Biopsy vs.

FNAC
Brainstorming Of Histotechnologist In Quality Assurance (Step-1)
Muhammad Luqman Qadir
Histopathology Laboratory Technologist
Chughtai Health Care Center
What is Biopsy?
• A biopsy is a medical test
commonly performed by a
surgeon, an interventional
radiologist, or an
interventional cardiologist.
The process involves the
extraction of sample cells or
tissues for diagnosis or
extent of a disease.
Types of Biopsy
• Punch Biopsy: A punch biopsy involves the removal of a skin sample, includes the
epidermis, dermis, and superficial fat, to investigate skin growth or lesion.
• Endoscopic Biopsy: An endoscopic biopsy is a technique that uses a thin, flexible
tube to see the inside of the body. Typically used to obtain samples from the
stomach, colon, esophagus, lung, or pancreas.
• Endometrial biopsy: A vacuum-assisted biopsy uses a suction device to collect a
tissue sample through a specially designed needle.
• Excisional biopsies involve removing entire lumps or suspicious areas.
• Incisional biopsies involve taking tissue samples of lumps or suspicious areas.
• Core Biopsy: The tissue removed during a core biopsy comes out as a long,
narrow piece.
• Mucosal biopsy is the removal of a small piece of skin or mucous membrane or
tissue.
• Shave biopsy: scraping or shaving a thin layer
Pictorial presentation

Mucosal Biopsy Core Biopsy

Incisional Biopsy
Fine-needle Aspiration Cytology (FNAC)
• FNAC stands for Fine Needle
Aspiration Cytology. It is a minimally
invasive diagnostic procedure used to
obtain cells from a lesion or mass
through a thin needle for cytological
examination.
• FNAC is commonly performed by
trained pathologists, radiologists, or
clinicians in various medical
specialties, including oncology,
radiology, and surgery.
Types of FNAC Technique
Difference between FNAC and Biopsy
Importance of Margin in histopathology
• Assessment of Completeness of
Resection
• Risk of Local Recurrence
• Prognostic Significance (Negative margins
are generally associated with better outcomes and
lower rates of recurrence compared to positive
margins. Therefore, margin status provides valuable
prognostic information to guide further treatment
decisions and follow-up strategies).

• Guiding Adjuvant Therapy (Margin status

influences decisions regarding the need for adjuvant
therapy such as radiation therapy or chemotherapy).

