Understanding Biopsies: Different Types and Their Medical Importance

Describe briefly the different types of biopsy.

Answer. Following are the different types of biopsies:

Incision biopsy—wedge biopsy
Excision biopsy
Trucut biopsy
Pap smear
FNAC
Frozen section biopsy
Punch biopsy
Ultrasound-guided biopsy
Brush biopsy

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Laparoscopic biopsy
CT-guided biopsy
Thoracoscopic biopsy
Endoscopic biopsy (gastroscopic or colonoscopic or through ERCP or cystoscopy)
Bronchoscopic biopsy
Open biopsy either laparotomy thoracotomy or craniotomy using
Dancly’s brain cannula

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Incision Biopsy

This is the excision of a portion of the lesion for microscopic examination.
This method is employed on large, diffuse lesions which has a size of 2 cm in its greatest dimension.
This method can also be done on lesions suspected of malignancy.
This method aims to remove a portion of the lesional tissue in question along with the sample of normal adjacent tissue for comparison.

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Types Of Incision Biopsy

Punch biopsy: This is done by using a surgical punch of diameter 4, 8, or 10 mm. This incisional biopsy is done in mass screening programs.
Wedge biopsy: This is done by making a wedge-shaped incision that begins 2 to 3 mm from normal tissue and penetrates the region surrounding abnormal tissue.
Tissue should always be incised narrow and deep.

Excision Biopsy

This procedure should be done for the small lesions which are clinically benign.
In this, the complete lesion should be removed for examination and diagnosis. So it is both diagnostic and curative.

Trucut Biopsy

It is done using a specialized device wherein a gun with a true cut tip is inserted into the surface tissue/organ and the gun is fired to close the punching needle to catch and cut the adequate tissue.
It is done in prostate, breast, and surface tumors.

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FNAC

This is the cytological study of tumor cells to find out the disease and also confirm whether it is malignant or not.
It is done by using 23 or 24-gauge needles fitted to specialized syringes which create negative pressure for aspiration and contents are smeared on slides.
It is contraindicated in testicular tumor.

Frozen Section Biopsy

It is done when a biopsy report is needed at the earliest.
It is done in the pathology set-up existing adjacent to the operation theater.
In this an unfied fresh tissue is frozen (using carbon dioxide) in a metal and sections are made and stained.
The advantage of this technique is that it is quick and the surgeon can decide further steps in surgery.

Ultrasound-guided or CT-guided

This procedure is conducted with a large needle with assisted CT scan equipment.
Simultaneous CTscanallowidentifiationand visualization of the exact size of the tumor on a computer screen.
It enables the operator to guide the needle into the tumor and obtain several samples of tissue.
Tissues were then later examined by a histopathologist.

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Brush Biopsy

In this, a brush biopsy kit is supplied by the manufacturer which consists of a brush biopsy instrument, bar-coded glass slide, alcohol-based fixative and protective plastic case for mailing, and instruction sheet.
In this, the nylon brush is designed to collect cells from all layers of epithelium including the basal cell layer of epithelium.

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The procedure includes the application of firm pressure on the lesion rotating brush 5–10 times.
After this nylon brush is manipulated on a glass slide so more cells are spread over the slide.
The slide is analyzed by a computer program designed for pathological review.
Results are interpreted as negative, positive, or typical.