Table of Contents
Biopsy and its types. Biopsy is the gold standard for the diagnosis of many diseases. This method of treatment in Germany allows to obtain a pathological sample and then using various methods of histological or cytological analysis to make a final diagnosis.
Biopsy, what is it and why is it needed?
A biopsy is the removal of a small volume of tissue, cells, or fluid, sufficient for analysis, from any organ to examine it for disease and to determine the structure of a mass. Usually a small volume of a sample of cells is removed using a hollow needle a few millimeters in diameter, in other cases a suspicious nodule or piece of tissue is surgically removed. Often tissue is removed by placing a needle through the skin (percutaneously) into the abnormal mass or nodule. Excision may be performed using a variety of techniques to visualize the pathologic area or area of cell removal. These methods include ultrasound, x-rays, computed tomography (CT) or magnetic resonance imaging (MRI). The resulting images help determine where to place the needle and where to directly perform the excision.
How do I need to prepare for the procedure?
Most biopsies are performed on an outpatient basis with minimal preparation. The attending physician will provide necessary instructions before the procedure based on the type of resection to be performed. The physician should know what medications the patient is taking, such as aspirin and herbal supplements. It is crucial to know if the patient has any allergic reactions to any medications. Also, the doctor needs to know about the presence of comorbidities, chronic diseases. If the patient has diabetes mellitus, it is necessary to adjust the dose of insulin before excision. In addition, the doctor needs to know about the patient’s pregnancy, as it will depend on the timing of the resection, the choice of drugs and the place of resection. Most likely, the doctor will advise to stop taking blood thinning medications for a certain period of time before the procedure and will also ask not to eat or drink anything for eight hours. Before surgery, you should remove all jewelry and wear loose, comfortable clothing. Preparation in children is similar to that of adults for the intervention.
When a nodule or mass is found, various imaging studies are performed to determine whether the nodule is slow-growing (benign, non-cancerous) or fast-growing (cancerous). Analyzing the images obtained cannot always clearly answer this question, then performing a tissue resection is required. Excision is often performed to verify cancer, but it can help identify other conditions such as infectious tissue lesions, autoimmune disorders, and cell analysis can also determine if inflammatory changes are present in the liver. Tissue resection is also performed when an organ transplant is performed. Tissue analysis helps to determine tissue matching to avoid organ rejection.
Tissue excision is performed in many areas of the body and for many reasons.
There are a large number of different types of biopsies:
A biopsy is often required for masses in the abdominal cavity. Tissue resection is usually used for differential diagnosis of neoplasms in different parts of the gastrointestinal tract. The masses may be deep within the abdominal cavity. The specimen of the mass is removed under the guidance of various imaging techniques (modern hardware diagnostic techniques) or surgically using a laparoscope or open surgery. Often excision can be performed during surgical intervention, when the surgeon sees changes in the operated organ and performs excision of the area.
Bone or bone tissue excision is used to verify cancer or infection in bone. This type of resection can be performed percutaneously, using larger diameter needles than other excision options, or open surgically.
Taking a bone marrow sample is necessary to detect various blood cancers such as leukemia, aplastic processes. A small sample of bone or marrow is removed with a special needle. Special syringes with needles (trepans) are used to take bone marrow.
A sample of breast cells. This procedure is done to determine whether a mass in the breast is cancerous or benign. It can be performed in several ways:
- mammography-oriented,
- ultrasound guided,
- MRI guidance.
In addition, excision of abnormal breast cells can be an alternative method to sectoral resection. In this case, the biopsy is called vacuum aspiration biopsy. Excision is performed under local anesthesia, without tears and large incisions. Also, this operation allows you to avoid such a complication as mastitis during subsequent breastfeeding. Removed formations of almost any size. Most often this procedure is performed when fibroadenoma and other benign masses are diagnosed.