• Quality Assurance in Surgery

• Margin Clearance Guidelines
Common Terminology in Surgical Pathology
• Histology: A branch of anatomy that deals with the minute structure of animal
and plant tissues as distinct with the microscope.
• Autopsy: Postmortem evaluation of a body to determine the cause and manner
of death.
• Biopsy: Removal of cells or tissues from the body for pathological examination.
• Blocks: Hardened tissues encased in wax blocks that are cut to produce glass
microscopic slides.
• Core Biopsy: A biopsy in which a cylindrical sample of tissue is obtained (as from
a kidney or breast) by a hollow needle. A core biopsy is a procedure where a
needle is passed through the skin to take a sample of tissue from a mass or lump.
• Cyst: A sac or pouch containing fluid or other materials that is encased by a tissue
membrane.
• Cytopathology: A subspecialty of anatomic pathology that focuses on the
diagnosis of diseased cells in specimens derived from body fluids or aspirated
tissue.
Common Terminology in Surgical Pathology
• Effusion: An abnormal collection of fluid in one or more of the body spaces.
• Excision: Surgical removal of tissue with a scalpel. Excision simply means “to cut out.”
• Incision: refers to a cut or a wound made by a sharp instrument, such as a scalpel, during
a surgical or medical procedure. Incisions are intentionally created to access underlying
tissues, organs, or structures for various purposes, including surgery, medical
interventions, or diagnostic procedures.
• Gross Description: An examination based on a description of material that is visible to
the naked eye.
• Lesion: A region in an organ or tissue which has suffered damage through injury or
disease, such as a wound, ulcer, abscess, or tumour.
• Lymphoma: A malignant proliferation of lymphocytes, which are cells involved in
immune function.
• Lipoma is a benign (non-cancerous) tumor composed of adipose (fat) tissue. It is one of
the most common types of soft tissue tumors. Lipomas typically develop slowly over
time and are usually small, soft to the touch, and movable under the skin.
Common Terminology in Surgical Pathology
• Mastectomy: Medical term for the partial or complete surgical removal of
a breast.
• Microscopic: Visible only with a microscope and not with the naked eye.
• Microtome: A device with a sharp blade, used in the laboratory for cutting
tissues so that they can be affixed to glass slides and examined with a
microscope after staining with biological dyes.
• Polyp: A specific type of abnormal growth on the skin or on mucous
membranes, which projects above the surfaces of those tissues.
• Prognosis: An informed estimate of the probable course and biological
behavior of a disease process.
• Appendectomy: An appendectomy is removing the appendix.
• Cholecystectomy: A cholecystectomy is surgery to remove the gallbladder.
• An endoscopy is a procedure used in medicine to look inside the body.
Common Terminology in Surgical Pathology
• Hysterectomy: A hysterectomy is surgery to remove a woman's uterus.
• Partial colectomy: A partial colectomy is removing part of the large intestine
(colon).
• Prostatectomy: A prostatectomy is removing all or part of the prostate gland.
• TURP: Transurethral resection of the prostate (TURP) is a surgery used to treat
urinary problems that are caused by an enlarged prostate.
• BPH: Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a
noncancerous increase in size of the prostate gland.
• Tonsillectomy: A tonsillectomy is removing of one or both tonsils.
• A thyroidectomy is an operation that involves the surgical removal of all or part
of the thyroid gland.
• Parathyroidectomy is the surgical removal of one or more of the (usually) four
parathyroid glands.
• Adrenalectomy is the surgical removal of one or both adrenal glands.
Common Terminology in Surgical Pathology
• Laryngectomy is the removal of the larynx and separation of the airway from the
mouth, nose and esophagus.
• Splenectomy is the surgical procedure that partially or completely removes the
spleen.
• Esophagectomy is the surgical removal of all or part of the esophagus.
• A pancreaticoduodenectomy, also known as a Whipple procedure, is a major
surgical operation most often performed to remove cancerous tumors off the
head of the pancreas. It is also used for the treatment of pancreatic or duodenal
trauma, or chronic pancreatitis. Due to the shared blood supply of organs in the
proximal gastrointestinal system, surgical removal of the head of the pancreas
also necessitates removal of the duodenum, proximal jejunum, gallbladder, and,
occasionally, part of the stomach.
• Orchiectomy is a surgical procedure in which one or both testicles are removed,
as a form of castration.
• Oophorectomy is the surgical removal of an ovary or ovaries.
• Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of
uterine leiomyomas, also known as fibroids.
 • Quality system
• Quality assurance
Quality a) Pre-analytical (Step-1)
Management b) Analytical
c) Post analytical
• Quality control
Biopsy Collection, Handling and
Rejection
Proper sample collection and appropriate rejection
criteria are essential to maintain the quality and
integrity of the specimens being analyzed.
Sample Collection
and Handling
• Proper Identification (Request
Form)
• Proper Labeling
• Sample Preservation
• Sampling Technique
• Tissue Handling
• Sample Size
• Timeliness
Request Form
Total Fixation Time
• Warm Ischemic Time
• Cold Ischemic time
• Transport time from
• Additional Fixation
Time
• Fixation Time In
processor
Proper Labeling
• Patient Name, Date of Birth
and Gender
• Accession number
• Site of specimen
• Source of specimen (e.g.
skin)
• Don’t attach the labels on
container lid
• Don’t overlap the labels that
result in covering the patient
details
Tissue Handling
(Avoid Mechanical
Trauma)
Typical crush artifact is shown
in this section of lymphoid
tissue. It is characterized by
dark, distorted cell nuclei,
some of which are extremely
elongated and intensely
basophilic .
Prevent Specimen
Drying

