Lab Pathology 4: Types of Biopsies

Lab Pathology 4
Introduction
Many medical conditions, including all cases of cancer, must be
diagnosed by removing a sample of tissue from the patient and
sending it to a pathologist for examination. This procedure is called
a biopsy, any organ in the body can be biopsied using a variety of
techniques, some of which require major surgery (e.g., staging
splenectomy for Hodgkin’s disease), while others do not even
require local anesthesia (e.g., fine needle aspiration biopsy of
thyroid, breast, lung, liver, etc). After the biopsy specimen is
obtained by the doctor, it is sent for examination to another doctor,
the anatomical pathologist, who prepares a written report with
information designed to help the primary doctor manage the
patient’s condition properly.
The pathologist is a physician specializing in rendering medical
diagnoses by examination of tissues and fluids removed from the
body. To be a pathologist, a medical graduate (M.D. or D.O.)
TYPES OF BIOPSIES
1. Excisional biopsy A whole organ or a whole lump is removed
(excised). These are less common now, since the development of
fine needle aspiration Some types of tumors (such as lymphoma, a
cancer of the lymphocyte blood cells) have to be examined whole to
allow an accurate diagnosis, so enlarged lymph nodes are good
candidates for excisional biopsies. Some surgeons prefer excisional
biopsies of most breast lumps to ensure the greatest diagnostic
accuracy. Some organs, such as the spleen, are dangerous to cut into
without removing the whole organ, so excisional biopsies are
preferred for these.
2. Incisional biopsy Only a portion of the lump is removed
surgically. This type of biopsy is most commonly used for tumors
of the soft tissues (muscle, fat, connective tissue) to distinguish
benign conditions from malignant soft tissue tumors, called
sarcomas.
3. Endoscopic biopsy This is probably the most commonly
performed type of biopsy. It is done through a fibrotic endoscope
the doctor inserts into the gastrointestinal tract (alimentary
tractendoscopy), urinary bladder (cystoscopy), abdominal cavity
(laparoscopy), joint cavity (arthroscopy), mid-portion of the chest
(mediastinoscopy), or trachea and bronchial system (laryngoscopy
and bronchoscopy), either through a natural body orifice or a small
surgical incision. The endoscopes can directly visualize an abnormal
area on the lining of the organ in question and pinch off tiny bits of
tissue with forceps attached to a long cable that runs inside the
endoscope.
4.Colposcopic biopsy This is a gynecologic procedure that typically
is used to evaluate a patient who has had pathologist.
5.Fine needle aspiration (FNA) biopsy This is an extremely simple
technique that has been used in Sweden for decade (aspirated) into
a syringe. These are smeared on a slide, stained, and examined under
a microscope by the pathologist. A diagnosis can often be rendered
in a few minutes. Tumors of deep, hard-to-get-to structures
(pancreas, lung, and liver, for instance) are especially good
candidates for FNA, as the only other way to sample them is with
major surgery.
Such FNA procedures are typically done by a radiologist under
guidance by ultrasound or computed tomography (CT scan) and
require no anesthesia, not even local anesthesia. Thyroid lumps are
also excellent candidates for FNA.
6.Punch biopsy This technique is typically used by dermatologists
to sample skin rashes and small masses.
7.Bone marrow biopsy in cases of abnormal blood counts, such as
unexplained anemia, high white cell count, Hematologists do bone
marrow biopsies all the time, but most internists and pathologists
and many family practitioners are also trained to perform this
procedure.
With the patient lying on his/her stomach, the skin over the biopsy
site is deadened with a local anesthetic. The needle is then inserted
deeper to deaden the surface membrane covering the bone (the
periosteum). A larger rigid needle with a very sharp point is then
introduced into the marrow space. A syringe is attached to the needle
and suction is applied. The marrow cells are then drawn into the
syringe.

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