A sample of endometrial tissue can be used in finding the cause of various types of uterine bleeding, recognizing cancer. This type of excision can be performed using a small needle-like device to capture the specimen, called an endometrial pipelle biopsy, which is a diagnostic operation used in gynecologic endocrinology. Excision of endometrial cells allows to detect the nature of thickening of the uterine lining, to investigate the causes of bleeding, as well as to recognize cancer (endometrial carcinoma). Pipel-biopsy is usually included in the list of tests before planning a pregnancy.
A kidney cell sample is taken to study the condition of the kidneys in patients with various kidney diseases, kidney failure, inflammation or suspected cancer (e.g. cancer). A tissue sample is also taken when performing a kidney transplant to exclude the possibility of rejection. The kidney is examined using imaging techniques (ultrasound, radiotherapy) with the aid of a specimen dissection device.
Liver tissue is dissected to recognize various diseases such as inflammatory changes, cirrhosis, infections and masses. In this case, the analysis of the examined material allows differentiating benign pathology from malignant pathology. It is also performed to study the transplanted tissue or liver section to exclude the processes of rejection of the transplant. This study is quite often performed in children. Resection of liver tissue is usually performed percutaneously. Excision of the liver sample can also be performed through a special catheter or surgically, depending on the volume and location of the mass.
A lung study is performed when a lung abnormality is visible on an X-ray or CT scan. A lung biopsy can be performed by bronchoscopy, inserting an instrument called a bronchoscope through the patient’s mouth into the airway to reach the area to be biopsied. Or through the skin by inserting a needle percutaneously or using an open surgical technique.
A lymph node examination is performed whenever there are enlarged or abnormal lymph nodes. It can be done with a needle or surgically.
In infections affecting different muscle groups, excision of the affected muscle is performed. In addition, muscle tissue is taken in case of various defects and diseases. Connective tissue is also excised, as well as blood vessels if there is any suspicion of pathology. This type of resection can be performed with the use of a needle or surgically.
Various nerve plexus masses may also require excision. Nerve plexus studies are performed to examine damage to small and large nerves, degeneration and destruction of nerve endings due to various diseases, as well as inflammatory changes. Nerve dissection is performed surgically, as well as using minimally invasive techniques.
Skin biopsy is performed if there are any changes in the skin. It allows to exclude dermatoses of unclear genesis, which can transform into malignant neoplasms. In addition, if there is a suspicion of myeloma, infections, neurodermatitis, tissue resection is also performed. Analysis of the obtained skin sections also allows you to assess the effectiveness of the ongoing treatment. A skin biopsy can be performed by excising a section of tissue with a scalpel.
Obtaining testicular and prostate tissue is performed to investigate male infertility. Excision is also performed to determine different types of testicular tumors: germ cell tumors, neoplasms from the stroma of the sexual cord, mixed tumors. When prostate tissue is obtained, cancer, prostate cysts and other neoplasms are recognized. Resection of testicular and prostate tissue is performed using a small incision or open operative method. The choice of method will depend on the size of the neoplasm and its location relative to major vessels. Needle excision of testicular and prostate tissue is rarely performed to diagnose cancer because it increases the likelihood that the cancer will spread. Ultrasound is primarily performed to recognize testicular cancer, and the affected testicle is often removed with an open surgical procedure called an inguinal orchiectomy. Resection of prostate tissue is also performed with ultrasound.
Another fairly common resection option is to take a section of thyroid tissue. Nodules can be of different nature: fast-growing nodules, cysts, adenomas, and nodules of colloid structure. The procedure is performed using a small diameter needle under ultrasound control. This type of biopsy is called fine-needle aspiration puncture biopsy. The method is used to recognize small nodular formations, while they are located quite superficially. The procedure is performed with a thin disposable needle put on a disposable syringe, under the control of various visualization methods, and the needle has an echo marker, which allows it to be clearly seen by ultrasound. In normal practice, 3-4 injections are made into different areas of the node to obtain enough material. Next, the contents of the node are applied to slides. The resulting slides are stained with various dyes, which allows you to determine the type of pathology, the presence of atypical cells.
