BIOPSY

From Big Medical Encyclopedia

BIOPSY (grech, bios life + opsis vision, sight) — intravital excision of fabrics or bodies for microscopic examination with the diagnostic purpose. In a broader sense words iod B. it must be kept in mind a research of fabrics and bodies at surgeries, and also with the research purpose.

B. allows to diagnose pathological process with a big accuracy, and also to define clinically not clear, e.g., initial stages of a new growth, to distinguish inflammatory, hyperplastic, neoplastic processes, various in a form and an etiology.

B. it is necessary also for specification of already made diagnosis and carrying out the differential diagnosis. Repeated B. allows to track morphological dynamics of pathological process and influence on it of medical actions.

Material for B. (unlike section) at the correct and timely fixing has no the changes connected with an autolysis that allows to apply the histochemical, gistoenzimologichesky, immunofluorescent, elektronnomikroskopichesky methods revealing thin functional and morphological changes in bodies. Thanks to this method the scientific data which brought considerable specifications in our ideas of pathological anatomy and a pathogeny of many diseases, napr, infectious diseases are obtained, a glomerulonephritis, an amyloidosis, leukoses, etc. B. with the scientific purpose for the first time was applied by R. Virkhov in the fifties of the last century. The first diagnostic biopsy is carried out by M. M. Rudnev (1875). In 1878 Mr. Ruge and Faith (Page A. Ruge, J. Veit) described trial excision of a piece of a neck of uterus for recognition of a malignant tumor. In the first decades of 20 century resorted to B. rather seldom, further the quantity them increased. In large hospitals and oncological institutions the quantity of biopsies is estimated in tens of thousands a year. To almost every third patient in modern to lay down. establishment make B. Thanks to progress of the medical equipment material for B. can be taken almost from each body. The conclusion about the nature of pathological process is taken out by the doctor-pathologist on the basis of a histologic research of an affected area taking into account a gross appearance and clinical data. If the received material is not enough and from it it is impossible to prepare a tissue specimen, then do smears and make a cytologic research. In some cases for specification of the diagnosis the cytologic research is made in parallel with histologic.

On the current situation the material deleted at surgical interventions is exposed to an obligatory histologic research for the purpose of specification of the presurgical clinical diagnosis.

Scope of B. is wide, especially in oncology where it is one of the leading diagnostic methods. B. allows to define the nature of a tumor, it histogenesis (see), degree of an anaplaziya of cells on the basis of what the conclusion about degree of a zlokachestvennost of a tumor becomes. Such detailing of process is necessary for the choice of the most reasonable method of treatment as tumor cells of a different origin and different degree of a maturity unequally give in to various methods of therapy. In modern conditions to inadmissibly treat the patient with a malignant tumor without preliminary morphological research it Often resort to the urgent (emergency) B. which is carried out to time of stay of the patient on the operating table that defines degree of radicalism of an operative measure. The research of operational material allows to establish whether the center entirely or within the struck fabrics is removed, to find out a state regional limf, nodes, etc. Not smaller value has B. and at diagnosis of many not tumoral processes in surgery, gynecology, hematology, otorhinolaryngology and urology.

B.'s results in many respects depend on that, material for a research (whether it from the center or only from the fabric surrounding it is received whether there are in it living or only one nekrotizirovanny tissues) is how successfully taken, and also from quality of tissue specimens since insufficiently thin, badly painted, deformed microscopic sections can complicate a research and stories to the wrong diagnosis.

The material received at intsizionny B. since the piece of rather big size is cut out from the most characteristic place that allows to study various departments of an affected area is optimum for a research.

During the transportation of material in pathoanatomical laboratory it is necessary to protect it from drying, rotting, freezing since it deforms fabrics and does not allow to conduct a full-fledged histologic research.

Especially careful attitude shall be to the material received at a puncture (aspiration) trepanobiopsiya when receive very small piece of fabric. This material demands special fixing, filling, quality tissue specimens.

For the correct assessment of a histologic picture the pathologist shall have a detailed information about the patient (a sex, age, the diagnosis), about localization of the center of defeat, its communication with anatomic educations (muscles, nerves, fastion and so forth), a type of the center during operation, the anamnesis, clinical displays of a disease, and to get acquainted in case of need with results of laboratory researches, x-ray films, with data on the previous therapy. Lack of clinical data considerably complicates a research and can lead to a diagnostic mistake. E.g., in an epithelium of a neck of uterus in a zone of an erosion at pregnancy there can be changes indistinguishable from cancer in situ.

However even at observance of all technical specifications diagnosis of pathological process is not always easy because of a big variety of pathological processes, existence of transient states. Quite often the research is made in the period of a disease without characteristic morphological features or these signs are veiled by the accumulated nonspecific changes. Great difficulties are presented by diagnosis of initial signs of a malignancy of a benign tumor, a histogenesis of sharply anaplazirovanny tumors, the beginnings of general diseases of blood.

