BI

OPSY
  
Biopsyi
sder
ivedf
rom aGr
eekwor
d(By
-op-
see)=Bi
o–meani
ngLI
FEandOpsy
–TOLOOK.

 Thi
sisthesur gical
removalofatissuespeci
meninalivi
ngbodyforthepurpose
ofexaminati
onanddi agnoses.I
tcouldalsobet
herapeut
ici
nval
uableinthemgt
ofcert
ainsurgicall
esi
ons.

HI
STORY

 1870,RugeandJoham Ver ti
nBer l
i
ni ntr
oducedsurgicalbi
opsyasan
essenti
altoolfordi
agnosis.
 1889,Emar chputforwardanargumentt hatconfi
rmat i
onsshoul
dbe
madebef oresurgeri
esformalignancies.
 Will
iamshal st
ed1stintr
oducedt hi
spr i
ncipl
einUnit
edSt at
es.
 1941,studyofexfoli
atedcell
sfrom femalegenit
altractbyPapani
col
aou.

AI
M
 Toestabli
shtissuediagnosi
s
 Gradetumors
 Todetectreceptors
 Forscreeni
ngpur poses
 Detecti
ngenzy mesandant i
gens
 Monitori
ng,tr
eatment,recur
renceandpr
ognosi
s
 Researchpurposes
 Medicolegal

I
NDI
CATI
ONS
 Anyl esiont hatper sistsformor ethan2weekswi thnoappar enteti
ologi
c
basi s
 Anyi nflammat orylesionthatdoesnotr espondt ol ocaltr
eatmentafter10
to14day s.
 Per sistenthy perkeratoti
cchangesi nsur facetissues.
 Anyper si st
entt umescence, eit
herv isibl
eorpal pabl ebeneathrel
ativ
ely
nor mal tissue.
 Ev aluat ionandmoni toringofti
ssuer ej
ecti
onaf tert r
ansplanti
on–kidney
andl i
ver
 Infl
ammat orychangesofunknowncauset hatper sistforlongperi
ods
 Lesi ont hati nterfer
ewi t
hlocalfunction
 Bonel esi onsnotspeci fi
call
yidenti
fiedbycl i
nical andr adi
ographic
findings
 Anyl esiont hathast hecharacteri
sticsofmal ignancy
CONTRAI
NDI
CATI
ONS

 Uncontr
oll
edbleedi ngdiat
hesi
s
 Anti
coagulanttherapy
 Over-
whelmingsepsi s
 Sever
eimpai r
edl ungfuncti
on
 Uncooperati
ve/Unwi l
l
ingpati
ent
 Locali
nfecti
onneart hesit
e

 Biopsyissenti n10%f ormaldehy desol ut i

on.Inspecial caseslike,toassess
receptor
s/todohi stochemistry,biopsyi ssenti nlowt emper ature;innormal
sali
neorinspeci ali
sedingredients.Ti ssuesar ekepti nf ormali
nf or24hour sand
thentakenfor‘ cutup’ bypathologists.Sect ionsaredoneaf t
ermaki ngtissue
blocksusingmi crotomeupt o5mi cronst hickness.Thesesect i
onsar eplacedon
aslideforstainingwi thhaemat oxy li
nandeosi n.Det ailedhistory,f
indi
ngs,
mar ki
ngsoft hespeci menshoul dbedonebyt hesur geonpr iortosendingt he
specimen.Bonespeci mensar edecal cifiedinhy drochloricacidfor7-21day s
beforesecti
oni ngandst ai
ning.Soi tsr eportwi l
lbedelay edusual l
y.

STORAGEOFSLI
DES/
BLOCKS

 Speci
mensar
ekeptf
or6weeks.

 Bl
ocksar
ekeptf
or30y
ear
s.

 Sl
i
desar
ekeptf
or10y
ear
s.

STAI
NS

Oftenaddi t
ionalmet hodslikedeepersect
ions;ext
rablocks;
speci
alst
ainsar
e
needed.
Specialstai
nsar ePAS( PeriodicAci
dSchi
ff)forgl
ycogen,muci
nandfungi;
PerlsPrussianbl ueforironinhaemochromatosis;
Reticul
inforfibroustissue;
El
ast i
nstainsf orfi
brosis;
Congor edf oramy loi
d;
Ziehl-
Neelsenf ormy cobacteria;
Grocottforfungi;
 Gi
emsast ai
nforprot
ozoa;
Wart
hin-
Star
rystai
nforspi
rochaet
es.

