One of the invasive methods for studying the state of the patient’s tissues is a biopsy. A biopsy implies that a portion of the affected tissue is removed from the subject by surgery, after which he undergoes a thorough histological and microscopic analysis. The procedure requires surgical intervention of varying degrees, and refers to complex diagnostic methods. However, there are situations when other, non-invasive and less dangerous methods of research cannot give the doctor the full information necessary for making a diagnosis and prescribing treatment. For example, a biopsy is the most accurate method for detecting cancerous lesions of the pancreas, although its value is not limited to this.
What is a biopsy of the pancreas, why is it prescribed
The biopsy procedure itself is a diagnostic procedure associated with a certain type of surgical intervention. Usually this method of examination is not prescribed as preventive or primary. If the patient has already undergone simpler diagnostic measures, for example, ultrasound or magnetic resonance imaging, and according to their results, neoplasms were detected, a tissue biopsy is performed to establish whether the process of cell degeneration is present in the body - benign or malignant .
During a biopsy of the pancreas, the physician gains direct access to the abdominal cavity or to the organ itself. From the potentially “dangerous” places of the organ - non-healing wounds, polyps, ulcers, tumors - the doctor, using special surgical tools, takes small particles of tissue. These particles, which will subsequently be sent for research, are called a biopsy sample.
The main goal of the procedure is to study tissue samples of the affected organ, identify a specific disease, make or confirm a diagnosis for the development of a treatment regimen, monitor the measures taken, determine the need for surgical intervention. In addition, a biopsy allows the most in-depth study of the affected area, and further differentiation of tumor processes in the cells.
The procedure for taking pancreatic tissue samples is usually carried out using a medical scalpel, as well as a special needle or endoscope.
Pancreatic Biopsy Types
Doctors carry out the procedure with various tools and methods, sometimes directly during operations on the abdominal cavity.
So, they distinguish:
- large needle biopsy;
- fine needle aspiration or percutaneous;
A thick needle biopsy of the organ makes it possible to obtain a relatively large sample of tissue for study once. The diameter of the needle used in this case is 1 millimeter.
A transdermal biopsy is also called a fine-needle aspiration. This type of procedure is carried out most often. In this case, the doctor uses a medical tool in the form of a special gun, at the end of which there is a nozzle in the form of a knife. When a button is pressed, the blade dissects the tissue. A long, thin needle with a syringe may also be used. A mandatory element of a percutaneous biopsy is a computed tomography scanner or an ultrasound scanner, with which the process is monitored.
Laparoscopic examinations are necessary to obtain a sample of a specific organ site. In this case, the doctor, making only small incisions, gets the opportunity to examine the abdominal cavity for the presence of metastases. If the patient is diagnosed with acute pancreatitis, laparoscopic biopsy makes it possible to assess the prevalence of inflammatory infiltrate.
An intraoperative biopsy is performed directly during surgery. The doctor, gaining access to the abdominal cavity as a result of surgical intervention, selects a biopsy sample for examination.
As for the endoscopic type of diagnosis, in this case, the doctor gets to the pancreas through the duodenum, using an endoscope and a special needle in the form of a nozzle on the endoscope. Thus, it is possible to take tissue from the head of the gland for examination.
In what cases is a procedure prescribed when it is not possible
Like any other type of diagnosis, a biopsy has a specific list of indications. Naturally, it can be carried out only as prescribed by the attending physician, if there is an objective need for this. So, a biopsy of the pancreas is performed in cases if:
- the patient is suspected of having cancerous organ tumors;
- other diagnostic methods showed the presence of neoplasms in the tissues of the gland, the nature of which must be established;
- non-invasive methods of examination do not allow to obtain the complete information necessary for diagnosis and treatment;
- the patient is diagnosed with acute or chronic pancreatitis;
- there is a need to establish the severity of the lesion of the patient with cancerous tumors.
Similarly, a biopsy procedure also provides for contraindications. A gland biopsy is not performed if:
- the patient gives a written refusal of a biopsy;
- the patient has a violation of blood coagulation properties;
- the subject is in serious condition, for example, connected to life support devices;
- There are non-invasive diagnostic methods that can provide similar information in the same volume as a biopsy.
