Biopsy

What is a biopsy?

Biopsy, one of the diagnostic methods, is the process of taking tissue, fluid or cells from the area where the disease is suspected using various surgical methods. Although cancer is the first thing that comes to mind when it comes to biopsy, it is preferred for the definitive diagnosis of many different diseases. The biopsy can be performed as a stand-alone procedure or, in some cases, during surgery. Samples taken by biopsy are examined in pathology laboratories. Changes or abnormalities in the sample taken as a result of these examinations are examined and reported by pathologists. This will clarify the diagnosis needed for appropriate treatment. In biopsy applications, it is also possible to remove the entire tissue if deemed necessary by the specialist. Biopsy therefore also has a therapeutic side.

Lung biopsy

Lung biopsy is performed to quickly confirm the diagnosis of lung cancer or diseases detected during imaging techniques. The area where the mass, the presence of which has been visualized in previous examinations, is located is anesthetized with local anesthesia and the necessary tissue pieces are taken by fine needle aspiration biopsy or thick needle biopsy. Computerized tomography or ultrasound imaging is performed during the biopsy procedure to precisely locate the mass. In a lung biopsy, a large needle is used to penetrate the lung membrane. The necessary samples are then collected with a fine needle. This method prevents air from entering the lung membrane. Even if air escapes during the biopsy, it can be evacuated with this method.

Liver biopsy

Liver biopsy is used to examine many liver diseases such as fatty liver disease, hepatitis and cirrhosis. In addition, liver biopsy can be performed to clarify the diagnosis of the mass visualized in the liver. Sedative medication is given intravenously before the liver biopsy. For this reason, the patient should not eat or drink anything for 5-6 hours before the procedure. The patient lies on his/her back, a small incision is made in the relevant area and then the necessary samples are taken by needle biopsy. Since patients need to be under observation after the liver biopsy, discharge is done the next day.

Some patients use a double needle system. With this system, a single needle is inserted through the skin into the liver and more samples can be taken. In this way, the patient's recovery process is faster and the risk of renewal of the biopsy procedure is minimized. In some cases, since entering the liver through the skin with a needle carries a risk of bleeding, biopsy samples can be collected by accessing the liver through the neck vein with a special needle system.

Bone marrow biopsy

Bone marrow biopsy and aspiration are performed together. This is because doctors prefer to perform both procedures together to examine the solid and liquid parts of the marrow. Bone marrow aspiration provides a fluid sample, while bone marrow biopsy can remove solid tissue. Bone marrow biopsy and aspiration can reveal whether a person has a blood disease or blood cancer. The most suitable point for both procedures is the pelvic bone in the lower back next to the buttocks.

Breast biopsy

During the breast biopsy, which takes about 15 minutes, cell and tissue samples can be taken or mass removal can be performed. The procedure is performed under local anesthesia in breast biopsy performed under CT, MRI or ultrasound guidance. Vacuum biopsy, needle biopsy or surgical biopsy methods can be used under general anesthesia. The size of the mass is the factor in determining the method of breast biopsy.

Thyroid biopsy

Thyroid biopsy does not involve the possibility of bleeding. In the thyroid biopsy procedure, which is performed under local anesthesia with ultrasound guidance, the access and passageway is first determined by the radiologist with a detailed ultrasound performed by the radiologist. Thyroid biopsy with fine needle aspiration technique is applied to each module individually in case of more than one module. In this way, the benign or malignant nature of each nodule can be determined. After the biopsy, the patient is kept under observation for approximately half an hour and then returns to his/her normal life.

Uterine biopsy

In uterine biopsy, also called endometrial biopsy, a tissue sample is obtained through a tube inserted into the uterus. In a uterine biopsy, which allows a sample to be taken from the lining of the uterus, the cells are examined under a microscope to determine whether there are abnormalities.

Stomach biopsy

Gastric biopsy, which enables the diagnosis of certain conditions such as stomach cancer, gastritis or ulcers, is also called endoscopic biopsy. The samples taken in this biopsy, which is performed by endoscopy, are examined in the laboratory. This determines whether harmful bacteria are present and whether there are any changes in the stomach cells.

