Biopsy and histological examination

The role of biopsy in comprehensive diagnostics

Establishing an accurate diagnosis in modern medicine requires a comprehensive approach. The results of studying biopsy material are never evaluated in isolation: they are considered in an inseparable complex with the patient's medical history, the findings of a thorough physical examination, as well as laboratory and instrumental diagnostic indicators. In many current clinical guidelines (for example, in the diagnosis of pancreatic cancer or renal parenchyma cancer), the diagnosis is established precisely based on the aggregate of all the aforementioned data. At the same time, the pathomorphological examination of biopsy or full surgical material acts as a decisive morphological component.

From a clinical standpoint, a biopsy belongs to the category of diagnostic surgeries—it is the targeted acquisition of tissues for subsequent histological examination. It is resorted to in those complex situations where highly informative non-invasive diagnostic methods do not allow the disease to be identified with certainty. It is important to note that if the diagnosis is reliably confirmed directly during such a procedure, the manipulation may organically transition from diagnostic to therapeutic. The main task of such interventions is to ensure reliable morphological verification, i.e., to accurately establish the morphogenetic nature of the identified tissue changes, as well as to conduct detailed topographic diagnostics of the developing pathological process.

Intraoperative and routine diagnostics

In surgical practice, there is often a need for urgent intraoperative (frozen section) diagnostics based on rapidly obtained biopsy material. However, this method has its objective limitations. Even while directly in the operating room during a direct surgical intervention (such as laparoscopy or open laparotomy), a correct diagnosis in certain occult or complex diseases cannot always be established, but only in a portion of cases.

Such statistics unequivocally emphasize the need for a subsequent, deeper, and more comprehensive histological examination of all resected surgical material on a routine basis. Only careful study allows errors to be avoided and all nuances of tissue remodeling to be accounted for.

The role of immunohistochemistry (IHC)

In modern pathological anatomy, routine analysis of biopsy material is regularly supplemented by immunohistochemical examination. This necessity is clearly reflected in current medical guidelines:

• In breast cancer, IHC makes it possible to determine the biological characteristics of the tumor, perform accurate staging of the process, and objectively assess therapeutic pathomorphosis following the therapy administered.
• In the case of gastrointestinal stromal tumor, the method is essential for the definitive confirmation of the diagnosis, with the mandatory inclusion of specific parameters of the neoplasm in the final report.
• In mycosis fungoides, IHC is used for the strict standardization of pathomorphological reports, as well as when examining repeat biopsies in the event of a changing clinical picture of the disease.

Clinical significance of biopsy: practical examples

The significance of biopsy for the correct determination of a disease is exceptionally high, which is confirmed by practice in various fields of medicine:

1. Oncological practice. At the slightest suspicion of a malignant tumor (affecting the skin, breast, bones, kidney, pancreas, colon, ovaries, and other organs), morphological verification is a strictly mandatory step before initiating any specific treatment. For bone sarcomas, biopsy is recognized as mandatory for absolutely all patients with a suspected malignant process.
2. Pulmonology. Pathomorphological examination plays a key role in the diagnosis of hypersensitivity pneumonitis: the definitive diagnosis is established only when specific morphological features are identified in lung tissue biopsy specimens.
3. Cardiology. Myocardial biopsy is rightly considered the "gold standard" for detecting heart inflammation (especially in combination with IHC assessment of inflammatory cells and the identification of viral genomes). It is used to diagnose cardiomyopathies, drug toxicity, and monitor transplant status. The method makes it possible to confirm giant cell or eosinophilic myocarditis, systemic vasculitis, and sarcoidosis.
4. Nephrology. When IgA nephropathy is suspected, kidney tissue analysis is performed to reliably confirm the diagnosis, objectively assess the degree of parenchymal damage, formulate a prognosis, and select the optimal treatment strategy.
5. Dynamic monitoring. Repeat biopsy (e.g., of the skin in mycosis fungoides) allows physicians to timely detect disease progression and promptly adjust therapy. At the same time, phenotypic variability in different lesion sites in the same patient has been described, even with biopsies performed within a very short timeframe, which always requires specialists to exercise special caution when interpreting results.

Class and exam questions

What else to study on this topic

• Detailed technique of laboratory processing of the biopsy specimen: fixation, tissue processing, and paraffin embedding.
• Staining techniques: application of hematoxylin and eosin, as well as additional specific stains.
• Organization of the work of the pathology department in a medical institution.
• Regulatory framework and legal aspects of working with biopsy and surgical material.

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.