needle biopsy procedures include:
Fine-needle aspiration. During fine-needle aspiration, a long, thin needle is inserted into the
suspicious area. A syringe is used to draw out fluid and cells for analysis. The sample is collected
by inserting a fine gauge needle (23-25 gauze) into the suspected mass that is later studied
under microscope. Example: breast biopsy
Core needle biopsy. A larger needle with a cutting tip is used during core needle biopsy to draw
a column of tissue out of a suspicious area. Example: breast biopsy
Vacuum-assisted biopsy. During vacuum-assisted biopsy, a suction device increases the
amount of fluid and cells that is extracted through the needle. This can reduce the number of
times the needle must be inserted to collect an adequate sample. Example: breast biopsy,
endometrial biopsy
Image-guided biopsy. Image-guided biopsy combines an imaging procedure — such as a CT
scan, MRI or ultrasound — with a needle biopsy.
Image-guided biopsy allows to access suspicious areas that can't be felt through the skin, such
as prostate. Example: stereotactic biopsy for breast biopsy

II. Endoscopic Biopsy


This type of biopsy is done through a fiberoptic endoscope. This is a long, thin tube that has a
close-focusing telescope on the end for viewing. The scope is passed through a natural body
orifice (for example, rectum or mouth) or a small incision. It is used to look at the organ in
question for abnormal or suspicious areas so that a small amount of tissue can be removed for
study. The endoscope is inserted into the abdominal cavity (laparoscopy).

III. Skin biopsy


This includes:
Skin biopsy procedures include:
Shave biopsy. During a shave biopsy, a tool similar to a razor is used to scrape the surface of
skin, where a thin piece of skin is removed from the surface using a sharp blade. This type of
biopsy involves removing the top layers of skin by shaving it off. Shave biopsies are used to
diagnose some basal cell or squamous cell skin cancers as well as other skin lesions. Shave
biopsies are also done with a local anesthetic.
Punch biopsy. Punch biopsies involve taking a deeper sample of skin with a biopsy instrument
that removes a short cylinder, or "apple core," of tissue. After a local anesthetic, the instrument
is rotated on the surface of the skin until it cuts through all the layers. To perform the
procedure, the care team uses a specialized tool that looks like a hollow pen but has a circular
scalpel on the end so the sample can be removed with a single movement.
Incisional biopsy. During an incisional biopsy, provider uses a scalpel to remove a small area of
skin. Whether receive stitches to close the biopsy site depends on the amount of skin removed.
Excisional biopsy. During an excisional biopsy, an entire lump or area of skin that appears
suspicious is removed.

FEMALE REPRODUCTIVE ORGAN BIOPSY


A. Breast biopsy
•This is a procedure to remove a sample of breast tissue for testing [pathological diagnosis],
usually done after a suspicious lesion discovered on either mammography or USG or MRI.
•Several methods for the breast biopsy now exist. Most appropriate Methods depends on
variety of factors such as size, location, appearance and characteristics of abnormalities.
Indications
• A suspicious area on mammography or ultrasound. This may include:
 Microcalcifications on MRI.
 BI-RADS score of 4 or 5 on mammography, ultrasound, or MRI.
• A suspicious hard palpable lump
• Skin changes like crusting, scaling, or dimpling of the breast, which may signal an
underlying breast cancer
• Abnormal nipple discharge
Methods of breast biopsy
1.Triple test: it includes clinical breast examination (CBE), Imaging (USG MRI Mammography)
and needle biopsy (Fine needle, core needle)
2.Fine Needle Aspiration Cytology (FNAC): Is a percutaneous ("through the skin") procedure
that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of
cells from a solid mass.
3.Core needle biopsy (CNB): This method is usually done under ultrasound guidance and
involves using two needles, one inner "puncture" needle that is inserted into the mass, and a
wider gauge needle with an open "gap" or "trough" on one side that allows for tissue to enter.
A spring-loaded sheath then is triggered by the technician that covers the trough in the needle
to allow sample tissue to be separated and removed for analysis.
4.Stereotactic biopsy: Is done with the help of a specialized device, which provides
mammographic guidance.