Kidney biopsy

A kidney biopsy is performed both to confirm kidney disease and to determine the condition of the transplanted kidney. Local anesthesia is applied in kidney biopsy, a procedure that takes approximately half an hour. Due to the risk of bleeding after the procedure, patients should be kept under observation for 24 hours. During this process, urine and blood counts are performed to check the condition of the patients.

The patient undergoing kidney biopsy lies face down. Ultrasound determines which part of the kidney the biopsy needle will enter and at which angle. In a kidney biopsy, a small incision is made where the needle will enter and the advancing needle is monitored with ultrasound. Patients may feel pressure and hear the sound of the needle during the procedure. However, since it is applied under local anesthesia, they do not feel any pain or ache. After the biopsy, ultrasound is used to check for bleeding.

How is a biopsy performed?

Different methods are used in the biopsy procedure. For this reason, some biopsies are performed under local anesthesia, while others are performed during surgery. Imaging-guided biopsy procedures also involve the use of different equipment.

Why is a biopsy done?

The reason for the biopsy is to ensure a definitive diagnosis of a mass, lesion or abnormal structure detected by examination or imaging in any part of the body. Biopsy, which is the most definitive method in cancer diagnosis, also plays a major role in determining whether the cancer has spread and in staging the cancer.

Types of biopsies

The main reason for the application of biopsy with more than one technique is the differentiation of the organ to be applied and the different width of the area to be sampled. In addition, the different structures of the samples taken by biopsy enable the biopsy to be diversified within itself.

Needle biopsy

Needle biopsy is divided into 2 subtypes. The first of these types is fine needle aspiration biopsy, also called percutaneous biopsy. In fine needle aspiration biopsy, which is performed with the help of a syringe with a black needle, cells are taken from the targeted tissue. It is a method especially used in thyroid modules and prostate diagnosis. Another type of needle biopsy is a thick needle biopsy. With a thick needle biopsy, it is possible to take cylindrical pieces of tissue from the targeted mass.

Brush biopsy

Biopsy is a method of examining the herd. For this reason, the brush biopsy is performed endoscopically and a small brush is used to take the sample.

Open surgical biopsy

Open surgical biopsy involves the removal of part or all of the mass in the suspected area. Because of this feature of open surgical biopsy, patients require general anesthesia.

Cone biopsy

A cone biopsy is a minor surgery in which a cone-shaped piece of the cervix is removed for examination. In cone biopsy performed with the colposcopy method, colposcopy allows a close look at the cervix.

Chorionic villus biopsy

Chorionic villus biopsy, also called CVS, is performed between 10 and 12 weeks of pregnancy. CVS is performed to detect chromosomal abnormalities or genetic problems in the unborn baby. This method can be performed from the cervix or from the abdomen.

Endoscopic biopsy

Endoscopic biopsy, in which tissue pieces are taken, uses instruments passed through the endoscope channel. A lasso-like equipment is used in this process. This allows the tissue to be cut by strangulation or catalyzed. With another instrument passed through the endoscope channel, the detached piece is removed.

Biopsy with shaving method

The process of removing the area under the skin lesions together with the upper layers of the skin is called biopsy by shaving method. Thanks to Tam, the shaving burned area can be removed parallel to the skin.

Senitic lymph node biopsy

Blue dye is applied to the patient before the procedure in order to identify the lymph nodes where the cancer cells in the tumor have the highest risk of spreading. Lymphatic vessels first carry the blue dye to the site of the cancer. Then, with a different device, the area where the discoloration is detected is detected and this area is removed.

Vacuum biopsy

The vacuum biopsy method also uses a kind of needle with sharp edges. This needle is inserted into the lesion and then moved back and forth. In this way, while the needle grinds the tissues, the vacuum inside the needle pulls the shaved tissues.

Stereotactic biopsy

In the stereotactic biopsy method used in both breast and brain, tissue samples are taken with the help of a needle or wire. Tomography is used to determine the area to be sampled.

Punch biopsy

In punch biopsy, which is applied for samples to be taken from the skin, a tissue sample is taken with a small cutting tool.

Excisional biopsy

Excisional biopsy is performed when the suspected area needs to be completely removed. This biopsy method, which is usually applied in suspicious skin changes, can also be used to remove small lesions that are easily accessible under the skin.