Tissue can be resected from almost any organ of the human body: brain, heart, bladder, parathyroid glands, stomach, intestines, uterus.
There are so many options and methods of biopsy.
Biopsy allows you to verify the pathology and prescribe the necessary treatment in time.
The most common questions about having a biopsy
What equipment is used during a biopsy?
There are many different methods of biopsy. The equipment used for biopsy or resection will vary depending on the type of procedure, the location, the general condition of the patient and the associated pathology. These data are necessary to decide the extent of the intervention.
A small-diameter needle is the primary instrument for performing tissue, fluid or cell dissection from an organ under examination. The needle is only a few millimeters long to prevent damage to the surrounding tissue. The needle is hollow, and the needle may have different containers inside to allow certain cells to pass above and unnecessary cells to remain in the needle itself.
There are several needle mechanisms used for tissue extraction. Typically, a vacuum device is used, which allows you to obtain pieces of tissue using a vacuum. Also, there is an automatic mechanism, which is fast enough, with the push of a button, to take a sample. In addition, the sample is taken manually, that is, using a piston. Automatic and vacuum methods are the most effective, because when they are used, the needle is clearly fixed and there is no displacement.
Other sterile equipment used when performing biopsies include various diameter syringes, scalpels for skin dissection, a specimen cup or tube, and a microscope when performing microsurgery.
What are the steps in performing a biopsy?
The steps of the biopsy will depend on the location of the pathologic mass to be examined. Extraction of most body tissues is performed with a fine, small diameter needle. This is the least invasive option and the patient usually recovers very quickly after this procedure. The patient can go home the same day or the next day. The use of imaging with X-rays, ultrasound equipment and other radiology techniques allows for precise placement of the needle to find the best place to take the tissue sample.
If the formation is deep enough in the tissue, it may be necessary to use open surgical methods, that is, with the help of an incision and gaining access to the necessary area, the tissue is taken. This type of surgery is performed in a hospital setting. In addition, the choice of biopsy option will depend on the location of large and small vessels. And also, depending on the localization of the site, the volume and complexity of the intervention will be determined. Perhaps, during the procedure itself, it may be necessary to increase the volume of surgical intervention.
The surgeon may use an instrument with a camera to help find the best place to biopsy and resect a small area of the abnormal focus.
Minimally invasive interventions such as needle excision, while using imaging, are most often performed by a specially trained radiologist, interventional radiologist, or neuroradiologist.
Resection of the tissue sample or cells is performed in the presence of an anesthesiologist who provides local anesthesia (if nerve plexus resection is necessary or if the operation is large). In other cases, the operating surgeon injects an anesthetic into the puncture area so that the patient does not feel pain. If the patient is very nervous, or the procedure is long enough, then the anesthesiologist administers special drugs so that the patient sleeps and is not anxious during the procedure. More extensive interventions may require intravenous anesthesia with large doses of anesthetic drugs.
When performing a biopsy on a child, more advanced anesthesia is most often required because the child cannot lie still for long periods of time.
If CT or MRI is used, the biopsy is performed in the X-ray room, and the position of the body during the procedure depends on the localization of the pathological focus.
When determining the point for biopsy, i.e. where the needle is to be inserted, the skin is treated. After that, the anesthesiologist provides local anesthesia or intravenous anesthesia drugs. Next, the needle is pricked into the area and an ultrasound sensor is placed over the needle or a picture is taken using X-rays, tomography methods. The needle is gradually inserted into the area of the focus, and with the help of various mechanisms (vacuum, spring mechanism, manual method), tissue or cells are taken. After the needle is removed, and the puncture site is clamped with a tight bandage to avoid the development of bleeding. The patient is observed for several more hours in the clinic after the procedure to rule out early complications of the procedure. Pain after the procedure may persist for several hours, and in the case of a larger volume for several days. During this time, the doctor will prescribe the necessary medications to alleviate the pain. The entire procedure takes about one hour on average.
