Biopsy

A biopsy is a medical test commonly performed by asurgeon, interventional radiologist, or an interventionalcardiologist involving sampling of cells or tissues for ex-amination. It is the medical removal of tissue from aliving subject to determine the presence or extent ofa disease. The tissue is generally examined under amicroscope by a pathologist, and can also be analyzedchemically. When an entire lump or suspicious area isremoved, the procedure is called an excisional biopsy.When only a sample of tissue is removed with preser-vation of the histological architecture of the tissue’s cells,the procedure is called an incisional biopsy or core biopsy.When a sample of tissue or fluid is removed with a needlein such a way that cells are removed without preservingthe histological architecture of the tissue cells, the pro-cedure is called a needle aspiration biopsy. Biopsies aremost commonly performed for insight into possible can-cerous and inflammatory conditions.

1 Etymology

Biopsy is of Greek origin, coming from the words βίοςbios, “life,” and ὄψις opsis, “a sight.”[1]

French dermatologist Ernest Besnier introduced the wordbiopsie to the medical community in 1879.[2]

2 History

One of the earliest diagnostic biopsies was developed bythe Arab physician Abulcasis (1013–1107). A needle wasused to puncture a goiter, and the material issuing wascharacterized.[3]

3 Conditions identified with biop-sies

3.1 Cancer

When cancer is suspected, a variety of biopsy techniquescan be applied. An excisional biopsy is an attempt to re-move an entire lesion. When the specimen is evaluated,in addition to diagnosis, the amount of uninvolved tissuearound the lesion, the surgical margin of the specimen isexamined to see if the disease has spread beyond the areabiopsied. “Clear margins” or “negative margins” means

Lung biopsy in a case of suspected lung cancer under control ofcomputer tomography.

that no disease was found at the edges of the biopsy spec-imen. “Positive margins” means that disease was found,and a wider excision may be needed, depending on thediagnosis.When intact removal is not indicated for a variety of rea-sons, a wedge of tissue may be taken in an incisionalbiopsy. In some cases, a sample can be collected by de-vices that “bite” a sample. A variety of sizes of needlecan collect tissue in the lumen (core biopsy). Smaller di-ameter needles collect cells and cell clusters, fine needleaspiration biopsy.[4]

Pathologic examination of a biopsy can determinewhether a lesion is benign or malignant, and can help dif-ferentiate between different types of cancer. In contrastto a biopsy that merely samples a lesion, a larger exci-sional specimen called a resection may come to a pathol-ogist, typically from a surgeon attempting to eradicatea known lesion from a patient. For example, a pathol-ogist would examine a mastectomy specimen, even if aprevious nonexcisional breast biopsy had already estab-lished the diagnosis of breast cancer. Examination of thefull mastectomy specimen would confirm the exact natureof the cancer (subclassification of tumor and histologic“grading”) and reveal the extent of its spread (pathologic“staging”).

3.2 Cancer liquid biopsy

Cancer is a heterogeneous genetic disease, and excisionalbiopsies provide only a snapshot in time of some of the

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2 7 REFERENCES

rapid, dynamic genetic changes occurring in tumors. Inaddition, excisional biopsies are invasive, can’t be usedrepeatedly, and are ineffective in understanding the dy-namics of tumor progression and metastasis.[5] However,liquid biopsy, or blood-sample tests, under developmentby Epic Sciences can generate actionable information foroncologists by analyzing circulating tumor cells (CTCs)[6]and fragments of tumor-cell DNA that are continuouslyshed by tumors into the bloodstream.[7] Highly sensitiveanalysis of individual CTCs have demonstrated a highlevel of heterogeneity seen at the single cell level for bothprotein expression and protein localization and the CTCsreflected both the primary biopsy and the changes seenin the metastatic sites. By detecting and quantifying ge-nomic alterations in CTCs and cell-free DNA in blood,liquid biopsy can provide real-time information on thestage of tumor progression, treatment effectiveness, andcancer metastasis risk.[8] This technological developmentcould make it possible to diagnose and manage cancerfrom repeated blood tests rather than from a traditionalbiopsy.[6][8][9][10]

3.3 Precancerous conditions

For easily detected and accessed sites, any suspicious le-sions may be assessed. Originally, this was skin or super-ficial masses. X-ray, then later CT, MRI, and ultrasoundalong with endoscopy extended the range.

3.4 Inflammatory conditions

A biopsy of the temporal arteries is often performedfor suspected vasculitis. In inflammatory bowel disease(Crohn’s disease and ulcerative colitis), frequent biopsiesare taken to assess the activity of disease and to assesschanges that precede malignancy.[11]

Biopsy specimens are often taken from part of a lesionwhen the cause of a disease is uncertain or its extent orexact character is in doubt. Vasculitis, for instance, isusually diagnosed on biopsy.

• Kidney disease: Biopsy and fluorescence mi-croscopy are key in the diagnosis of alterations ofrenal function. The immunofluorescence plays vitalrole in the diagnosis of Crescentic glomerulonephri-tis.

• Infectious disease: Lymph node enlargement maybe due to a variety of infectious or autoimmune dis-eases.

• Metabolic disease: Some conditions affect thewhole body, but certain sites are selectively biop-sied because they are easily accessed. Amyloidosisis a condition where degraded proteins accumulatein body tissues. In order to make the diagnosis, thegingival.

• Transplantation: Biopsies of transplanted organs areperformed in order to determine that they are notbeing rejected or that the disease that necessitatedtransplant has not recurred.