5.Vacuum-assisted breast biopsy (VABB): Is a more recent version of core needle biopsy using
a vacuum technique to assist the collection of the tissue sample.
6.Excisional biopsy: Involves surgically removing the suspicious area of the breast to examine it
under the microscope for diagnosis.
B. Vulvar biopsy
A vulvar/vaginal biopsy takes one or more samples of tissue from the vulva or vagina. The vulva
is the outer parts of the female genitals, including the labia, which are often called the lips, and
the clitoris. The vagina is the opening that leads to the cervix, which is the entrance to the
uterus.
Indications

 Malignancy is suspected
 An autoimmune blistering disorder is suspected
 Lesions have atypical vascular patterns, pigmentation or texture
 Condition has not resolved with standard treatment
 Results have implications for the diagnosis and management of systemic illness or
serious local disease (egg, Behcet disease, Crohn disease)
 Removal of a lesion is requested for functional or aesthetic reasons.
The most common types of vulvar skin biopsy are shaved or snip biopsy, punch biopsy,
incisional or excisional biopsy.

C. Cervical Biopsy
A cervical biopsy is a procedure in which a small sample of tissue is removed from the cervix
and the cells are examined under a microscope for abnormalities. Cervical biopsies are used to
diagnose cancer or precancerous cervical cells.
The cervix contains two parts: the endocervix and the exocervix.
The endocervix is the upper part that leads to the uterus.
The exocervix is the lower area that’s exposed to the vaginal canal.
Cancer cells most often develop in between these two areas in what's called the
“transformation zone.” In order to properly diagnose cervical cancer, doctors perform
a biopsy of this tissue if a Pap smear yielded abnormal results.
Purpose

 The presence of abnormal cells during a Pap smear


 Testing positive for HPV
 A growth or lump on your cervix
 Genital warts
 Irritation or inflammation of the cervix
 Experiencing bleeding after sex
 Abnormal or excessive vaginal bleeding
 Ongoing abnormal vaginal discharge

Types of cervical biopsy


1. Colposcopic biopsy
A colposcope is an instrument that gives doctors extra light and magnification to see the tissues
of the vagina and cervix more clearly, but it doesn't go inside the vagina. Instead, the doctor
places it just outside of the vagina to get the clearest view possible. If an area of concern is
detected using this colposcope, the doctor typically takes a biopsy of the cervical tissue using a
different instrument.
Colposcopy biopsy procedure: The doctor looks for abnormal areas in the cervix through a
colposcope. Using forceps meant for biopsies, the doctor removes a small area on the surface
of the cervix for testing. A colposcopy biopsy may cause some cramping and possibly brief pain.
Afterward, the patient may experience a small amount of bleeding or discharge

2. Endocervical curettage (ECC)


Endocervical curettage, also known as endocervical scraping and is performed as part of the
colposcopic exam, especially if the cervix appears abnormal. It's also done when the
transformation zone isn’t visible with a colposcopy.
Endocervical curettage procedure: The doctor inserts a small, thin tool—either a curette (which
looks like a narrow spoon) or a brush— into the endocervical area. This tool is then gently
scraped against the walls of the cervical canal, removing some of the tissue. Similar to a
colposcopy biopsy, this may cause light cramping and bleeding.

3. Cone biopsy
Also known as conization, this is when a piece of tissue shaped like a cone is removed from the
cervix for testing. The cone may include tissue from both the endocervix, as the point of the
cone, and the exocervix, as the base. The sample may also include the transformation zone.
This type of biopsy is used to remove precancers completely and even treat cancer if it's in an
early stage. Cone biopsies are performed using either a scalpel or laser.
Cone biopsy procedure: A colposcope is used to help guide the instruments to retrieve the
sample. A cone biopsy may be performed in one of three ways:
a) LEEP: During a loop electrosurgical excision procedure (LEEP), the doctor removes the
tissue sample with a heated wire loop that acts as a knife. It may be done under local
anesthetic in the doctor's office. This may also be called large loop excision of the
transformation zone (LLETZ).
b) Cold knife cone biopsy: This procedure is done in a hospital, and instead of a heated
wire, the doctor takes a tissue sample with a scalpel, similar to what is used during
surgical procedures. Because of this, the patient may receive stronger anesthesia, such
as general anesthesia that puts her to sleep, or spinal or epidural anesthesia.
c) Laser: During this procedure, laser is used to remove the cervical tissue.

