Biopsy 337102 215177488 2008-05-27T01:27:29Z Novangelis 897682 [[WP:UNDO|Undid]] revision 214843531 by [[Special:Contributions/60.50.104.134|60.50.104.134]] ([[User talk:60.50.104.134|talk]]) [[Image:Brain biopsy under stereotaxy.jpg|thumb|Brain biopsy]] A '''biopsy''' (in [[Greek language|Greek]]: ''βίος'' life and ''όψη'' look/appearance) is a [[medical test]] involving the removal of [[Cell_(biology)|cell]]s or [[Biological tissue|tissue]]s for examination. The tissue is generally examined under a [[microscope]] by a [[pathologist]], and can also be analyzed chemically (for example, using [[PCR]] or [[gas chromatography]] techniques). When only a sample of tissue is removed, the procedure is called an ''incisional biopsy'' or ''core biopsy''. When an entire lump or suspicious area is removed, the procedure is called an ''excisional biopsy''. When a sample of tissue or fluid is removed with a needle, the procedure is called a [[needle aspiration biopsy]]. ==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|goiter]], and the material issuing was characterized. <ref>Anderson, J. B., Webb, A.J.: Fine-Needle Aspiration Biopsy and the Diagnosis of Thyroid Cancer. [[British Journal of Surgery]] 74:292-6, 1987</ref> ==Cancer== When cancer is suspected, a variety of biopsy techniques can be applied. An ''excisional biopsy'' is an attempt to remove the 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, [[Needle aspiration biopsy|fine needle aspiration biology]]. <ref>Sausville, Edward A. and Longo, Dan L.: Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy in [[Harrison's Principles of Internal Medicine]], 16th Ed. Kaspar, Dennis L. et al., editors. p.446 (2005)</ref> [[Pathology|Pathologic]] examination of a biopsy can determine whether a lesion is [[Benign_tumor|benign]] or [[Malignant_tumor|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 ([[Staging (pathology)|pathologic "staging"]]). ==Precancerous conditions== For easily detected and accessed sites, any suspicious lesions may be assessed. Originally, this was skin or superficial masses. [[X-ray]], then later [[Computed tomography|CT]], [[Magnetic resonance imaging|MRI]], and [[ultrasound]] along with [[endoscopy]] extended the range. ==Inflammatory conditions== A biopsy of the [[temporal artery|temporal arteries]] is often performed for suspected [[vasculitis]]. In [[inflammatory bowel disease]] ([[Crohn's disease]] and [[ulcerative colitis]]), frequent biopsies are taken to assess the activity of disease and to assess changes that precede malignancy. <ref>Friedman, S. and Blumberg, R.S.: Inflammatory Bowel Disease in [[Harrison's Principles of Internal Medicine]], 16th Ed. Kaspar, Dennis L. et al., editors. pp. 1176-1789 (2005)</ref> Biopsy specimens are often taken from part of a [[lesion]] when the cause of a disease is uncertain or its extent or exact character is in doubt. [[Vasculitis]], for instance, is usually diagnosed on biopsy. ===Kidney disease=== Biopsy and fluorescence microscopy are key in the diagnosis of alterations of renal function. ===Infectious disease=== Lymph node enlargement may be due to a variety of infectious or autoimmune diseases. ===Metabolic disease=== Some conditions affect the whole body, but certain sites are selectively biopsied because they are easily accessed. [[Amyloidosis]] is a condition where degraded proteins accumulate in body tissues. In order to make the diagnosis, the [[gingival]] ===Transplantation=== Biopsies of [[organ transplant|transplanted organs]] are performed in order to determine that they are not being [[transplant rejection|rejected]] or that the disease that necessitated transplant has not recurred. ===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. <ref>[http://men.webmd.com/Men-Medical-Reference/Testicular-Biopsy Mens health - Testicular Biopsy]</ref> ==Commonly biopsied sites== ===Bone marrow=== Since [[blood]] cells are formed in the [[bone marrow]], a [[bone marrow examination|bone marrow biopsy]] is employed in the diagnosis of abnormalities of blood cells when the