Monday Medical: Taking the fear out of biopsies
For Steamboat Pilot & Today
The word “biopsy” can conjure dread among patients who worry that it will lead to a cancer diagnosis.
It’s normal to be nervous, say medical experts, but patients shouldn’t automatically assume the worst. Rather, patients should see a biopsy as a tool that providers use to determine a proper diagnosis.
“We see many biopsies on a daily basis and the majority of them are not cancer,” said Dr. Catherine Salisbury, a pathologist and medical director of the laboratory at UCHealth Yampa Valley Medical Center. “And in the handful of ones that do turn out to be malignant, the smaller the lesion or tumor is, and the earlier it is detected, the better the odds that the patient will have a successful outcome.”
What is a biopsy?
Salisbury explained that a biopsy is a sampling of tissue taken from a patient so that the cells can be examined more closely in a laboratory setting to determine whether a disease or other malady is present.
Common types of biopsies include shave or punch biopsies for skin cancer, needle core biopsies for breast cancer, needle biopsies for prostate cancer and pap smears to screen for gynecologic cancers.
What happens during a biopsy?
The least invasive type of biopsy employs cytology with a brush or fine needle to aspirate, or draw fluid containing free-floating cells, from a body site. This type of biopsy is most often used for screening purposes, such as pap smears, or when a lesion is easily seen or felt and is sometimes all that is needed by researchers to determine if there is something wrong.
More often, she said, providers need to perform a tissue biopsy, where a larger needle is used to take a core sample of tissue.
“This allows the cells to be extracted intact so that pathologists are better able to see the entire architecture of the cells in relation to their surroundings,” said Salisbury. “Through this process, we get a more informative representation of what is happening in the tissue and can make a more definitive diagnosis.”
Both of these types of biopsies use local anesthetics to numb the area for pain. For more complicated biopsies, a patient might be given an IV sedative or other medication to relax them.
What happens in the medical lab?
Take a breast biopsy, for example.
If a radiologist detects a lesion or something suspicious that needs to be further explored after a mammogram, the radiologist would perform a needle core biopsy. The tissue sample is promptly placed into a formalin-filled container to preserve it.
The sample is examined by a pathologist who describes and slices the tissue and places it onto a cassette block. The block is sent to a histology laboratory and placed into a “processor” overnight where the tissue is treated with multiple chemicals. After several hours, the tissue is dehydrated and infused with paraffin wax.
The next morning, a histotechnologist, a laboratory technician with expertise examining and preparing tissue, prepares the tissue for a microscopic exam by embedding the sample into a bigger block of wax. This block is cut into very thin slices on a machine called a microtome and placed onto glass slides, which are stained with chemical dyes that allow the tissue to be seen under the microscope.
A pathologist then examines it and makes a diagnosis on whether the cells are benign or cancerous.
Waiting for results
While scheduling a biopsy might produce anxiety, waiting for the results can also be stressful.
“We work diligently to get the results out by the next day but if additional testing is needed or if it is a more difficult or complex case, we might need a little more time,” said Salisbury. “Even though our histology lab is in Denver, digital pathology allows quick and easy access to our slides. A courier comes every afternoon and takes our tissue cassettes, and then the lab sends us digitally-scanned slides as soon as they are ready the following morning. This way, patients don’t have to wait for a courier to ship slides back to us.”
Enhanced patient care
Pathology has become more specialized, moving into the realm of personalized medicine, which involves research at a molecular level and examining genetic markers to see how tumors respond to various chemotherapy drugs. That enables providers to develop a specific and strategic treatment plan for the best individual patient outcome.
Mary Gay Broderick writes for UCHealth. She can be reached at email@example.com.
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