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Needle biopsies

Percutaneous biopsy in oncology.

Biopsy is the procedure of obtaining a small piece (sample) from a suspicious tissue or mass in order to learn its nature. The sample is examined by the pathologists, and after some special procedures,  important information can be obtained. While this information was previously only limited to whether the mass was cancer or not, today, other vital data can be obtained from the biopsy, such as the type of cancer, the rate of proliferation of cells, involvement of vessels and nerves, ratio of hormone receptors and genetic structure of the tumor.

Until recently, the only way to get a biopsy was surgical operation. However, surgical biopsy was not preferred by both patients and physicians because it was performed with an incision under general anesthesia, required hospitalization and the risk of complications was higher. Because of these limitations of the surgical biopsy, imaging-guided fine needle biopsies were introduced. In these biopsies, cell samples were sucked into a syringe after placing a thin needle into the suspicious mass under ultrasound or CT guidance. This biopsy technique, called a fine-needle aspiration biopsy (FNAB), rapidly replaced surgical biopsy. This method is currently used as a standard biopsy method in thyroid nodules and lymph node biopsies.

With the advances in technology, it was understood that much more information could be obtained from the biopsy samples, but for this, real tissue fragments was necessary and not just cell aspirates.  Based on this need, cutting biopsy needles (trucut biopsy, core biopsy) were developed and widely used in all parts of the body, especially breast, liver, bone and soft tissues. Nowadays, thanks to this biopsy method, very important information can be reached such as the type of cancer, growth rate, involvement of the vessels and nerves, amount of hormone receptors and genetic structure. With this information, it can be found out which treatment method and even which chemotherapy regimen can be effective in the patient, and thus, personalized cancer treatment can be administered.

Today, FNAB is preferred only in thyroid nodules and some lymph node biopsies. All other imaging-guided biopsy procedures are performed by taking the pieces from the tissue with the cutting needle. In breast and subcutaneous tissues, it is sometimes preferable to take the entire mass. In such cases, the BLES (Breast Lesion Excision System) and the Vacuum Biopsy System can be used to remove all suspicious masses as a whole or in small parts without surgery.

Interventional oncology in cancer management

Prof Saim Yilmaz, MD

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