• Specimen is not
allowed to dry out prior
to fixation. If immediate
fixation is
not practicable, gauze
moistened with saline
can be used to prevent
this.
Avoid Heat • A localized area at the edge of this breast specimen
exhibits strong acidophilic with a loss of nuclear and
Damage cytoplasmic detail. These effects are the result of
heat damage caused when cautery was used during
the removal of the specimen. Adjacent glandular
tissue is unaffected
Avoid Chemical Damage

• Monsel’s solution (ferric subsulphate

solution) is a topical hemostatic
agent used to control bleeding following
mucosal biopsy. It causes coagulation and
necrosis of the mucosal surface. If it is
applied before a biopsy is taken it
causes local basophilia and signs of early
necrosis, masking pathological changes
that may be present. Monsel’s solution
artifact is most commonly seen when
the patient is rebiopsied or wider excision
is done later. The effects are seen
in micrograph A of a H&E stained cervical
biopsy. Micrograph B, stained with
Perl’s method, shows the extensive
deposition of iron on the specimen
surface.
Check
Fixative
pH
Expedite Large
Specimen Fixation

• The specimen dimensions

allow rapid penetration of the
fixative. Large specimens
should be rapidly transported
to the lab to allow grossing
(tissue slices of 4-5mm
thickness can be prepared to
allow proper fixation to
occur).
Sample Size (Use
Sufficient Fixative and
a Suitable Container)

This container is too small for

the mass of tissue it contains.
There is insufficient fixative
present and the specimen
may well have been distorted
as it was pushed into the
container.
Fixation Time for
Specific Specimen
• Establish standardized
fixation time for all routine
and specialized biopsy
• Document the recommended
fixation time
• Establish the acceptance and
rejection polices related to
fixation time
Contact Information
in LIS

• Laboratory uses the

alternate identifiers
for patient that must
be the unique,
specific and traceable
in LIS.
Maintain the Chain
of Custody

All the specimen must be signed of

chain of custody from carried out by
transporter and logged into LIS of
pathology department foe
accessioning.
• Transporter login
• SMD login
• Laboratory personnel login
• Transcriptionists Login
• Consultant Login
Sample Rejection
• Inadequate Fixation
• Poor Labeling
• Contamination
• Insufficient Tissue
• Incorrect Container/Fixative
• Transportation Issues
• Unlabeled or Misidentified
Specimens
• Delay in Processing
Fixation Artifacts
Properly versus poorly fixed tissue
A paraffin section of kidney that has been fixed using neutral
buffered formalin. This is an example of poorly-fixed tissue
showing inferior nuclear and cytoplasmic morphology with
excessive shrinkage and poorly defined cell margins. Note the
vacuolation and fragmentation of both nucleus and cytoplasm of
cells of the distal tubule and retraction of the glomerulus due to
shrinkage.

A paraffin section of biopsy that has been fixed using

neutral buffered formalin. This is an example of well-fixed
tissue showing good nuclear and cytoplasmic morphology
with minimal shrinkage showing clearly defined basement
membranes and cell margins.
 Tissue Processing

Xylene
10 % Formalin
Ascending Gradient Paraffin wax
of Alcohol
Embedding Machines
Microtome
Slide Stainers & Cover slippers
Microscope
Common histological stains
Stain Color Notes
Aldehyde fuchsin Black/Purple Use for beta cell of pancreas

Alkaline Red/Blue Used for Endothelial tissue

phosphatase

Alcian blue Blue Common mucin stain

Eosin Pink/Red typical for general staining when combined with hematoxylin
Image is of normal skin

Hematoxylin Blue/Purple typical for general staining when combined with hematoxylin
Image is of normal skin

Giemsa Blue/violet/pink commonly used in blood or bone marrow smears

Reticulin stain Blue/black stains reticular fibers
Sudan black Brown/black Stain myelin cells
PAS Red/ Magneta used to stain glycogen, basement membranes, reticular fibres, cartilage, glycoproteins,
glycolipids and mucins in tissues
Tumor Markers
Reporting
Reporting