4. Punch biopsy
Punch biopsy procedure: The doctor may use a dye to highlight areas of concern on the cervix.
He or she then uses a small tool called punch biopsy forceps, which is hollow with a sharp,
circular tip. The doctor turns the tool to the left and right so the tool will lower approximately 4
millimeters deep into the skin. The biopsy instrument is then removed with the sample inside of
it.
The patient may be given a local anesthetic, either through an intravenous (IV) line in the arm
or by mouth. With general anesthesia, the patient stays in a recovery room after the procedure
until it's safe to go home.
5. Wedge biopsy
this is done if definite growth is visible. Any necrotic tissue is to be avoided. A nearer the edge is
the ideal site.
wedge biopsy procedure:
 posterior vaginal speculum is introduced.
 anterior and posterior lip of cervix is to be held by Allis forceps.
 with a scalpel, a wedge of tissue is cut from the edge of lesion including adjacent
healthy tissue for comparative histologic study
 hemostasis may be achieved by gauge packing or by sutures.

Preparation for a cervical biopsy


 Refrain from using any medications, creams or powders in or around the vagina for 24
to 48 hours.
 Avoid vaginal intercourse or tampons for 24-48 hours before and after the procedure.
 Ask about taking over-the-counter medications for pain before the procedure.
 Make sure not to schedule a biopsy during the menstrual cycle because it may skew
results.
 Inform the doctor in the event of pregnancy.
Risk and complication associated with cervical biopsy

 Bleeding
 Foul-smelling vaginal discharge
 Fever and/or chills
 Severe pain in the lower abdomen
 Contact the care team if any of the above occur

D. Endometrium Biopsy
An endometrial biopsy is the removal of a small piece of tissue from the endometrium, which is
the lining of the uterus. This tissue sample can show cell changes due to abnormal tissues or
variations in hormone levels. this biopsy is taken by using a thin plastic tube like straw or
suction tube by creating a suction i.e. Vacuum-assisted biopsy.
Purpose

 An endometrial biopsy may be performed to help diagnose abnormalities of the uterus.


It can also rule out other diseases
 find the cause of postmenopausal bleeding or abnormal uterine bleeding
 screen for endometrial cancer
 evaluate fertility
 test your response to hormonal therapy
Indications

 Abnormal uterine bleeding


 Evaluation for endometrial neoplasia or precancerous hyperplasia
 Surveillance of previously diagnosed endometrial hyperplasia or cancer
 Evaluation of uterine response to hormone therapy

Contraindications
Absolute Contraindications

 Pregnancy
 Acute pelvic inflammatory disease
 Acute cervical infection
 Acute vaginal infection
 Cervical cancer
 Lack of patient consent
Relative Contraindications

 Morbid obesity
 Cervical stenosis or severe narrowing of the cervix
 Clotting disorder or coagulopathy
 blood clotting disorders

MALE REPFRODUCTIVE ORGAN BIOPSY


1)Testicular biopsy
2)Prostatic biopsy
A. Testicular biopsy
Testicular biopsy is a procedure in which a small portion of testicle is removed for examination.
It is done through open biopsy or needle biopsy.
Indications
there are very precise indications for testicular biopsy, and they are primarily in the context of a
male -factor infertility evaluation.it is done when a semen analysis suggests that there is
abnormal sperm and other test have not found the cause.in some cases sperm obtained from a
testicular biopsy can be used in invitro fertilization. this biopsy can provide information
regarding spermatogenesis and the suitability of sperm for in vitro fertilization. Suspected
testicular cancer is not an indication for a testicular biopsy (this is because the combination of
the ultrasound and blood marker test is usually sufficient to make a firm diagnosis. also, a
biopsy may injure the testicle and spread cancer into the scrotum, which is not usually
affected).

