Biopsy

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Biopsy
A biopsy is a medical test commonly performed by a
surgeon, interventional radiologist, or an interventional
cardiologist involving sampling of cells or tissues for examination. It is the medical removal of tissue from a
living subject to determine the presence or extent of
a disease. The tissue is generally examined under a
microscope by a pathologist, and can also be analyzed
chemically. When an entire lump or suspicious area is
removed, the procedure is called an excisional biopsy.
When only a sample of tissue is removed with preservation of the histological architecture of the tissue’s cells,
the procedure is called an incisional biopsy or core biopsy.
When a sample of tissue or fluid is removed with a needle
in such a way that cells are removed without preserving
the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are Lung biopsy in a case of suspected lung cancer under control of
most commonly performed for insight into possible can- computer tomography.
cerous and inflammatory conditions.

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that no disease was found at the edges of the biopsy specimen. “Positive margins” means that disease was found,
and a wider excision may be needed, depending on the
diagnosis.

Etymology

Biopsy is of Greek origin, coming from the words βίος
bios, “life,” and ὄψις opsis, “a sight.”[1]

When intact removal is not indicated for a variety of reasons, a wedge of tissue may be taken in an incisional
French dermatologist Ernest Besnier introduced the word biopsy. In some cases, a sample can be collected by debiopsie to the medical community in 1879.[2]
vices that “bite” a sample. A variety of sizes of needle
can collect tissue in the lumen (core biopsy). Smaller diameter needles collect cells and cell clusters, fine needle
aspiration biopsy.[4]
2 History
Pathologic examination of a biopsy can determine
whether a lesion is 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 pathol3 Conditions identified with biop- ogist would examine a mastectomy specimen, even if a
previous nonexcisional breast biopsy had already estabsies
lished the diagnosis of breast cancer. Examination of the
full mastectomy specimen would confirm the exact nature
of the cancer (subclassification of tumor and histologic
3.1 Cancer
“grading”) and reveal the extent of its spread (pathologic
When cancer is suspected, a variety of biopsy techniques “staging”).
can be applied. An excisional biopsy is an attempt to remove an entire lesion. When the specimen is evaluated,
in addition to diagnosis, the amount of uninvolved tissue 3.2 Cancer liquid biopsy
around the lesion, the surgical margin of the specimen is
examined to see if the disease has spread beyond the area Cancer is a heterogeneous genetic disease, and excisional
biopsied. “Clear margins” or “negative margins” means biopsies provide only a snapshot in time of some of the
One of the earliest diagnostic biopsies was developed by
the Arab physician Abulcasis (1013–1107). A needle was
used to puncture a goiter, and the material issuing was
characterized.[3]

1

2

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rapid, dynamic genetic changes occurring in tumors. In
addition, excisional biopsies are invasive, can’t be used
repeatedly, and are ineffective in understanding the dynamics of tumor progression and metastasis.[5] However,
liquid biopsy, or blood-sample tests, under development
by Epic Sciences can generate actionable information for
oncologists by analyzing circulating tumor cells (CTCs)[6]
and fragments of tumor-cell DNA that are continuously
shed by tumors into the bloodstream.[7] Highly sensitive
analysis of individual CTCs have demonstrated a high
level of heterogeneity seen at the single cell level for both
protein expression and protein localization and the CTCs
reflected both the primary biopsy and the changes seen
in the metastatic sites. By detecting and quantifying genomic alterations in CTCs and cell-free DNA in blood,
liquid biopsy can provide real-time information on the
stage of tumor progression, treatment effectiveness, and
cancer metastasis risk.[8] This technological development
could make it possible to diagnose and manage cancer
from repeated blood tests rather than from a traditional
biopsy.[6][8][9][10]

3.3

Precancerous conditions

For easily detected and accessed sites, any suspicious lesions may be assessed. Originally, this was skin or superficial masses. X-ray, then later CT, MRI, and ultrasound
along with endoscopy extended the range.

3.4

Inflammatory conditions

A biopsy of the temporal arteries is often performed
for suspected vasculitis. In inflammatory bowel disease
(Crohn’s disease and ulcerative colitis), frequent biopsies
are taken to assess the activity of disease and to assess
changes that precede malignancy.[11]
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.
• Kidney disease: Biopsy and fluorescence microscopy are key in the diagnosis of alterations of
renal function. The immunofluorescence plays vital
role in the diagnosis of Crescentic glomerulonephritis.
• Infectious disease: Lymph node enlargement may
be due to a variety of infectious or autoimmune diseases.
• Metabolic disease: Some conditions affect the
whole body, but certain sites are selectively biopsied because they are easily accessed. Amyloidosis
is a condition where degraded proteins accumulate
in body tissues. In order to make the diagnosis, the
gingival.

