Biopsy
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COLLECTION & HANDLING OF HISTOLOGICAL SPECIMENS 1. A request form must be filled out for each patient with as much information available. 2. Tissue specimens should be placed into a container of 10% buffered formalin. 3. All specimen containers should be labeled with the patients’ name, the name of the hospital, the name of the doctor, and site or source of the specimen. *BM biopsies and/or aspirations should be allowed to clot. The BM smears should be completely air dried, labeled and packaged in a protective manner, and sent along with biopsy and aspiration *Calculi such as kidney, ureter, bladder, prostate etc. can be sent dry and unfixed. *All foreign body specimens can be sent dry and unfixed. 4. Place the specimen container and the paperwork into separate compartments of the biohazard bags. 5. Do not mix patient/cases in a bag. Put only one case/patient per bag and only 4 vials per bag. If you have more than 4 vials for the same patient, use more than one biohazard bag. 6. After sp. collection, all non-reusable specimen collection and barrier protection materials should be placed in red biohazard bags and autoclaved prior to disposal. All reusable autopsy equipment must be autoclaved or disinfected according to standard laboratory procedures before re-use. The following specimens will be rejected: • Swabs that have dried • Specimens not in appropriate transport media (unless prior arrangements have been made or specimens collected on a moist swab for less than 6 hrs. prior to receipt) • Specimens not sent at correct temperature • Specimens not sent within the appropriate time from collection • Specimens determined to be of no clinical value after consultation and concurrence with the attending physician • Specimen containers contaminated on the outside BIOPSY - Gk. Bios (life) & opsy (look/appearance) - Medical test involving removal of cells/tissues for examination - Biopsy specimens often taken from part of a lesion when the cause of a disease is uncertain or its extent or exact character is in doubt - Pathologic exam of biopsy can determine whether a lesion is
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benign or malignant, and can help differentiate bet diff types of cancer Margins of biopsy specimen are carefully examined to see if the disease may have spread beyond the area biopsied. o Clear margins/Negative margins – no disease found at the edges of specimen o Positive margins – disease was found; additional treatment may be needed
How is a Biopsy Performed? Can be obtained in various ways depending on type of specimen needed Flexible endoscopes (flexible, fiberoptic tube with a viewing lens and lights) allow a surgeon to view the inside of the body through a small incision and take a tissue sample Tissue samples are usually small and taken from tissue that appears changed in structure, such as a tumor • Endoscopic biopsy o Performed through a fiberoptic endoscope (long, thin tube that has a close-focusing telescope on the end for viewing) through a natural body orifice (i.e. rectum) or a small incision (i.e. arthroscopy) o Endoscope: view organ in question for abnormal or suspicious areas, in order to obtain a small amt. of tissue for study o Endoscopic procedures are named for the organ or body area to be visualized and/or treated o Can insert the endoscope into the GIT (alimentary tract endoscopy), bladder (cystoscopy), abdominal cavity (laparoscopy), joint cavity (arthroscopy), mid-portion of the chest (mediastinoscopy) or trachea and bronchial system (laryngoscopy and bronchoscopy) • Bone marrow biopsy o Involves taking small amount of BM fluid (aspiration) and/or solid BM tissue (core biopsy) usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells • Excisional or Insicional Biopsy o Often used when a wider/deeper portion of skin is needed o Using a scalpel (surgical knife), full thickness of skin is removed for further examination, and wound is sutured with surgical thread o Excisional biopsy technique : entire tumor is removed; usually preferred when melanoma is suspected
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o Incisional biopsy technique : only a portion of tumor is removed Fine needle aspiration (FNA) biopsy o Use of a thin needle to remove very small pieces from a tumor o Local anesthetic sometimes used to numb the area o Rarely causes much discomfort and leaves no scar o Not used for diagnosis of suspicious mole o May be used to biopsy large lymph nodes near a melanoma to see if the melanome has metastasized (spread) o CT scan (computed tomography) or ultrasound may be used to guide a needle into a tumor in an internal organ such as the lung or liver Punch biopsy o Taking a deeper sample of skin with a biopsy instrument o Removes short cylinder, or “apple core”, of tissue o Local anesthetic; instrument rotated on surface of the skin until it cuts through all layers including dermis, epidermis and most superficial parts of the subcutis (fat) Shave biopsy o Removing the top layers of skin by shaving it off; with local anasthetic Skin biopsy o Removing a sample of skin for examination under microscope to determine if melanoma is present o Performed under local anesthesia; Px feels small needle stick and a little burning for about a minute with little pressure but no pain
Common Biopsy Sites : o Bone marrow o Breast o GIT o Kidney o Liver o Lung o Lymph nodes o Skin o Thyroid o Brain Following a biopsy, the tissue specimen is sent to one of the following areas of anatomical pathology to be examined and analyzed:
Surgical Pathology, Cytology, Autopsy BIOPSY SPECIMENS 1. Fixed tissue • In 10% buffered formalin or paraffin-embedded • For routine H&E stains and special stains as well as immunohistochemistry and in situ hybridization • If submitted more than 2 weeks after it is collected, paraffinembedded tissue is preferred for submission • Over-fixation will form strong formalin bond in tissue and make Ag retrieval more difficult • Blocks rather than slides are preferred since epitopes and nucleic acids can degenerate more quickly once tissue is prepared for slides thus decreasing sensitivity of special assays • Fixed tissue from multiple organs can be combined in one container • Should be stored and shipped at RT. DO NOT FREEZE. 2. Fresh or Unfixed Tissue • For culture and molecular techniques inc. specific primer and consensus PCR • Specimens should be collected aseptically and as soon as possible after death • Separate sterile instrument should be used for each collection site and each specimen should be placed in a separate sterile container in small amounts of viral transport media or saline • Frozen tissue should be stored at -70°C and shipped on dry ice
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benign or malignant, and can help differentiate bet diff types of cancer Margins of biopsy specimen are carefully examined to see if the disease may have spread beyond the area biopsied. o Clear margins/Negative margins – no disease found at the edges of specimen o Positive margins – disease was found; additional treatment may be needed
How is a Biopsy Performed? Can be obtained in various ways depending on type of specimen needed Flexible endoscopes (flexible, fiberoptic tube with a viewing lens and lights) allow a surgeon to view the inside of the body through a small incision and take a tissue sample Tissue samples are usually small and taken from tissue that appears changed in structure, such as a tumor • Endoscopic biopsy o Performed through a fiberoptic endoscope (long, thin tube that has a close-focusing telescope on the end for viewing) through a natural body orifice (i.e. rectum) or a small incision (i.e. arthroscopy) o Endoscope: view organ in question for abnormal or suspicious areas, in order to obtain a small amt. of tissue for study o Endoscopic procedures are named for the organ or body area to be visualized and/or treated o Can insert the endoscope into the GIT (alimentary tract endoscopy), bladder (cystoscopy), abdominal cavity (laparoscopy), joint cavity (arthroscopy), mid-portion of the chest (mediastinoscopy) or trachea and bronchial system (laryngoscopy and bronchoscopy) • Bone marrow biopsy o Involves taking small amount of BM fluid (aspiration) and/or solid BM tissue (core biopsy) usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells • Excisional or Insicional Biopsy o Often used when a wider/deeper portion of skin is needed o Using a scalpel (surgical knife), full thickness of skin is removed for further examination, and wound is sutured with surgical thread o Excisional biopsy technique : entire tumor is removed; usually preferred when melanoma is suspected
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o Incisional biopsy technique : only a portion of tumor is removed Fine needle aspiration (FNA) biopsy o Use of a thin needle to remove very small pieces from a tumor o Local anesthetic sometimes used to numb the area o Rarely causes much discomfort and leaves no scar o Not used for diagnosis of suspicious mole o May be used to biopsy large lymph nodes near a melanoma to see if the melanome has metastasized (spread) o CT scan (computed tomography) or ultrasound may be used to guide a needle into a tumor in an internal organ such as the lung or liver Punch biopsy o Taking a deeper sample of skin with a biopsy instrument o Removes short cylinder, or “apple core”, of tissue o Local anesthetic; instrument rotated on surface of the skin until it cuts through all layers including dermis, epidermis and most superficial parts of the subcutis (fat) Shave biopsy o Removing the top layers of skin by shaving it off; with local anasthetic Skin biopsy o Removing a sample of skin for examination under microscope to determine if melanoma is present o Performed under local anesthesia; Px feels small needle stick and a little burning for about a minute with little pressure but no pain
Common Biopsy Sites : o Bone marrow o Breast o GIT o Kidney o Liver o Lung o Lymph nodes o Skin o Thyroid o Brain Following a biopsy, the tissue specimen is sent to one of the following areas of anatomical pathology to be examined and analyzed:
Surgical Pathology, Cytology, Autopsy BIOPSY SPECIMENS 1. Fixed tissue • In 10% buffered formalin or paraffin-embedded • For routine H&E stains and special stains as well as immunohistochemistry and in situ hybridization • If submitted more than 2 weeks after it is collected, paraffinembedded tissue is preferred for submission • Over-fixation will form strong formalin bond in tissue and make Ag retrieval more difficult • Blocks rather than slides are preferred since epitopes and nucleic acids can degenerate more quickly once tissue is prepared for slides thus decreasing sensitivity of special assays • Fixed tissue from multiple organs can be combined in one container • Should be stored and shipped at RT. DO NOT FREEZE. 2. Fresh or Unfixed Tissue • For culture and molecular techniques inc. specific primer and consensus PCR • Specimens should be collected aseptically and as soon as possible after death • Separate sterile instrument should be used for each collection site and each specimen should be placed in a separate sterile container in small amounts of viral transport media or saline • Frozen tissue should be stored at -70°C and shipped on dry ice