Many patients ask: How will I feel during and after the biopsy procedure?
During the needle puncture, the patient usually feels a slight sharp pressure in the biopsy area. During the entire procedure, the patient feels no pain as the procedure is performed under the supervision of an anesthesiologist with the administration of analgesic drugs. With local anesthesia, light contact with the needle is felt. Within a short period of time, the biopsy area becomes numb. Before the biopsy, the patient is given a mild sedative, and additional medications may be given intravenously before or during the procedure if necessary. After the procedure, pain is felt in the area where the needle was inserted for several days. After surgery, the dressing is removed on the day of the procedure. The pain and sensation of the procedure itself may vary depending on the volume and location of the pathological focus and, in addition, it depends on the individual characteristics of the body.
What steps are performed after a biopsy?
Once a tissue or cell sample is obtained, it is sent to the pathanatomy department for histologic and cytologic analysis. The pathologist will examine the tissue using various staining agents under a microscope. The pathologist’s full report is sent to the treatment department to the doctor a few days later. If a breast biopsy has been performed, the radiologist will likely discuss the findings with the patient. The radiologist may recommend follow-up visits after the procedure or treatment is completed. The visit may include an exam, performing an ultrasound. If a more detailed understanding of the changes is needed, a CT or MRI scan is performed, as well as laboratory tests: a general blood count, blood chemistry, and others. At the follow-up visit, any changes or side effects that have occurred since the procedure or treatment should be discussed with your doctor.
What are the advantages of biopsy over other methods?
Needle biopsy is a less invasive procedure, unlike open and closed surgical procedures. These techniques are performed through a small incision in the skin and with small doses of local or general anesthesia. The procedure is not painful and the results are as accurate as taking a tissue sample through extensive surgery. Recovery time is brief, and patients can resume their normal activities fairly quickly. Any procedure that involves skin damage carries a risk of infection. The probability of infection requiring antibiotics is less than one in 1000, which is several times less than with other sampling methods.
The biopsy procedure is safe and causes minimal trauma. Complications that can arise from biopsies include: bleeding, infection, damage to neighboring structures (intestine during abdominal biopsy or lung parenchyma).
What are the contraindications and downsides of biopsy?
In some cases, the amount of tissue obtained from the biopsy may not be sufficient and then a second operation is necessary. This may be particularly common when trying to recognize lymphoma. If the resection was performed clearly and without technical difficulty, but tissue or cell analysis did not provide the necessary information, then open surgery is required. Usually, the procedure is not performed if there are any skin changes in the area of the operation to be performed. In addition, if the pathological formation is so small that it is not visible on the images, then extensive intervention is required. Also, if there is a risk of spreading the formation, then it is better to use other methods of tissue removal. In addition, the usual contraindications for biopsy are: blood diseases, intolerance to drugs. Also, a relative contraindication is the possibility of using alternative non-invasive diagnostic options with similar efficacy and informativeness. There are no other contraindications and restrictions for biopsy.
In order to avoid negative consequences of the biopsy, it should be performed by a highly qualified specialist.
In addition to high-quality specialists and modern technology, our clinics in Munich treat each patient individually, taking into account all the peculiarities of the body and weighing all the risks. In addition, Munich continues to develop new ways and methods of performing biopsies, and engineers, taking into account all the advantages and disadvantages of the equipment, improve it, which results in a lower percentage of various complications.
The price of this procedure depends on a variety of factors:
- which organ is being biopsied,
- concomitant pathology,
- general condition of the body, and others.
In addition, the price depends on whether the biopsy is a needle biopsy or a conventional surgical biopsy.
Cost of services
- NAME OF SERVICE ADDITIONALLYPRICE, €
- Biopsy Nephrology 1500