Brain biopsy A biopsy is a medical test involving the removal of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When only a sample of tissue is removed with preservation of the histological architecture of the tissues cells, the procedure is called an incisional biopsy or core biopsy. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy.
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1 Etymology 2 Breast biopsy o 2.1 Fine needle aspiration o 2.2 Core needle biopsy o 2.3 Vacuum assisted biopsy o 2.4 Direct & frontal biopsy o 2.5 Open surgical biopsy 3 Skin biopsy o 3.1 Shave biopsy o 3.2 Punch biopsy o 3.3 Incisional biopsy o 3.4 Excisional biopsy o 3.5 Curettage biopsy o 3.6 Fine needle aspirate o 3.7 "Scoop", "scallop", or "shave" excision
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4 History 5 Cancer 6 Precancerous conditions 7 Inflammatory conditions o 7.1 Kidney disease o 7.2 Infectious disease o 7.3 Metabolic disease o 7.4 Transplantation o 7.5 Fertility 8 Commonly biopsied sites o 8.1 Bone marrow o 8.2 Gastrointestinal tract o 8.3 Lung o 8.4 Liver Analysis of biopsied material 10 See also 11 References 12 External links
[edit] Etymology
Biopsy is of Greek origin, coming from the words bio, meaning life, and opsia, meaning to see.
Liver core needle biopsy. A core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle. For palpable (able to be felt) lesions, the physician fixes the lesion with one hand and performs a freehand needle biopsy with the other. In case of non-palpable lesions stereotactic mammography, or ultrasound, or PEM guidance is used. With stereotactic mammography it is possible to pinpoint the exact location of a mass based on images taken from two different angles of the x-ray machine. With ultrasound, the radiologist or surgeon can watch the needle on the ultrasound monitor to help guide it to the area of concern. With PEM (positron emission mammagraphy), the lesion is targeted in 3D based on a positron emission tomography (PET) image of the breast. The needle used during core needle biopsy is larger than the needle used with FNA. The core biopsy needle also has a special cutting edge allowing removal of a bigger sample of tissue. With core needle biopsy a relatively large sample can be removed through a small single incision in the skin. Typically, the breast area is first locally anesthetized with a small amount of anesthetic fluid. Then, the needle is placed into the breast. As with FNA, the radiologist or surgeon will guide the needle into the area of concern by palpating the lump. If the lesion cant be felt the core needle biopsy is performed under imageguidance using either stereotactic mammography, ultrasound or even magnetic resonance imaging (MRI). A core needle biopsy procedure takes a few minutes to perform and is almost painless.
Surgeon doing a surgical breast biopsy Open surgical biopsy means that a large mass or lump is removed during a surgical procedure. Surgical biopsy requires an approximately 3 to 5 centimeters incision and is normally performed in an operating room in sterile conditions. Open surgical biopsy in some cases can be performed with local anesthesia but in most cases general anesthesia may be necessary. Ten years ago, most breast biopsies were open surgical procedures. Today most patients are candidates for less invasive biopsy procedures such as core needle biopsy. Depending on the location of the lesion to be biopsied, a radiologist will often perform needle localization beforehand to guide the surgeon to the site being biopsied.
When a cut is made through the entire dermis down to the subcutanous fat. A punch biopsy is essentially an incisional biopsy, except it is round rather than elliptical as in most incisional biopsies done with a scalpel. Incisional biopsies can include the whole lesion (excisional), part of a lesion, or part of the affected skin plus part of the normal skin (to show the interface between normal and abnormal skin). Incisional biopsy often yield better diagnosis for deep pannicular skin diseases and more subcutanous tissue can be obtained than a punch biopsy. Long and thin deep incisional biopsy are excellent on the lower extremities as they allow a large amount of tissue to be harvested with minimal tension on the surgical wound. Advantage of the incisional biopsy over the punch method is that hemostasis can be done more easily due to better visualization. Dog ear defects are rarely seen in incisional biopsies with length at least twice as long as the width.
[edit] History
One of the earliest diagnostic biopsies was developed by the Arab physician Abulcasim (1013-1107 AD). A needle was used to puncture a goiter, and the material issuing was characterized.[6]
[edit] Cancer
When cancer is suspected, a variety of biopsy techniques can be applied. An excisional biopsy is an attempt to remove an entire lesion. When the specimen is evaluated, in addition to diagnosis, the amount of uninvolved tissue around the lesion, the surgical margin of the specimen is examined to see if the disease has spread beyond the area biopsied. "Clear margins" or "negative margins" means that no disease was found at the edges of the biopsy specimen. "Positive margins" means that disease was found, and a wider excision may be needed, depending on the diagnosis. When intact removal is not indicated for a variety of reasons, a wedge of tissue may be taken in an incisional biopsy. In some cases, a sample can be collected by devices that "bite" a sample. A variety of sizes of needle can collect tissue in the lumen (core biopsy). Smaller diameter needles collect cells and cell clusters, fine needle aspiration biopsy.[7] Pathologic examination of a biopsy can determine whether a lesion is benign or malignant, and can help differentiate between different types of cancer. In contrast to a biopsy that merely samples a lesion, a larger excisional specimen called a resection may come to a pathologist, typically from a surgeon attempting to eradicate a known lesion from a patient. For example, a pathologist would examine a mastectomy specimen, even if a previous nonexcisional breast biopsy had already established the diagnosis of breast cancer. Examination of the full mastectomy specimen would confirm the exact nature of the cancer (subclassification of tumor and histologic "grading") and reveal the extent of its spread (pathologic "staging").
[edit] Transplantation
Biopsies of transplanted organs are performed in order to determine that they are not being rejected or that the disease that necessitated transplant has not recurred.
[edit] Fertility
A testicular biopsy is used for evaluating the fertility of men and find out the cause of a possible infertility, e.g. when sperm quality is low, but hormone levels still are within normal ranges.[9]
[edit] Lung
Biopsies of the lung can be performed in a variety of ways depending on the location.
[edit] Liver
Main article: Liver biopsy In hepatitis, most biopsies are not used for diagnosis, which can be made by other means. Rather, it is used to determine response to therapy which can be assessed by reduction of inflammation and progression of disease by the degree of fibrosis or, ultimately, cirrhosis. In Wilson's disease, the biopsy is used to determine the quantitative copper level.