diagnosis cannot be made from the peripheral blood alone. In malignancies of blood cells ([[leukemia]] and [[lymphoma]]) a bone marrow biopsy is used in staging the disease. The procedure involves taking a core of [[trabecular bone]] using a [[trephine]], and then aspirating material. ===Gastrointestinal tract=== Flexible [[endoscopy]] enables access to the upper and lower [[gastrointestinal tract]], such that biopsy of the [[esophagus]], [[stomach]] and [[duodenum]] via the mouth and the [rectum], [[colon]] and terminal [[ileum]] are commonplace. A variety of biopsy instruments may be introduced through the endoscope and the visualized site biopsied. Until recently, the majority of the small intestine could not be visualized for biopsy. The double-ballon “push-pull” technique allows visualization and biopsy of the entire gastrointestinal tract. <ref> Saibeni, S., Rondonotti, E., Iozzelli, A., Spina, L., Tontini, G.E., Cavallaro, F., Ciscato, C., de Franchis, R., Sardanelli, F., Vecchi, M.: [http://www.wjgnet.com/1007-9327/13/3279.asp Imaging of the Small Bowel in Crohn's Disease: A Review of Old and New Techniques] [http://www.wjgnet.com/1007-9327/index.jsp World Journal of Gastroenterology] 13(24): 3279-87, 2007</ref>. Needle core biopsies or aspirates of the pancreas may be made through the duodenum or stomach.<ref> Iglesias-Garcia, J., Dominguez-Munoz, E., Lozano-Leon, A., Abdulkader, I., Larino-Noia, J., Antunez, J., Forteza, J.: [http://www.wjgnet.com/1007-9327/13/289.asp Impact of Endoscopic Ultrasound-Guided Fine Needle Biopsy for Diagnosis of Pancreatic Masses]. [http://www.wjgnet.com/1007-9327/index.jsp World Journal of Gastroenterology] 13(2): 289-93, 2007</ref> ===Lung=== Biopsies of the [[lung]] can be performed in a variety of ways depending on the location. ===Liver=== 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. ==Analysis of biopsied material== After the biopsy is performed, the sample of tissue that was removed from the patient is sent to the [[pathology]] [[laboratory]]. A [[pathologist]] is a [[physician]] who specializes in diagnosing [[diseases]] (such as [[cancer]]) by examining tissue under a [[microscope]]. When the laboratory receives the biopsy sample, the tissue is processed and an extremely thin slice of [[Tissue (biology)|tissue]] is removed from the sample and attached to a glass slide. Any remaining tissue is saved for use in later studies, if required. The slide with the tissue attached is treated with dyes that stain the tissue, which allows the individual [[Cell (biology)|cell]]s in the tissue to be seen more clearly. The slide is then given to the pathologist, who examines the tissue under a microscope, looking for any abnormal findings. The pathologist then prepares a report that lists any abnormal or important findings from the biopsy. This report is sent to the physician who originally performed the biopsy on the patient. ==See also== [[Bone marrow examination]]</br> [[Endometrial biopsy]]</br> [[Lymph node biopsy]]</br> [[Skin biopsy]]</br> ==External links== * [http://www.cap.org/apps/docs/reference/myBiopsy/index2.html MyBiopsy.org] - Information about biopsy results for patients. This site is created by pathologists, the physicians who diagnose cancer and other diseases by looking at biopsies under a microscope. * [http://radiologyinfo.org/en/sitemap/modal-alias.cfm?modal=biop RadiologyInfo] - The radiology information resource for patients: Biopsy ==References== <references/> {{pathology-stub}} [[Category:Medical tests]] [[Category:Pathology]] [[Category:Surgical procedures]] [[bs:Biopsija]] [[bg:Биопсия]] [[ca:Biòpsia]] [[cs:Biopsie]] [[da:Biopsi]] [[de:Biopsie]] [[et:Biopsia]] [[es:Biopsia]] [[eu:Biopsia]] [[fa:بافت‌بردارى]] [[fr:Biopsie]] [[it:Biopsia]] [[he:ביופסיה]] [[hu:Biopszia]] [[mk:Биопсија]] [[nl:Biopsie]] [[ja:病理学#.E7.94.9F.E6.A4.9C.E7.B5.84.E7.B9.94.E8.A8.BA]] [[no:Biopsi]] [[pl:Biopsja]] [[pt:Biopsia]] [[ru:Биопсия]] [[simple:Biopsy]] [[sk:Biopsia]] [[sr:Биопсија]] [[fi:Biopsia]] [[sv:Biopsi]] [[tr:Biyopsi]] [[uk:Біопсія]] [[zh:活體組織切片]]