BIOPSYfinal 1
BIOPSYfinal 1
BIOPSYfinal 1
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
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
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.
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
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
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:
significant coagulopathy
painful anorectal conditions
severe immunosuppression
acute prostatitis
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