B. Prostatic biopsy
a prostate biopsy is a procedure to remove samples of suspicious tissue form the prostate. The
transrectal approach is the most common; the client is placed in the sims position. A rectal
examination is performed to identify any hard nodules. the biopsy is performed with ultrasound
guidance for the needle position. from 6 to 12 cores may be removed for microscopic
examination.
A prostate biopsy may be done in several different ways:
Transrectal method. This is done through the rectum and is the most common.
Perineal method. This is done through the skin between the scrotum and the rectum.
Transurethral method. This is done through the urethra using a cystoscope (a flexible tube and
viewing device).
Indications
A prostate biopsy is used to detect prostate cancer. physician may recommend prostatic biopsy
if:

 A PSA test shows levels higher than normal for age


 if lumps or other abnormalities during a digital rectal exam
 if the patient had a previous biopsy with a normal result, but still have
elevated PSA levels
 A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous
Contraindications

 significant coagulopathy
 painful anorectal conditions
 severe immunosuppression
 acute prostatitis

Nursing Considerations (Responsibilities)


Before the Test
• Confirm the patient’s identity using two patient identifiers according to facility policy.
• Describe the procedure to the patient, and explain that breast biopsy permits microscopic
examination of a breast tissue specimen. Offer her emotional support, and assure her that
breast masses don’t always indicate cancer.
• Inform the patient scheduled for a needle biopsy that she’ll need to sit still during the
procedure.
• If the patient is to receive a local anesthetic, advise her that she doesn’t need to restrict food,
fluids, and medication. If she’s to receive a general anesthetic, advise her to fast from midnight
before the procedure until after the biopsy.
• Tell the patient who will perform the biopsy, and where and when it will be done. Explain that
pretest studies, such as blood tests, urine tests, and chest X-rays, may be required.
• Make sure the patient or a responsible family member has signed an informed consent form.
• Check the patient’s history for hypersensitivity to anesthetics.

During the Test


• Remind the patient undergoing a needle biopsy to sit still.
• Assist with the collection of specimens into the appropriate container, if indicated.
• Complete the histopathology request form ensuring it matches patient identity and includes
all relevant clinical details, particularly relevant previous treatment, procedures and biopsies.
Record the details of the procedure in the patient’s record, including details of the local
anesthetic and any medication given.
.
After the Test
• If the patient has received a general or local anesthetic, monitor the patient’s vital signs
regularly. If she
has received a general anesthetic, check her vital signs every 15 minutes for 1 hour, every 30
minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours.
• Administer analgesics for pain, as ordered, and provide ice bags for comfort.
• Instruct the patient to wear a support bra at all times until healing is complete.
• Observe for and report bleeding, tenderness, and redness at the biopsy site.
• Provide emotional support to the patient awaiting diagnosis.

Teaching to the patient

In the first 24 hours after procedure:


 Drink 8 to 12 (8-ounce) glasses of liquids.
 Eat well-balanced, healthy meals.

The first 4 days after procedure, may have vaginal discharge that looks like menstrual bleeding.
The amount varies for everyone.
 Use sanitary pads for vaginal discharge.
 Over the next 2 to 3 weeks after procedure, vaginal discharge will become clear and
watery and then will stop.

For 4 to 6 weeks after procedure or until healthcare provider tells cervix is healed:
 Don’t put anything inside vagina (such as tampons and douches) or have vaginal
intercourse.
 Take showers instead of baths. Don’t soak in water (such as swimming pools, hot tubs,
or baths).
 Don’t do any heavy housework (such as vacuuming, yard work, or carrying groceries or
laundry).
 Don’t lift objects over 10 pounds (4.5 kilograms).
 Don’t do any strenuous exercise (such as running and aerobics).

next period may be late, or may have a heavier blood flow than usual.

If any of the following symptoms are seen post biopsy emergency visit to hospital is required:
 A fever of 101° F (38.3° C) or higher
 Chills
 Large blood clots or heavy bleeding that fills a sanitary pad every 1 to 2 hours
 Vaginal discharge that smells bad or has a very strong smell
 Pain that isn’t helped by pain medications
 Any other questions or concerns

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