• Fertility: A testicular biopsy is used for evaluatingthe fertility of men and find out the cause of a pos-sible infertility, e.g. when sperm quality is low, buthormone levels still are within normal ranges.[12]

4 Biopsied sites

5 Analysis of biopsied material

After the biopsy is performed, the sample of tissue thatwas removed from the patient is sent to the pathologylaboratory. A pathologist is a physician who specializes indiagnosing diseases (such as cancer) by examining tissueunder a microscope. When the laboratory (see Histology)receives the biopsy sample, the tissue is processed and anextremely thin slice of tissue is removed from the sam-ple and attached to a glass slide. Any remaining tissue issaved for use in later studies, if required. The slide withthe tissue attached is treated with dyes that stain the tissue,which allows the individual cells in the tissue to be seenmore clearly. The slide is then given to the pathologist,who examines the tissue under a microscope, looking forany abnormal findings. The pathologist then prepares areport that lists any abnormal or important findings fromthe biopsy. This report is sent to the physician who orig-inally performed the biopsy on the patient.

6 See also

• Interventional radiology

7 References

[1] “biopsy”. Online Etymology Dictionary.

[2] Zerbino DD (1994). “Biopsy: Its history, current and fu-ture outlook”. Likars’ka sprava / Ministerstvo okhoronyzdorov'ia Ukrainy (3–4): 1–9. PMID 7975522.

[3] Anderson JB, Webb AJ (1987). “Fine-needle aspi-ration biopsy and the diagnosis of thyroid cancer”.The British journal of surgery 74 (4): 292–296.doi:10.1002/bjs.1800740422. PMID 3580805.

[4] Sausville, Edward A. and Longo, Dan L. “Principles ofCancer Treatment: Surgery, Chemotherapy, and BiologicTherapy”, Harrison’s Principles of Internal Medicine, 16thEd. Kaspar, Dennis L. et al., eds. p.446 (2005).

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[5] Marrinucci D, Bethel K, Luttgen M, Bruce RH, NievaJ, Kuhn P (Sep 2009). “Circulating tumor cells fromwell-differentiated lung adenocarcinoma retain cytomor-phologic features of primary tumor type”. Archivesof Pathology & Laboratory Medicine 133 (9): 1468–71. doi:10.1043/1543-2165-133.9.1468 (inactive 2015-01-10). PMID 19722757.

[6] Nieva J, Wendel M, Luttgen MS, Marrinucci D, Bazhen-ova L, Kolatkar A, Santala R, Whittenberger B, BurkeJ, Torrey M, Bethel K, Kuhn P (Feb 2012). “High-definition imaging of circulating tumor cells and as-sociated cellular events in non-small cell lung can-cer patients: a longitudinal analysis”. Physical Biol-ogy 9 (1): 016004. Bibcode:2012PhBio...9a6004N.doi:10.1088/1478-3975/9/1/016004. PMC 3388002.PMID 22306961.

[7] Crowley E, Di Nicolantonio F, Loupakis F, Bardelli A(Aug 2013). “Liquid biopsy: monitoring cancer-geneticsin the blood”. Nature Reviews Clinical Oncology 10(8): 472–484. doi:10.1038/nrclinonc.2013.110. PMID23836314.

[8] Nieva JJ, Kuhn P (Aug 8, 2012). “Fluid biopsy for solidtumors: a patient’s companion for lifelong characteriza-tion of their disease.”. Future Oncology 9 (8): 989–998. doi:10.2217/fon.12.91. PMC 3658625. PMID22894671.

[9] Hekimian K, Meisezahl S, Trompelt K, Rabenstein C,Pachmann K (2012). “Epithelial Cell Dissemination andReadhesion: Analysis of Factors Contributing to Metas-tasis Formation in Breast Cancer”. ISRN Oncology 2012:601810. doi:10.5402/2012/601810. PMC 3317055.PMID 22530147.

[10] Rolle A, Günzel R, Pachmann U, Willen B, Höffken K,Pachmann K (2005). “Increase in number of circulatingdisseminated epithelial cells after surgery for non-smallcell lung cancer monitored by MAINTRAC(R) is a pre-dictor for relapse: A preliminary report”. World J SurgOncol 3 (1): 18. doi:10.1186/1477-7819-3-18. PMC1087511. PMID 15801980.

[11] Friedman, S. and Blumberg, R.S. “Inflammatory BowelDisease”, Harrison’s Principles of Internal Medicine, 16thEd. Kaspar, Dennis L. et al., eds. pp.1176-1789, 2005.

[12] Mens health - Testicular Biopsy

[13] Saibeni S, Rondonotti E, Iozzelli A, Spina L, Tontini GE,Cavallaro F, Ciscato C, de Franchis R, Sardanelli F, Vec-chi M (2007). “Imaging of the small bowel in Crohn’sdisease: a review of old and new techniques”. World J.Gastroenterol. 13 (24): 3279–87. PMC 4172707. PMID17659666.

[14] Iglesias-Garcia J, Dominguez-Munoz E, Lozano-LeonA, Abdulkader I, Larino-Noia J, Antunez J, Forteza J(2007). “Impact of endoscopic ultrasound-guided fineneedle biopsy for diagnosis of pancreatic masses”. WorldJ. Gastroenterol. 13 (2): 289–93. PMC 4065960. PMID17226911.

8 External links• Mybiopsyinfo.com - What is a biopsy? How is abiopsy examination performed? This website givesyou answers to these and many other questions.

• MyBiopsy.org - Information about biopsy results forpatients. This site is created by pathologists, thephysicians who diagnose cancer and other diseasesby looking at biopsies under a microscope.

• RadiologyInfo - The radiology information resourcefor patients: Biopsy

• Fine needle aspiration biopsy on Wikisurgery

• Core needle (Trucut) biopsy on Wikisurgery

4 9 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

9 Text and image sources, contributors, and licenses

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