Role of morphological examination in clinical practice
The results of a pathological-anatomical analysis are never evaluated by physicians in isolation. They are always considered in an inseparable complex with the gathered medical history, as well as physical, instrumental, and laboratory examination data. In many modern clinical guidelines, precisely this cumulative approach serves as the foundation for establishing a diagnosis.
At the same time, the pathological-anatomical examination of biopsy or large-scale surgical material acts as the decisive morphological component. This is especially critical in the diagnosis of complex oncological conditions, such as pancreatic cancer or renal parenchyma cancer. Additional methods provide accurate topographic diagnostics and reliable morphological verification — establishing the true morphogenetic nature of the changes detected in the tissues.
Biopsy: Essence of the Method and Clinical Significance
Biopsy is the intravital collection of a small volume of tissue, which is called a biopsy specimen. In the laboratory, this material undergoes detailed microscopic examination. The procedure itself belongs to the category of diagnostic surgical operations. It is resorted to in situations where highly informative non-invasive methods do not make it possible to definitively confirm the disease. If the correct diagnosis is established directly during such an intervention, the diagnostic operation immediately transitions into a therapeutic one.
The significance of biopsy in medicine is colossal. When a malignant tumor is suspected (e.g., neoplasms of the skin, breast, kidney, pancreas, colon, or ovaries), morphological verification is an absolutely mandatory stage before starting any therapy. For patients with suspected bone sarcoma, performing a biopsy is strictly mandatory in all cases without exception.
Application of Biopsy in Non-Oncological Pathology
Pathomorphological analysis of biopsy material plays a key role not only in tumors, but also in many other diseases:
- Pulmonology: in hypersensitivity pneumonitis, the diagnosis is made exclusively based on the identification of specific microscopic signs in any obtained lung tissue biopsy specimens.
- Cardiology: myocardial biopsy is recognized as the "gold standard" for identifying inflammatory processes in the heart (often combined with IHC evaluation of inflammatory cells and the search for viral genomes). It is used to diagnose cardiomyopathies, drug toxicity, monitor transplant status, and reliably confirms giant cell or eosinophilic myocarditis, sarcoidosis, and vasculitis.
- Nephrology: when IgA nephropathy is suspected, a biopsy is necessary to confirm the diagnosis, accurately assess the degree of renal parenchyma damage, predict the course of the disease, and select optimal treatment tactics.
In some cases, a repeat biopsy is required. For example, in cutaneous mycosis fungoides, repeated material collection allows for the timely detection of disease progression. At the same time, specialists need to exercise extreme caution when interpreting data, as phenotypic variability may be observed in the same patient across different lesions, even in biopsies performed with a short time interval.
Immunohistochemistry and Intraoperative Diagnostics
Standard histological examination is regularly supplemented with immunohistochemical (IHC) analysis.
- Breast Cancer: IHC makes it possible to determine the biological characteristics of the tumor, perform accurate staging, and evaluate therapeutic pathomorphosis.
- Gastrointestinal Stromal Tumors: the method is necessary to confirm the diagnosis with mandatory reflection of specific parameters in the report.
- Skin Pathology: IHC is used to detect signs of malignant transformation of lymphocytes infiltrating the skin.
Intraoperative (express) diagnostics, performed directly during surgical intervention (during laparoscopy, laparotomy), should be highlighted separately. This method has its limitations: a correct diagnosis can only be made in a portion of cases. This emphasizes the need for subsequent, more prolonged and comprehensive histological (and IHC) examination of all surgical material.
Class and exam questions
Why is a biopsy needed if a non-invasive examination can be performed?
Non-invasive methods do not always make it possible to determine the morphogenetic nature of changes. Biopsy provides morphological verification, which is a mandatory stage before initiating treatment, especially when malignant tumors are suspected.
What is the essence of intraoperative express diagnostics?
This is a microscopic examination of tissues directly during surgery. However, the method has limitations, and an accurate diagnosis is made only in a portion of cases, therefore a full histological examination is always required after surgery.
What is IHC and why is it needed?
Immunohistochemical examination complements classical pathological anatomy. It helps to identify specific biological characteristics of tissues (for example, staging breast cancer or finding transformed lymphocytes in the skin).
Why is a repeat biopsy performed?
A repeat biopsy (e.g., in mycosis fungoides) allows for the timely detection of disease progression when the clinical picture changes and helps adjust treatment, taking into account possible cell variability in different lesions.
What else to study on this topic
- Detailed technique of laboratory processing of a biopsy specimen (fixation, tissue processing, embedding)
- Hematoxylin and eosin staining and additional staining methods
- Organization of the pathological anatomy service
- Legal aspects of working with biopsy and surgical material
- Evaluation of therapeutic pathomorphosis in oncology
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