Diagnosis with these cases is helped by a research of in addition cut out pieces from the sent material using various histologic, histochemical and bakterioskopichesky techniques.

Rules of the direction of material B. in pathoanatomical laboratory, are stated to its registration, fixing and processing in the orders M3 of the USSR.

The equipment of a biopsy

Receiving necessary material for a morphological research can be carried out in various ways. In this regard distinguish several types of B.: intsizionny, puncture and aspiration.

At intsizionny B. in the surgical way fabric for the subsequent histologic research is removed. It is the most widespread method. Intsizionny B. is called total if for a research all pathological center is removed. Excision of fabric at superficially located pathological educations is carried out by a scalpel, an electroknife or special tools like a conchotome. In these cases, especially at the ulcerated, superficially located educations, B. is carried out without anesthesia or the local anesthesia is used. It should be seen off so that not to receive artifacts (see. Artefact ) in the excised pieces of fabric (it is not necessary to apply too intensive infiltration by novocaine and to enter solution directly into the pathological center etc.). At intsizionny B. it is necessary to use in some cases an anesthesia (B. limf, nodes of a front mediastinum during a mediastinoskopiya). Intsizionny B.'s carrying out demands observance of certain rules. It is necessary to excise a piece, taking the pathological and not changed fabric. It is inexpedient to take on a research of fabric from the nekrotizirovanny site (an ulcer, a tumor). At small, superficial educations it is necessary to excise them completely, i.e. to resort to total B., and to take in the formed defect. After excision of a piece of fabric at suspicion of a malignant tumor the place of excision is subjected by electrothermic coagulations or process 96% alcohol. The sizes of a piece are defined depending on character and localization of the pathological center; it also shall be sufficient for carrying out a research. After opening of the pathological center the issue of a possibility of removal it completely is resolved. When it is impracticable, from the pathological center the site of fabric is excised. At B. limf, a node it is necessary to aim to remove the last (or several nodes adjacent to each other) completely, without breaking integrity of the capsule. Careful attitude to fabrics, their minimum Traumatization due to compression, crush or stretching are indispensable conditions correctly carried out B.

The excised piece of fabric for a histologic research is immersed in the fixing solution (freshly cooked solution of formalin in the ratio 1 h formalin on 4 — 5 h water).

The histologic research of biopsirovanny material is widely combined with a cytologic research. In this regard it is reasonable before immersion of the excised piece of fabric to take in the fixing solution from its surface a print or a smear for a cytologic research. Such technique is especially valuable at the emergency B. when the urgent histologic research is impossible or special histochemical reactions are necessary. In such cases the cytologic research does not substitute, and supplements a histologic research.

Eagle for a trepanobiopsiya of a design of Palinki: 1 — a needle in assembled form; 2 — 5 — details of a needle: 2 — a cannula; 3 — mandrin with the acute trihedral end; 4 — a rod with a spiral cutter with two cuttings (below — the enlarged image of a cutter); 5 — an electrocoagulator with the picturizing tube.

Puncture B.'s feature is receiving necessary material for a histologic research by means of special or usual syringe needles, troakar. The needle gets a column of fabric from the pathological center which is exposed to histologic studying. Use of usual syringe needles (with a diameter up to 1 mm) gives the chance in some cases to combine puncture B. with a cytologic research. However during the use of usual syringe needles of small diameter the column of fabric manages to be received not always. In this regard apply special needles with a diameter up to 2 — 3 mm to puncture B., various on a design, e.g. the split needle with Silvermen's cannula, a turbinal needle of Bigleyzen, a needle in the form of «whistle» with mandrin, a cutting needle of Tyshchenko, a needle with a spiral cutter of Palinki (fig.) etc. Also special tools like drills in which the needle is given rotary motion are known, and extraction of the cut-out column of fabric is carried out by the syringe or a special pomp. For puncture B. of dense educations (bones, cartilages) use special trepans. From here this type of B. received the name trepanobiopsiya (see). The possibility of electrothermic coagulation of the puncture channel is provided in separate designs of needles for puncture B. (e.g., Palinki's needle) that reduces danger of dissimination of malignant tumors, bleedings and formation of hematomas. Puncture B. is carried out under a local anesthesia with a preliminary section of skin over the place of immersion of a needle to a zone of the pathological center.

The main condition of the correct performance of puncture B. is exact definition of access to the pathological center, from to-rogo material for a cytologic or histologic research shall be received.

At aspiration B. necessary material for a histologic research is received aspiration via the hypodermic needle or special tools from hollow bodies or cavities. So, aspiration B. gives the chance to receive material from a perigastrium of a uterus, from a stomach (at their sounding), from pleural or belly cavities, etc.

