biopsy

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During a biopsy, the doctor takes a tissue sample from the patient.He examines these under the microscope to determine cell changes that occur, for example, in cancer or inflammation. Read everything you need to know about the biopsy, how it is performed and what you need to consider.

What is a biopsy?

A biopsy is taking a sample of tissue. The aim is to discover and diagnose pathological changes in the cells through precise microscopic examinations of the sample obtained. A small piece of tissue (less than a centimeter) is sufficient for this. The removed piece of tissue is called a biopsy.

The biopsy is used to confirm a suspected diagnosis - for example, if the doctor suspects a certain disease based on blood tests or an imaging procedure (such as ultrasound, X-rays, computed tomography).

Minimally invasive or surgical

Minimally invasive procedures are often used for a biopsy, such as:

• Fine needle biopsy (fine needle aspiration)
• Punch biopsy
• Vacuum biopsy or vacuum suction biopsy

A kind of special form among the biopsies is the stereotactic biopsy, which is mainly used to obtain tissue samples from the brain. Using imaging (such as computer tomography), tissue is removed from a small drill hole in the skull at a location that has been precalculated with millimeter precision (e.g. from a brain tumor).

Surgical (surgical biopsy procedures), on the other hand, are the incisional biopsy, in which the doctor removes part of the tissue change, and the excisional biopsy, in which the entire suspicious area is cut out.

Fine needle biopsy and punch biopsy

With a fine needle biopsy, the doctor takes tissue or fluids through a wafer-thin cannula that is less than a millimeter in diameter. This method is particularly suitable for the removal of tissue with a rather soft consistency, such as bone marrow or lung tissue. The thyroid, liver and lungs are also often biopsied using this technique.

The punch biopsy is based on the same principle as the fine needle aspiration. However, the doctor uses a larger needle (diameter less than a millimeter). The punch biopsy is used, for example, if breast or prostate cancer is suspected. The needle position is checked by means of imaging processes (e.g. computer tomography) in order to rule out damage to neighboring organs.

Vacuum biopsy (vacuum suction biopsy)

After careful disinfection, the doctor makes an incision about four to five millimeters long in the skin. He pushes a special biopsy needle through this, which consists of an outer and an inner needle. The outer needle forms the opening to a tiny tissue extraction chamber, while the inner needle has a rotating blade. The doctor uses this to cut out a small piece of tissue. A device is attached to the end of the biopsy needle, which creates a vacuum and sucks the cut-out tissue cylinder into the removal chamber of the outer needle.

Since only a very small biopsy can be obtained with this method, the doctor often cuts out four to five cylinders of tissue. The entire biopsy takes about ten minutes and is often done under local or short anesthesia.

When to do a biopsy

The doctor can use biopsies to make a reliable diagnosis of the disease state of an organ. Taking a tissue sample is therefore particularly important when there is a suspicion of cancer such as:

• cervical cancer
• Lung cancer
• Colon cancer
• Skin cancer
• Cancers of the liver and biliary tract
• Prostate cancer
• Breast cancer

In addition, cancer precursors and inflammatory diseases can also be detected by means of a biopsy. These include:

• Vasculitis (inflammation of the blood vessels)
• chronic inflammatory bowel disease (Crohn's disease, ulcerative colitis)
• Inflammation of kidney structures (glomerulonephritis)
• Autoimmune diseases

What do you do with a biopsy?

The procedures differ depending on which organ is to be biopsied:

Prostate biopsy

You can read about how a tissue sample is taken from the prostate and when it is carried out in the article Prostate Biopsy.

Breast biopsy

In the article Biopsy: Breast you can read which extraction techniques play a role in the breast and when they are necessary.

Liver biopsy

How doctors take tissue samples from the liver and which diseases can be diagnosed with them can be found in the article Liver biopsy.

Kidney biopsy

In the so-called percutaneous kidney biopsy, the patient lies on his stomach. The puncture site on the lateral abdominal region is disinfected and a local anesthetic is administered. Since the kidney itself is not sensitive to pain, it is sufficient to numb the overlying skin.

With constant ultrasound control, the doctor now inserts the puncture needle through the tissue into the kidney and punches a tissue cylinder from the organ, which he can retrieve when the puncture needle is withdrawn. Finally, he supplies the puncture canal with a sterile plaster; a seam is usually not necessary.

Lung biopsy

The doctor can sometimes obtain a sample of the lung tissue directly through surgery by opening the chest (thoracotomy).

The biopsy with a bronchoscope is more gentle as part of a lung endoscopy (bronchoscopy): the patient is first given an anesthetic. The doctor then inserts a thin, rigid stainless steel tube through the trachea into the lungs, through which various surgical instruments can be advanced. For example, he can take tissue samples from the lung wall with a small pair of pliers or take a smear with a fine brush.