REFERENCES

• Transplantation: Biopsies of transplanted organs are
performed in order to determine that they are not
being rejected or that the disease that necessitated
transplant has not recurred.
• Fertility: 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.[12]

4 Biopsied sites
5 Analysis of biopsied material
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 (see Histology)
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.

6 See also
• Interventional radiology

7 References
[1] “biopsy”. Online Etymology Dictionary.
[2] Zerbino DD (1994). “Biopsy: Its history, current and future outlook”. Likars’ka sprava / Ministerstvo okhorony
zdorov'ia Ukrainy (3–4): 1–9. PMID 7975522.
[3] Anderson JB, Webb AJ (1987). “Fine-needle aspiration biopsy and the diagnosis of thyroid cancer”.
The British journal of surgery 74 (4): 292–296.
doi:10.1002/bjs.1800740422. PMID 3580805.
[4] Sausville, Edward A. and Longo, Dan L. “Principles of
Cancer Treatment: Surgery, Chemotherapy, and Biologic
Therapy”, Harrison’s Principles of Internal Medicine, 16th
Ed. Kaspar, Dennis L. et al., eds. p.446 (2005).

3

[5] Marrinucci D, Bethel K, Luttgen M, Bruce RH, Nieva
J, Kuhn P (Sep 2009). “Circulating tumor cells from
well-differentiated lung adenocarcinoma retain cytomorphologic features of primary tumor type”. Archives
of Pathology & Laboratory Medicine 133 (9): 1468–
71. doi:10.1043/1543-2165-133.9.1468 (inactive 201501-10). PMID 19722757.
[6] Nieva J, Wendel M, Luttgen MS, Marrinucci D, Bazhenova L, Kolatkar A, Santala R, Whittenberger B, Burke
J, Torrey M, Bethel K, Kuhn P (Feb 2012). “Highdefinition imaging of circulating tumor cells and associated cellular events in non-small cell lung cancer patients: a longitudinal analysis”. Physical Biology 9 (1): 016004. Bibcode:2012PhBio...9a6004N.
doi:10.1088/1478-3975/9/1/016004. PMC 3388002.
PMID 22306961.
[7] Crowley E, Di Nicolantonio F, Loupakis F, Bardelli A
(Aug 2013). “Liquid biopsy: monitoring cancer-genetics
in the blood”. Nature Reviews Clinical Oncology 10
(8): 472–484. doi:10.1038/nrclinonc.2013.110. PMID
23836314.
[8] Nieva JJ, Kuhn P (Aug 8, 2012). “Fluid biopsy for solid
tumors: a patient’s companion for lifelong characterization of their disease.”. Future Oncology 9 (8): 989–
998. doi:10.2217/fon.12.91. PMC 3658625. PMID
22894671.
[9] Hekimian K, Meisezahl S, Trompelt K, Rabenstein C,
Pachmann K (2012). “Epithelial Cell Dissemination and
Readhesion: Analysis of Factors Contributing to Metastasis Formation in Breast Cancer”. ISRN Oncology 2012:
601810. doi:10.5402/2012/601810. PMC 3317055.
PMID 22530147.
[10] Rolle A, Günzel R, Pachmann U, Willen B, Höffken K,
Pachmann K (2005). “Increase in number of circulating
disseminated epithelial cells after surgery for non-small
cell lung cancer monitored by MAINTRAC(R) is a predictor for relapse: A preliminary report”. World J Surg
Oncol 3 (1): 18. doi:10.1186/1477-7819-3-18. PMC
1087511. PMID 15801980.
[11] Friedman, S. and Blumberg, R.S. “Inflammatory Bowel
Disease”, Harrison’s Principles of Internal Medicine, 16th
Ed. Kaspar, Dennis L. et al., eds. pp.1176-1789, 2005.
[12] Mens health - Testicular Biopsy
[13] Saibeni S, Rondonotti E, Iozzelli A, Spina L, Tontini GE,
Cavallaro F, Ciscato C, de Franchis R, Sardanelli F, Vecchi M (2007). “Imaging of the small bowel in Crohn’s
disease: a review of old and new techniques”. World J.
Gastroenterol. 13 (24): 3279–87. PMC 4172707. PMID
17659666.
[14] Iglesias-Garcia J, Dominguez-Munoz E, Lozano-Leon
A, Abdulkader I, Larino-Noia J, Antunez J, Forteza J
(2007). “Impact of endoscopic ultrasound-guided fine
needle biopsy for diagnosis of pancreatic masses”. World
J. Gastroenterol. 13 (2): 289–93. PMC 4065960. PMID
17226911.