TYPESOFBI
OPSI
ES

 CLOSEDI
NDI
RECTBI
OPSY
 FNABC

 Cor
eneedl
ebi
opsy(
tru-
cut
,Abr
am’
s,
vi
msi
l
ver
man,
menghi
ni)

 Punchbi
opsy

 Loopbi
opsy

 Endoscopi
cbi
opsy

 CLOSEDI
MAGEGUI
DEDBI
OPSY

 St
ereot
act
ic

 Ul
tr
asound,
CT,
MRI

 OPENDI
RECTBI
OPSY

 I
nci
sional

 Exci
sional

 mar
ginal

 wi
del
ocal

 r
adi
cal

ASPI
RATI
ONBI
OPSY

Aspi
rat
ionbi
opsyi
stheuseofaneedl
eandsy
ringet
openet
rat
eal
esi
onf
or
aspi
rat
ioni
fit
scont
ents.
  I
ndi
cat
ions:

o Todet
ermi
net
hepr
esent
soff
lui
dwi
thi
nal
esi
on

o Toascer
tai
nthet
ypeoff
lui
dwi
thi
nal
esi
on

o Whenexpl
orat
ionofani
ntr
aosseousl
esi
oni
sindi
cat
ed

 Procedure:
 I ti
sdoneusi ng23or24gaugeneedl efixedtospeciali
sed
syringeswhi chcr
eatesnegat i
vepressur eforaspi
rationand
cont ent
sar esmearedont heslides.Dr ysli
desaswel lassli
des
fixedwi t
h100%met hanolareusedf orstudy.
 Iti
sdonei nparotid,t
hyr
oid,lymphnode, breastandallothersurface
l
esions.
 Infoll
icularcarcinomaoft hyroi
ditisnotver yuseful
,asangi oi
nvasi
on
andcapsul arinvasionwhichar especi
ficcannotbedet ected..

Fi
neneedl
easpi
rat
ioncyt
ology(FNAC)ofthyroi
d.I
tisalsodonei
nbr
east
,ly
mph
nodeandot
herswell
i
ngs.I
tisnotdonefortesti
cul
artumour
FNACvacuum cr
eat
orwi
thl
oadedsy
ringe[ Camecosy
FNACgun; ringe(
Sweden)
hol
der
]

CORENEEDLEBI OPSY
 Ski ncleansing+LA
 Smal lskininci sion
 Lesi onappr oachatanangl e450
 St abil
izethel esionandi ntr
oducet heneedlev i
atheskinunti
li
tabuts
againstthel esi on
 Ful l
ymechani cal bi
opsyguni st henfi
red
 I ti
sdoneusi ngaspeci al
iseddev i
cewher eingunwithtr
ucutti
pisinserted
i
ntot hesurf acet issue/organandguni sfir
edtoclosethepunchingti
pof
theneedl etocat chandcutadequat etissue.I
tisdoneinprostat
e,breast
andsur facet umour s.I
tcannotbedonet odeeperti
ssuesorti
ssueswhi ch
arecloset omaj orv essels/st
ructur
es.
Tr
ucutbiopsygunusedf
ort
rucutbi
opsy
.Itgi
veshi
stol
ogi
cal
diagnosi
s/ort
oassess
hi
stochemist
ry.

I
NCI
SIONALBI OPSY
 Anincisional
biopsyi
sthesurgical
sampl i
ngofalesi
on(repr
esent
ati
vepar
t).
 Ifalesionislar
georhasdif
ferentcharact
eri
sti
csinvar
iousl
ocati
onsmore
thanonear eamayneedtobesampl ed

 I
ndicati
ons:
 Sizel i
mitati
onsandulceratedlesion
 Hazar dousl ocat
ionoft
hel esi
on
 Gr eatsuspicionofmali
gnancy
 Pr
incipl
e:
 Repr esentativ
eareasarebiopsiedinawedgef ashi
on.
 Mar ginsshoul dext
endintonormal ti
ssueonthedeepsurf
ace.
 Necr oti
ct i
ssueshouldbeav oi
ded.
 Anar r
owdeepspeci meni sbetterthanabroadshall
owone.

EXCI
SIONALBIOPSY
 Anexcisi
onalbi
posyi
mpl
i
est
hecompl
eter
emov
aloft
hel
esi
on.

 I
ndi
cat
ions:

 l
esionsLesst han1cm
 Thelesi
ononcl i
nicalexam appear
sbeni
gn.
 Whencompl et eexcisi
onwithamar gi
nofnor
mal
tissuei
spossi
ble
wit
houtmutilation.
  Techni
que:
 Skininci
sionshoul dbecur v
il
inearandfoll
owt helangersli
nes
 Theent i
relesionwith2t o3mm ofnor mal appeari
ngt i
ssue
surroundi
ngt helesionisexcisedifbeni
gn
 2–3cm i fmal ignant.
 Lesionswithin5cm ofar eol
armar gin-
--
-circumareolar
 Tissueforcepsshoul donlybeappl i
edwhent helesionhasbeencl
ear
ly
defined

ENDOSCOPICBIOPSY
 Gast
roscopi
corcol
onoscopi
cort
hroughERCP,
orcy
stoscopi
c,ar
thr
oscopi
c

OPENBI
OPSY

 Lapar
otomy
 –Thoracotomy
 -Crani
otomyusi
ngdandy
`sbr
aincannul
a

FROZENSECTIONBIOPSY
 Donewheneverr
epor
tisneededatt
heear
li
estt
ime.

