Biopsy (investigation tests)

Content

Introduction

The "biopsy" is an examination that consists in taking a portion or a fragment of tissue to ascertain (diagnose) its nature.

During the examination, a small amount of tissue or a sample of cells is removed from the part of the body to be investigated, to analyze them under a microscope and identify the presence of a disease, follow its progress, and / or evaluate its effectiveness. of a cure.

The biopsy can also be used to assess the severity of an already established disease (for example, the level of inflammation) and its degree (for example, the aggressiveness of a tumor).

In addition, it provides a series of useful information for the doctor to decide on the most suitable treatment or to evaluate the effectiveness of the prescribed drugs.

Biopsy can be used to check for:

  • benign and malignant tumors (cancer)
  • inflammation of the liver (hepatitis) or kidney (nephritis)
  • lymph node infections (for example due to tuberculosis)
  • various skin diseases

Usually, with a simple visit from the family doctor or specialist, it is not possible to verify whether a lump or a new formation are tumors and, in some cases, to find out it is necessary to perform a biopsy.

The exam

Biopsies can be done in many areas of the body. The ways to obtain a sample of the tissue to be examined vary according to the type of material to be taken and the area of ​​the body from which it comes:

  • biopsy punch, it is performed to take small pieces of skin (skin) using a disposable, cylindrical (punch), metal scalpel that allows, with its sharp edge, to obtain circular sections of various sizes and depths of the skin. Typically, it is performed under local anesthesia to numb only the area from which the tissue will be removed. The wound can be closed with a few stitches
  • biopsy by aspirated needle, is carried out using a special empty needle inside that allows you to aspirate a part of tissue or a set of cells. The needle, of variable size, is guided to the area to be collected using X-rays, ultrasound, CT scan or nuclear magnetic resonance imaging (MRI). Often, the test is also used to take cell samples from an organ or from areas that lie below the surface of the skin. If the part to be picked up is large, a larger needle will be used. To prevent the person undergoing the biopsy from feeling pain, the area on which it will be performed is usually asleep using a local anesthetic. This type of biopsy is usually used to analyze lumps in the breast or to take breast tissue. tissue from the bone marrow
  • endoscopic biopsyIt is performed, for example, to take tissue from the stomach during a gastroscopy or from the large intestine (colon) during a colonoscopy. It is done through the endoscope, a thin, flexible tube with a light and a camera at one end. which allows to visualize the inside of the body. Small cutting instruments can be connected to it to allow the endoscopist (surgeon, specialized nurse) to take a sample of tissue. An anesthetic is used during the endoscopic biopsy
  • biopsy of excision (excision), is a "surgical operation used to remove a" larger area of ​​tissue that cannot be picked up with other types of technique. It consists in the elimination of the entire area that has alterations and a portion of the surrounding normal tissues as occurs, for example, for a "sentinel" lymph node (ie a lymph node that can indicate to the doctor the progress of a disease) or a lump in the breast. It is performed by the surgeon in the operating room, usually putting only the area to be operated asleep (local anesthesia). In this case, usually, after the examination you can go home. If, on the other hand, the excisional biopsy it concerns an internal organ you may need to stay in the hospital for one night
  • biopsy perioperative (either extemporaneous or intraoperative), is performed in the operating room during a surgical operation. The removed tissue sample is analyzed immediately to inform the surgeon about the nature of the cells taken while the operation is in progress. The result of the biopsy, in fact, helps the surgeon decide how to continue the operation

At the end of the examination, and in the following days, the person undergoing the biopsy will have to pay attention to the sutures and will have to avoid some movements.

Results

The tissue sample taken with the different types of biopsy is sent to the laboratory where it is cut into thin slices and analyzed under a microscope to observe the shape of the cells that constitute it and to establish whether or not there are abnormal cells.

Biochemical and / or genetic analyzes may also be required.

The results of the examination (report) are dealt with by the specialist in pathological anatomy who analyzed the tissue sample. The report contains all the information and is written by the pathologist for the attention of the treating physician.

Other useful information

Biopsies are generally simple tests, often performed under local anesthesia and, in some cases, can be performed in the clinic. Usually, the person who undergoes it after the exam does not feel any discomfort.

However, if the tissue sample is taken from an internal organ such as the liver or bone marrow, pain may be felt. In these cases, the family doctor or the surgeon himself may prescribe painkillers.

Rarely, blood loss may occur after an internal organ biopsy. In some cases, surgery or a blood transfusion may be required to stop it. It is therefore particularly important that people who have undergone an internal organ biopsy stay in the hospital. Conversely, for other biopsies such as those involving the lining of the cervix (cervix), only light vaginal bleeding may occur for a short period of time.

Bibliography

NHS. Biopsy (English)

Mayo Clinic. Needle biopsy (English)

In-depth link

Italian Association for Cancer Research (AIRC). Exam guide

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