8 External links
• Mybiopsyinfo.com - What is a biopsy? How is a
biopsy examination performed? This website gives
you answers to these and many other questions.
• 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.
• RadiologyInfo - The radiology information resource
for patients: Biopsy
• Fine needle aspiration biopsy on Wikisurgery
• Core needle (Trucut) biopsy on Wikisurgery

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9 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

9

Text and image sources, contributors, and licenses

9.1

Text

• Biopsy Source: https://en.wikipedia.org/wiki/Biopsy?oldid=660929937 Contributors: Karada, Chadloder, Glenn, Zoicon5, Tpbradbury,
Oaktree b, Secretlondon, Robbot, RedWolf, Kukkurovaca, Neutrality, Rich Farmbrough, Bender235, Ylee, Pabloes, Remuel, MANOJTV,
Arcadian, LostLeviathan, Helix84, Wouterstomp, Velella, Cburnett, Eleassar777, MarcoTolo, Graham87, Margosbot~enwiki, Lmatt, Tedder, Rewster, YurikBot, Nephron, HLGallon, FF2010, Garion96, Andrew73, SmackBot, Unyoyega, Emj, NCurse, Hibernian, Deli nk,
A. B., Nakon, Acdx, SashatoBot, Kashmiri, Ben Moore, Novangelis, Mmdoogie, JForget, Rustavo, 5-HT8, Chasingsol, Ernstl, Roberta
F., Alaibot, JamesAM, John254, Insomniacpuppy, ThomasPusch, Escarbot, Mentifisto, Mack2, JAnDbot, MER-C, Hut 8.5, Magioladitis,
Celithemis, Vito Genovese, Phil E.Stein, Boghog, Mikael Häggström, AntoniusJ~enwiki, Johan1298~enwiki, Hehkuviini, Philip Trueman,
A4bot, Crohnie, Addere, MuanN, Carlifenkm, SieBot, HendrixEesti, Roentgendoc, ClueBot, Northerncedar, Niceguyedc, Goodnight3455,
Estirabot, Zao275, Skunkboy74, Bajikian, Salam32, ZooFari, Drausama, Addbot, Fieldday-sunday, Ironholds, Michael Harpur Edwards,
Numbo3-bot, Lightbot, Jarble,
, Luckas-bot, Yobot, AnomieBOT, Noq, IRP, Materialscientist, Jjolsen, Citation bot, Maarte.bynens,
Olivier Wouters, Capricorn42, J04n, Addingrefs, Omnipaedista, Locobot, Roseclearfield, Tobby72, Hellerhoff, BenzolBot, Stephen Morley, Adlerbot, Jonesey95, FoxBot, Kalaiarasy, Ndkartik, KHowe83, Angelito7, EmausBot, Ponydepression, ZéroBot, AManWithNoPlan,
L Kensington, Puffin, ClueBot NG, BG19bot, Gautehuus, Mwikiped, ProBonoPublicoA90, Rexgraham, JJMurphy1970, Ianrennie and
Anonymous: 125

9.2

Images

• File:Biopsie_Lunge_Computertomographie_BC.png Source:
https://upload.wikimedia.org/wikipedia/commons/5/50/Biopsie_
Lunge_Computertomographie_BC.png License: CC BY-SA 3.0 Contributors: Own work Original artist: Hellerhoff
• File:Wiki_letter_w_cropped.svg Source: https://upload.wikimedia.org/wikipedia/commons/1/1c/Wiki_letter_w_cropped.svg License:
CC-BY-SA-3.0 Contributors:
• Wiki_letter_w.svg Original artist: Wiki_letter_w.svg: Jarkko Piiroinen

9.3

Content license

• Creative Commons Attribution-Share Alike 3.0

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