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[[Image:Brain biopsy under stereotaxy.jpg|thumb|Brain biopsy]]
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{{SK}} Bone biopsy, Soft tissue biopsy, Biopsy in musculoskeletal system, Biopsy of organs


==Overview==
== Overview ==
A '''biopsy''' (in Greek: ''bios'' = life and ''opsy'' = 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]].
[[Biopsy]] is the gold standard test for the diagnosis of [[Tumor|tumors]]. The [[tumor]] is then staged into [[benign]] and [[malignant]] [[tumors]].


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 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 cells 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.
===Biopsy===
*[[Biopsy]] is the gold standard test for the diagnosis of [[Tumor|tumors]].<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref><ref>{{cite book | last = Czerniak | first = Bogdan | title = Dorfman and Czerniak's bone tumors | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2016 | isbn = 9780323023962 }}</ref>


==In cancer==
'''Prerequisites for a Biopsy'''
[[Pathology|Pathologic]] examination of a biopsy can determine whether a lesion is [[Benign_tumor|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 ([[Staging (pathology)|pathologic "staging"]]).  
*[[Complete blood count|CBC]], [[Platelet|platelets]] and [[coagulation studies]] should be done.
*Cross-sectional [[imaging]] to evaluate local [[anatomy]] such [[Computed tomography|CT scan]] and [[Magnetic resonance imaging|MRI]].
*Treatment center carrying out [[biopsy]] must be capable of proper diagnosis and treatment.
*The surgeon who performs [[biopsy]] should preferably be the one who is later going to do the final excision.


In an ''excisional biopsy'', the margins of the specimen may be carefully 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 additional treatment may be needed.
'''Technique'''
*Open
*Closed


==Other==
===Open Technique===
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.
*The tumor is surgically exposed and [[biopsy]] of the [[tumor]] is taken.
{| align="right"
|
[[File:Biopsy.jpg|300px|thumb| Open Biopsy.[https://commons.wikimedia.org/wiki/File:Brain_biopsy_under_stereotaxy.jpg Source: Case courtesy of Dake~commonswiki, via Wikimedia Commons]]]
|}
===Types===
===Incisional biopsy===
*A small surgical [[incision]] carefully placed to access [[tumor]] without contamination of critical structures.


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>
===Excisional biopsy===
*It is done for small, superficial [[soft tissue]] masses.


==External links==
'''Incision'''
* [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.
*Longitudinal [[incision]] in the extremities is taken.
*It should allow for extension of the [[incision]] for definitive management.


* [http://radiologyinfo.org/en/sitemap/modal-alias.cfm?modal=biop RadiologyInfo] - The radiology information resource for patients: Biopsy
'''Approach'''
*Never expose [[Neurovascular bundle|neurovascular]] structures during the procedure.
*During the [[biopsy]], all tissue exposed is considered contaminated with [[tumor]].
*Meticulous [[hemostasis]] must be carried out.
*Post-surgery [[Hematoma|hematomas]] are considered contaminated with [[tumor]].
*Always deflate the [[tourniquet]] prior to wound closure.


==References==
'''Biopsy'''
<references/>
*Perform through the involved compartment of the [[tumor]].
*For [[bone]] lesions with a [[soft tissue]] mass, perform the [[biopsy]] using the [[soft tissue]] mass.
 
'''Closure'''
*If [[Drain (surgery)|drain]] is kept, remove the [[Drain (surgery)|drain]] out of the skin in line with surgical [[incision]].
*This helps in excising the [[Drain (surgery)|drain]] site with definitive surgical extensive [[incision]].


<br>
===Closed Technique===


[[Category:Medical tests]]
===Types===
[[Category:Pathology]]
===Fine Needle Aspiration (FNA)===
[[Category:Surgery]]
*It provides [[Cytological|cytologic]] specimen.
[[Category:Surgical procedures]]
*It is the most commonly used for [[carcinoma]].
*It is usually not preferred for [[sarcoma]].
{| align="right"
|
[[File:Needle biopsy.jpg|300px|thumb| Needle Biopsy.[https://upload.wikimedia.org/wikipedia/commons/0/02/Needle_biopsy.jpg Source: Case courtesy of Linda Bartlett (photographer) [Public domain], via Wikimedia Commons]]]
|}
===Core biopsy (Tru-cut Biopsy)=== 
*It allows for [[tumor]] structural examination.
*It allows evaluation of both the [[Cytological|cytologic]] and [[stromal]] elements of the [[tumor]].
*It is frequently used for [[Sarcoma|sarcomas]].


===== Sequence of Diagnostic Studies =====
* The various investigations must be performed in the following order:


[[bs:Biopsija]]
**[[X-rays|X-ray]]
[[bg:Биопсия]]
**[[MRI]]
[[ca:Biòpsia]]
*[[Biopsy]]
[[da:Biopsi]]
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[[es:Biopsia]]
[[eu:Biopsia]]
[[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]]
[[sk:Biopsia]]
[[sr:Биопсија]]
[[fi:Biopsia]]
[[sv:Biopsi]]
[[tr:Biyopsi]]
[[uk:Біопсія]]
[[zh:活體組織切片]]


==References==
{{Reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: Orthopedics]]
[[Category: Oncology]]
[[Category: Up-To-Date]]

Latest revision as of 18:51, 23 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Synonyms and keywords: Bone biopsy, Soft tissue biopsy, Biopsy in musculoskeletal system, Biopsy of organs

Overview

Biopsy is the gold standard test for the diagnosis of tumors. The tumor is then staged into benign and malignant tumors.

Biopsy

Prerequisites for a Biopsy

Technique

  • Open
  • Closed

Open Technique

  • The tumor is surgically exposed and biopsy of the tumor is taken.
Open Biopsy.Source: Case courtesy of Dake~commonswiki, via Wikimedia Commons

Types

Incisional biopsy

  • A small surgical incision carefully placed to access tumor without contamination of critical structures.

Excisional biopsy

Incision

  • Longitudinal incision in the extremities is taken.
  • It should allow for extension of the incision for definitive management.

Approach

  • Never expose neurovascular structures during the procedure.
  • During the biopsy, all tissue exposed is considered contaminated with tumor.
  • Meticulous hemostasis must be carried out.
  • Post-surgery hematomas are considered contaminated with tumor.
  • Always deflate the tourniquet prior to wound closure.

Biopsy

Closure

  • If drain is kept, remove the drain out of the skin in line with surgical incision.
  • This helps in excising the drain site with definitive surgical extensive incision.

Closed Technique

Types

Fine Needle Aspiration (FNA)

Needle Biopsy.Source: Case courtesy of Linda Bartlett (photographer) [Public domain, via Wikimedia Commons]

Core biopsy (Tru-cut Biopsy)

Sequence of Diagnostic Studies
  • The various investigations must be performed in the following order:

References

  1. ↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
  2. ↑ Czerniak, Bogdan (2016). Dorfman and Czerniak's bone tumors. Philadelphia, PA: Elsevier/Saunders. ISBN 9780323023962.

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