Fist biopsy

Punch biopsy, which is used to take samples of the lower surfaces of the skin, is performed under local anesthesia. With a sharp and circular instrument, it is rotated on the skin surface down to the lowest layers of the skin. This allows a biopsy sample to be obtained.

How does the biopsy process work?

The topics to be considered during the biopsy, which is usually performed under local anesthesia for about half an hour, are as follows.

• Ensuring sterilization of the biopsy area
• Taking precautions during the procedure according to the test results of the patient's hepatitis and HIV tests
• The patient's vascular access is open
• Pre-checking coagulation values
• Having the imaging tools and equipment to be used in the procedure ready
• A cytopathologist is present at the procedure to confirm that the biopsy specimen is adequate

What should be considered before a biopsy?

The points that patients should pay attention to before the biopsy vary according to the type of biopsy to be performed and the area to be applied. For this, the points that patients should pay attention to in biopsies applied to different regions can be summarized as follows.

• Due to the high risk of bleeding in kidney biopsy, medications that may increase the risk of bleeding should be discontinued 7-10 days before the procedure. In addition, patients should not eat or drink anything for 6 hours before the biopsy procedure. It is sufficient for patients to take their regular hypertension and heart medications, if any, with a very small amount of water. Before the biopsy, some blood tests should be done to determine the coagulation status.
  
  
• Patients who will have a liver biopsy should discontinue the blood thinners they have used before the procedure with the doctor's knowledge. Before the procedure, the blood count is checked and examined for clotting problems. Instead of these examinations, blood values showing the coagulation picture taken from the patient within 15 days can also be used. Since intravenous medication will be administered during the biopsy, patients should not eat or drink anything for 6 hours before the procedure.
  
  
• Patients who will have a thyroid biopsy do not need to make any preparation before the procedure. However, the procedure may need to be planned for these patients if they are taking blood thinners.
  
  
• People who will have a lung biopsy should not drink anything for 8 hours before the procedure. If local anesthesia is used for lung biopsy, patients may be allowed to consume fluids on the morning of the procedure. Any sensitivity to latex, drugs, patches or anesthetics should be reported to the physician before the procedure. All medications and herbal supplements should also be reported to the doctor. If patients have a history of bleeding disorders or are taking blood thinners, blood thinners should be discontinued before the procedure.
  
  
• Before the breast biopsy, patients should inform their physicians about their allergies, whether they are taking blood thinners, whether they have a pacemaker or other electronic device in the body.
  
  
• In addition, women who are pregnant or suspected of being pregnant should inform their specialist before having a biopsy.

What should be considered after a biopsy?

The points to be considered after the biopsy also vary depending on the biopsy site. For this reason, the following are among the points that patients should pay attention to after biopsies performed in different areas.

• Patients undergoing lung biopsy undergo control tomography. This ensures that there are no undesirable conditions such as air leakage or bleeding between the lung membranes. The small bandage applied after the biopsy can be removed within 24 hours after the procedure. After the lung biopsy, the patient must be hospitalized overnight and blood pressure, pulse and respiratory values must be monitored during this period. After the biopsy, a possible bleeding or air leak between the lung membranes can be detected. For this reason, blood tests or chest X-rays may be performed if necessary. If there are no problems after the biopsy, patients can start eating after 2 hours. The bandage must be removed for patients to take a shower.
  
  
• Since there is a small risk of bleeding in kidney biopsies, patients are kept under observation for the first 24 hours after the procedure. During the period of observation in the hospital, the patient should not get up, even for toilet needs. Patients should wait 2 hours after the procedure to eat or drink water and get the doctor's approval. After the procedure, patients are evaluated for urinary bleeding in suicide while under control. Blood counts are usually checked 2 to 3 hours after the procedure and at 6 to 8 hour intervals.
  
  
• After the liver biopsy, patients must be hospitalized overnight. During this time, their pulse and blood pressure are under constant control. After the biopsy, patients should rest on their right side for at least 2 hours and return to their normal lives after discharge, provided that they do not exert themselves.
  
  
• In breast biopsy, bandages are applied instead of the procedure in all methods except open biopsy. It is possible for patients to continue their normal lives after the procedure. Some patients may experience bruising or mild pain after the procedure. If an open biopsy is performed in breast biopsy, the patient is stitched and patients go home and rest on the same day. They can continue their normal life the next day.