 Hereanunf
ixedfr
eshti
ssuei
sfr
ozen(
usi
ngCO2)i
namet
alandsect
ions
ar
emadeandst ai
ned.

 PI
TFALLS

 Techni
cal
l
ydi
ff
icul
t

 Di
ff
icul
ttogetaccur
ater
esul
t

 ADVANTAGES:
-It
squi
ckandsur
geonscandeci
det
hef
urt
herst
epst
o
fol
l
ow

 USES:
-

 CAbr east
 Foll
icul
arCAofthyroi
dwhenFNACf ail
s
 foraccessi
ngon-t
ablecl
ear
ancemar gi
nanddepth.
 studyoflymphnodesandthei
rposi
tivi
tyf
ormali
gnancy
.
STEREOTATI
CBI
OPSY

 Thi
susesimageintensi
fi
ert
oenhancet heaccuracyofthesiteofthe
bi
opsy.Radi
ologi
cali
magesoft hesit
eoft helesi
on,thelocati
onthesize
andtheshapethedeptandothercharacter
ist
icsareempl oyedinordert
o
 i
ncr
easetheaccur
acyofthepr
ocedur
ethi
sinv
olv
esul
tr
asoundCT-
scan
MRIandmammogr aphy
.

EXFOLI
ATI
VEBI
OPSY

 Exfol
iat
ivecytologyi sthehistopat hologicexami nat
ionofcellsthathave
beenobtainedbyt heirphysicalremov al,fol
lowedbyt heirpl
acementona
gl
asssl i
de,andt henappr opr i
atelystained.Thet erm"Papsmear "i
s
commonl yusedf orexfoli
ativecy t
ology ,butitonlyr
eferstothemet hodof
stai
ningandisi nhonoroft hemanwhoi screditedwithdevelopingthe
stai
ningtechnique, Dr.Papanicolaou.

ANESTHESI
A

 Gener
al,r
egi
onal,
orlocal-bl
ockanest
hesiaispr
eferr
edtoi
nfi
lt
rat
ion-
whenblockanest
hesiai
snotpossibl
e,di
stanti
nfi
l
trat
ionmaybeused

 Donoti
njectdi
rect
lyi
ntot
hel
esi
on

I
NCI
SIONS

 I
nci
si
onsshoul
dbemadewi
thascal
pel
.

 Shoul
dext
endbey
ondt
hesuspect
eddept
hoft
hel
esi
on

 Theyshoul
dpar
all
eli
mpor
tantst
ruct
ures

 Margi
nsshoul
dincl
ude2to3mm ofnor
mal
appear
ingt
issuei
fthel
esi
on
i
sthoughtt
obebenign.

 5mm ormor emaybenecessar

ywithl
esionsthatappearmal
i
gnant
,
vascul
ar,
pigment
ed,
orhavediff
useborders.

 Longi
tudi
nal
int
heext
remi
ti
es

I
NTRAOPERATI
VECONSI
DERATI
ONS

 Ul
cer
s-

 Avoidcent
ral necroti
careas
 I
ncludeadjoiningnormal t
issue.
 I
ndeeplysituat edti
ssuetakewholethi
cknessandnor
mal
tissue.
 Handleti
ssuesgent lytopreserv
earchi
tect
ure

HANDLI
NGOFTI
SSUESPECI
MEN

 Di
recthandli
ngofthelesionwi
llexposei
ttocr
ushi
njur
yresul
ti
ngi
n
al
ter
ati
ont hecel
l
ulararchit
ect
ure.
  Specimenshoul dbei mmedi atel
yplacedin10%formalinsoluti
onand
shouldbecompl etel
yimmer sed.
 Bouin’
ssol ut
ion( pi
cri
cacid+Acet icaci
d+Formaldehyde)fortest
icul
ar
biopsy(preserv
esnucl ei&chromosomes)andper i
pheralnerv
es.
 Chromat esoluti
onf orchr
omaf i
nomas
 Gluter
aldehydefort i
ssuesforelectr
onmi cr
oscope.

CONCLUSI
ON

 Aswear eintheeraofev i
dence-basedmedici
netheuseofbiopsyi
n
sur
gerycannev erbeov er
-emphasize.
 Acarefulsurgi
calhar
v estofasampl eoft
issuewit
hpert
inenti
nfor
mat
ion
soastoassistthepathologi
stinmakingthecorr
ectdi
agnosisis
par
amount .