BIOPSIES

Many illnesses appear to be similar and yet are quite different in terms of their ultimate outcome and treatment. Often, despite many tests of body fluids and innumerable X-rays and scans, a definite explanation of a disease is not clear. Under these circumstances a biopsy may be necessary to define its exact nature.

In a biopsy a small piece of the diseased tissue is removed and examined under a microscope. The specimen may also be sent for special biochemical studies, as well as for culture. In most instances a biopsy involves at least a mild degree of discomfort, and sometimes there may be a small risk, depending on the type of biopsy and how it is obtained. For instance, a biopsy of the skin has less hazard than a biopsy of the liver, which lies within the abdominal cavity. A biopsy can make a great difference in the ability of the physician to treat you effectively. Unless it will add to your well-being, a biopsy will not be requested unless it is absolutely necessary. If a biopsy is ordered for you, ask your physician why and what the complications might be.

Bone Marrow Biopsy

A bone marrow test is a kind of biopsy. The blood cells are made in the bone marrow, and a bone marrow specimen shows the early development of blood cells before they enter the bloodstream. It is not always possible to diagnose disorders of the blood by blood tests alone.

Either the area of the breastbone (sternum) or the pelvic bone is anesthetized with a local injection. A needle is then inserted into the bone and a sample of the bone marrow removed. The procedure takes about ten minutes and usually causes relatively little discomfort and poses virtually no danger.

Lung Biopsy

A biopsy of the pleura (lining of the chest wall) or lung may be necessary if you have a disorder of the respiratory system that cannot be determined by X-rays and an examination of sputum. If fluid collects in the pleural space, it is not possible to tell its cause without obtaining a sample of the liquid, because a number of illnesses can affect the pleural fluid in the same way.

A disease can affect the lung without causing fluid to collect. It may be necessary to do a bronchoscopy, which allows the physician to see any abnormalities within the bronchi. If something unexpected is seen, it is often possible to take a biopsy through the bronchoscope. If the abnormal area is out of reach of the bronchoscope, a needle is inserted through the skin of the chest wall into the lung, after preparation with a local anesthetic. This is called a needle lung biopsy, and it is not always successful in obtaining the tissue. Therefore, an open lung biopsy may be necessary. This involves making a small cut through the chest wall and removing a tiny piece of lung. After this type of procedure a tube may be placed in the chest for a few hours a keep the lung expanded until the hole closes. Although more complex than the other biopsies, in almost all cases an open lung biopsy can be done without danger. It is considered only when the diagnosis is elusive. Lung biopsies are usually done in hospital because of the risk of temporary collapse of the lung.

Liver Biopsy

The liver can be affected by many diseases that may show similar abnormal liver function test results and nuclear scan findings. A liver biopsy often permits a definite diagnosis. Some liver diseases improve quickly; others linger and may require more potent medications. More than one biopsy may be done during the course of an illness and treatment.

Invariably, the seriousness of the disease warrants the small hazard involved. The skin of the upper abdomen is frozen with a local anesthetic. You will then be instructed to hold your breath as a fine needle is quickly inserted in your liver and withdrawn with the specimen. The test takes only a few moments and causes little discomfort. In rare instances there is some bleeding after the test, but this usually stops quickly. It is extremely rare for there to be any dangerous effects of this examination.

Muscle and Skin Biopsies

Muscle and skin biopsies can also be done. Small tumors of the skin are often removed at the time of biopsy. Many conditions affect the cells or the blood vessels of the muscles. Some neurological diseases that affect the muscles can be determined through a biopsy. The procedure is simple and can often be done within a few minutes with local anesthesia and minimal discomfort. The muscles of the thigh or upper arm are common sites of the biopsy, and no danger is involved.

A number of unusual illnesses that mainly affect the elderly can cause damage to blood vessels. A biopsy of a blood vessel may clarify a diagnosis of these diseases, for example, polymyalgia rheumatica, a disease that causes unusual aches and pains. A biopsy of a small artery in the scalp may be necessary. The test done with local anesthesia takes a few moments and has no danger. An accurate diagnosis in this case is essential, because lack of proper treatment can result in blindness.

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