Biopsy/Cytology/Exploratory Procedures

DR.P.J.ALAGOA B.Med.sc, MB BS, FMCS, FICS.
DEPT. OF SURGERY
NIGER DELTA UNIVERSITY
BIOPSY/CYTOLOGY/EXPLORATORY
PROCEDURES
BIOPSY
INTRODUCTION
 Investigation of disease sometimes requires

that tissue be collected for study & analysis.
 The collection of such samples has been made easier

by advances in surgical technique, equipment,
anaesthesia, tissue processing & image techniques.
 The discovery of the cellular nature of cancer was a
pivotal development in Pathology & Oncology.
DEFINITIONS
 The term Biopsy derives from the words –

Bios (life) and Opsis (sight).
 It is defined as the examination of tissue
removed from a living body to discover the
presence, cause or extent of disease.
 In most cases it implies the examination of
material under the light or electron
microscope for histopathological or
cytological assessment
 Tissue removed for biopsy might be used for
purposes other than the malignancy or
benignity of a lesion e.g gastric antral
biopsies may be used for culture of H.pylori &
liver biopsies may be performed for chemical
analysis of haemachromatosis.
USES OF BIOPSY
1. Establishing the diagnosis of the primary

lesion.
2. Staging of malignant disease e.g nodal
biopsy
3. Grading of malignant disease
4. Treatment
GUIDELINES FOR BIOPSY
1. The tissue should be representative of the whole

lesion. Multiple specimens may be necessary.
2. Crushing and charring should be avoided.
3. Zones of haemorrhage, necrosis & obvious
infection should be avoided.
4. In lesions of skin & mucosa, healthy marginal
tissue should be included in the specimen
5. During biopsy the tissue & surrounding tissue
should be handled with care to avoid massaging
tumour cells into circulation.
6. The Pathologist should be provided with all
relevant information
TYPES OF BIOPSIES
1. EXCISION BIOPSY
- This is a surgical procedure in which the
entire lesion is excised with no attempt at
obtaining generous margins of adjacent
normal tissue.
- Removal of the entire lesion eliminates the
problem of misdiagnosis due to sampling
error
2. INCISIONAL BIOPSY
- This is the removal of a small segment from
the main bulk of a tumour or organ. It is done
when excision biopsy is contraindicated.
- A portion of the most representative or
suspicious area of the lesion is removed.
-
3. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)
- This is a great advance in the management of
solid tumours esp breast where Rx is now often
based on FNAC
- The aim is to obtain a small number of
representative cells or groups of cells for
cytological analysis
- Advantages are that it is quick, easy, relatively
painless & extremely specific if biopsy is positive
TECHNIQUE:
 The skin is cleaned with an alcohol swab
 For the (R) handed the (L) hand is used to steady the
lump while the needle (21G) is inserted & the syringe
aspirated
 The needle is redirected within the lump in several
directions
 The negative pressure is released before the withdrawal
of the needle
 The syringe is withdrawn & the needle separated from
it.
 The syringe is filled with air & reconnected to
the needle
 The cellular material from within the needle is
injected onto a clean slide which is air-dried &
fixed with Formalin
ASPIRATION RESULTS
 C1 – NORMAL
 C2 - BENIGN
 C3 - ATYPICAL (EQUIVOCAL)
 C4 - SUSPECTED CARCINOMA
 C5 - CARCINOMA
4. CORE BIOPSY
- Uses a percutaneous technique to get tissue large
enough for formal histology
- Bleeds more, more painful & requires more pressure
dressing than FNAC
- Uses: Liver, Kidney, Prostate & other soft tissue
tumours
- L.A – Lignocaine
- Trucut biopsy needles have been superceeded by
automated devices ( Biopsy gun & Bard Magnum)
- All biopsies can be guided – USS, CT
5. ENDOSCOPIC BIOPSY
- Essential especially in GIT diseases
- The endscopy device is fitted with sharpened
cusps for gripping & cutting. Tissue is then
withdrawn.
- Cytological specimens can also be obtain
using cytological brushes
EXPLORATORY PROCEDURES
1. EXPLORATORY LAPARATOMY
- Exploration of the peritoneal cavity
- Indicated as a diagnostic & therapeutic
procedure.
- Trauma, Intestinal obstruction, Intra-
peritoneal haemorrhage, masses, Cases of
unconfirmed diagnosis etc
2. EXPLORATORY BURR HOLE
- Head injury when there is marked deterioration in
consciousness with clear localizing signs & there is
no CT
- Disadvantages:
1. Most comatose pts do not have a haematoma
2. A burr hole as close as 1cm from a haematoma
may miss it.
3. Only a small amount of subdural haematoma can
be evacuated using a burr hole
4. The procedure can cause more bleeding
5. Can best be a temporizing measure
THANKS
FOR
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DR.P.J.ALAGOA B.Med.sc, MB BS, FMCS, FICS.

 Investigation of disease sometimes requires

 The collection of such samples has been made easier

 The term Biopsy derives from the words –

1. Establishing the diagnosis of the primary

1. The tissue should be representative of the whole

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