The biopsy of tumors of the central nervous system is made but to the general rules at direct intervention on a head and spinal cord and their covers. Considering features of a consistence of the majority of tumors of c. the N of page, is recommended after fixing of material in 10% formalin to prepare drugs a freeze-etch method which provides the smallest deformation of fabric elements, or filling in photoxylin. The last is necessary at a brittle or semi-fluid condition of tumoral fabric, and also at a research of the processes which are localized in a meninx. Paraffin embedding deforms fabric elements and can be used only restrictedly (it is necessary to avoid overheating of fabric). At urgent B. it is recommended to fix thin pieces of fabric in 20% formalin with gradual warming up up to the temperature not over 80 ° (!). More high temperature sharply breaks histologic structure. The standard coloring hematoxylin-eosine insufficiently fully reveals structure of tumors of a brain. Therefore in all cases it is recommended to apply in parallel the coloring hematoxylin-pikrofuksinom allowing to distinguish collagenic fibers in tumors of a connective tissue origin, in covers in fibrous growths after the previous operations from growths (tumoral and reactive) glial cells of N of fibers. At homogeneous structure of tumoral fabric reliability of a method is rather high. However it is necessary to consider that heterogeneity of cellular structure is inherent in many neuroectodermal tumors.

Reliability is provided with a full research of all delivered material and decreases at its insufficient quantity, and also at urgent B. V difficult cases it is necessary to use additional histologic methods: impregnation of argyrophil fibers, coloring of lipids and glial fibers.

At statement of the histologic diagnosis it is necessary to pay attention to macroscopic features, a consistence of tumoral fabric, existence of the large centers of a necrosis, cystous cavities. It is necessary to consider also kliniko-anamnestic data (age, sex, duration of a current) and especially given operation about localization of a tumor, the relation to a meninx, to roots of nerves. When there are no sufficient data for the exact diagnosis, it is necessary to be careful and reflect it in the conclusion. It is sometimes reasonable to be limited only to the instruction on the malignant nature of a tumor or to point to germination of marrow by tumor cells, without specifying a type of a tumor. In certain cases urgent B. when coloring by usual methods does not reveal an explicit atipizm of cells, can draw the conclusion only in a descriptive form. Uncertainty of the conclusion in such cases should be preferred to more categorical, but the unreasonable diagnosis which can lead the surgeon on the wrong way.

Biopsy of separate bodies — see articles devoted to bodies and methods of endoscopy (e.g., a gastrobiopsiya — see. Gastroscopy ; a biopsy of a liver, kidney, uterus — see. Uterus , Liver , Kidney ).


Bibliography: Avtandilov G. G. Methodical instructions to doctors to capture of material for a patologogistologichesky research, Nalchik, 1956; Vail S. S. Value and a technique of morphological studying of bioptichesky and operational materials in oncology, in book: Semiotics and diagn. zlokachestven, tumors, under the editorship of A. I. Serebrov and S. A. Holdin, page 64, JI., 1970; Vinogradova T. P. Diagnosis of bone and joint pathology on biopsies, M., 1964; Krayevsky N. A. Morphology and classification of tumors of the person, in book: Wedge, onkol., under the editorship of H. N. Blochina and B. E. Peterson, t. 1, page 10, M., 1971; To r and-e in with to and y N. A. and And e of t r about in and A. S. Morphological researches in modern clinic, Arkh. patol., t. 33, No. 2, page 3,1971; Fell P. S inka. An advanced needle for trepan biopsy at tumors of a mammary gland, Vopr, onkol., t. 13, jvft 12, page 70, 1967; The guide to pathoanatomical diagnosis of tumors of the person, under the editorship of N. A. Krayevsky and A. V. Smolyannikov, M., 1971, bibliogr.; Smolyannikov A. V. To a question of value of biopsies and a histologic research of the bodies and fabrics deleted at surgeries, Voyen. - medical zhurn., No. 1, page 32, 1954; Shevchenko I. T. Bases of clinical inspection of oncological patients, Uchen. zap. Kiyevsk. nauch. - issled. rents-genoradiol. and onkol. in-that, t. 6, page 5, 1961.

B. tumors of the central nervous system — Smirnov L. I. Tumors of a head and spinal cord, M., 1962; Hominsky B. S. Histologic diagnosis of tumors of the central nervous system, M., 1969. bibliogr.; A ren d t A. Histologiscl. - diagnostischer Atlas der Geschwiilste des Zentralnerven-systems und seiner Anhangsgebilde, Jena, 1964; Z u 1 with h K. J. Biologie und Patho-logie der Hirngeschwiilste, Handb. Neurochir., hrsg. v. H. Olivecrona u. W. Tonnis, Bd 3, S. 1, B., 1956.

T. A. Naddachina; Of B. Falileev (PMC.), B. S. Hominsky (neyrokhir.).

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