If lung cancer is suspected, the lungs can be flushed with a saline solution through the bronchoscope, which loosens superficial tumor cells and is sucked out with the fluid. This process is known as bronchial lavage.

If the suspicious area of ​​the lungs cannot be reached with a bronchoscope, the doctor takes the tissue sample as part of a fine needle biopsy: The doctor defines the skin area over which the lungs are to be biopsied. He then sticks a thin biopsy needle through the skin at this point and guides it carefully and under ultrasound control into the desired area of ​​the lungs. There he sucks off some tissue and then pulls the needle back again. No anesthesia is required for the procedure, the puncture is about as painful as a normal blood sample - the patient can be given a local anesthetic if desired.

Bone biopsy

After local anesthesia of the skin over the affected bone, the doctor makes a small skin incision and presses a hollow needle into the bone. As a result, a bone cylinder is punched out, which remains inside the needle and is withdrawn with it. After any bleeding has stopped, the wound is closed with a sterile plaster or suture.

Sentinel node biopsy

Lymph nodes that are first affected when a tumor spreads are called sentinel lymph nodes. To find this, the doctor injects a few milliliters of a weakly radioactive substance (technetium) into the vicinity of the main tumor before the surgical removal of the tumor. This accumulates in tumor cells, spreads through the lymphatic system and is absorbed by the sentinel lymph nodes. There it can be detected with a probe - the sentinel lymph node is identified with it and can be removed.

The removed lymph nodes are examined in the laboratory. If there are no cancer cells in it, the probability is high that the tumor has not yet spread and can be removed more gently. However, if the sentinel lymph nodes that were removed contain cancer cells, all lymph nodes in the tumor drainage area should be excised.

Stereotactic biopsy of the brain

The doctor attaches the so-called stereotactic ring via drill holes to the patient's skull under anesthesia. This should prevent head movements. Using computed tomography images of the suspicious areas of the brain, a computer determines the exact angle at which the cannula has to be inserted into the skull for a biopsy. With the cannula, the surgeon takes several samples from different depths along the suspicious brain area.

Biopsy: uterus and cervix

A biopsy of the cervix is ​​indicated if the colposcopy shows a abnormally altered surface. The patient is given a local anesthetic for the procedure. The doctor then inserts small forceps over the vagina to the cervix and removes a tiny piece of tissue. This is then examined under the microscope. The biopsy of the uterus is based on the same principle.

Placental biopsy

After disinfecting the abdominal skin, the doctor pierces a thin hollow needle under ultrasound control and guides it to the placenta. Cells of the mother cake are aspirated through the needle. In the laboratory, they are examined for various diseases (for example hemophilia or cystic fibrosis).

The placenta biopsy usually only takes a few minutes and can usually be performed without local anesthesia.

Evaluation of the biopsy

After the tissue is taken, the sample is examined in a laboratory by a pathologist. First, however, the biopsy is pretreated in order to prevent degradation processes. To do this, water is first removed from the tissue sample in alcohol baths. Then it is poured into paraffin, cut into wafer-thin slices and stained. As a result, individual structures are highlighted and can be analyzed under the microscope.

When examining the biopsy, the pathologist pays attention to the following points:

• Presence of tumor cells in the tissue sample
• Grade of dignity (benign or malignant tumor)
• Type of tumor
• Degree of maturity of the tumor (grading)
• other cell changes, for example pathogen infestation or tissue remodeling

What are the risks of a biopsy?

The risks of a biopsy differ depending on the extraction method. General risks of tissue harvesting are:

• Bleeding and bruising around the donor site
• Germ colonization and infection of the extraction point
• Wound healing disorders
• Carry-over of tumor cells and formation of metastases in the removal channel (rare)
• Injury to neighboring tissue structures (such as organs, nerves)

Such risks can be reduced by inserting the biopsy needle, for example, under ultrasound control, the patient receiving antibiotics as a preventive measure and properly treating the wound resulting from the tissue removal (careful wound hygiene).

What do I have to consider after a biopsy?

The rules to be followed in the initial period after a biopsy depend on the type of tissue removal and the organ affected. The needle biopsies are usually outpatient procedures so that you can go home after the examination.

If the biopsy was performed during surgery, you will usually need to stay in hospital for follow-up. Again, the length of your hospital stay depends on the type of biopsy; Your doctor will explain the follow-up treatment to you.

In the case of a routine examination, you will receive the result of your biopsy after two to three days, especially if a suspicion of cancer needs to be clarified. If examinations in special laboratories are necessary, it can also take significantly longer.

Tags:  hospital Menstruation skin care