For pregnant women, this type of surgical intervention is practically not prescribed, because of the potential danger to the unborn child. Children's age in some cases can also be an obstacle to a biopsy of the pancreas.
Rules for preparing for the examination
The main requirement on which the effectiveness of the diagnosis depends is the need to conduct it strictly on an empty stomach. 24 hours before the start of the procedure, the patient is forbidden to drink alcohol, for 12 hours you can not smoke.
On the day before the biopsy, a light meal is recommended, without fatty, spicy and fried foods. In the evening, a loose dinner is allowed, but no later than 8-10 hours before the biopsy. At the same time, you can not drink any liquid.
The research process itself, regardless of the method of its implementation, can be quite painful, as the doctor warns the patient in advance. A biopsy is usually performed using local anesthesia or general anesthesia. In this case, the physician in advance clarifies the patient’s absence of an allergy to anesthetics, if necessary, directs him to allergy tests.
Women in the first trimester of pregnancy must definitely inform the doctor about their special situation.
How are different types of procedures
A biopsy is carried out only in a medical institution, under the supervision of an ultrasound or computed tomography scanner. In some cases, the patient may be identified in a hospital hospital.
The surgeon, nurses and anesthetist are required to comply with all aseptic rules in the process of collecting material for research.
A percutaneous biopsy is the safest and least traumatic for the subject. The doctor can use a thin long needle or a special gun. Given the pain of the process, often the patient is offered local anesthesia.
After the anesthesia has acted, under the supervision of an ultrasound machine or computed tomograph, a physician inserts a needle into the organ tissue through the anterior abdominal wall. As a result of pumping air from the needle cavity, biological material enters it. The biopsy gun works in a similar way. If the affected area has a size of less than 2 centimeters, or if the patient has to undergo surgery or laparoscopy of the abdominal cavity, conducting a fine-needle aspiration biopsy becomes impractical.
A large needle biopsy is performed in a similar way - an anesthetic is also administered to the patient, and the doctor, using a large diameter needle (1 mm), takes out tissue for examination.
Laparoscopy is considered the most successful way to perform biopsy examinations. In this case, minimal invasiveness and trauma are combined with high informational content. In addition to the pancreas, during laparoscopy, the doctor can examine the entire abdominal cavity, assess the condition of the organs located there, identify metastases and foci of necrosis. The patient is put into a state of drug sleep, after which carbon dioxide is supplied to the abdominal cavity. A physician makes two or more small punctures through which special instruments, such as a laparoscope or biopsy needles, get into the abdominal cavity.
An endoscopic biopsy is most often relevant for cases when neoplasms of small size lie in the deep layers of tissues of the head of the organ. The subject, through the oral cavity and esophagus, an endoscope is inserted into the stomach cavity. From the stomach, the device enters the duodenum, from where a special nozzle can capture cells from the head of the gland. Given the small coverage of this method, it is rarely used.
Intraoperative examination is carried out directly during abdominal abdominal surgery. The method is considered the most informative, but also the most dangerous and traumatic for the patient. All requirements for abdominal operations are advanced to it. The patient is under general anesthesia when the surgeon dissects the wall of his abdominal cavity, thus gaining direct access to the organ. The intraoperative biopsy itself can be performed in several ways. So, a direct biopsy is possible only in the presence of large superficial tumors located in the region of the upper or lower edge of the gland. It is carried out through an incision, or using special needles and pistols. The transduodenal method is performed through the duodenum, closed or open, using needles and an endoscope. The procedure can also be carried out with a thin needle with a 10 milliliter syringe, which contains 3-4 milliliters of air. The tumor is punctured and material is taken from it.
Features of the processing of seized material
After the surgeon has taken the affected tissue, they must be sent to the laboratory for examination. Tissues are transferred in special sterile tubes. Diagnostics, before proceeding with the study of biomaterial, processes it and prepares for research.
The selected tissues are subjected to paraffin treatment or freezing, after which they are cut into thin sheets - slices, using a microtome knife. The obtained sections are placed on rectangular sterile glasses, and subjected to staining.
Material prepared in this way is examined under a light microscope. Using high-precision optics, the doctor can determine the nature of the pathology that affected the organ, its severity, and even the prognosis of its development.
If microscopic examination is not enough to make a diagnosis and determine a cancerous tumor, an immuno-histological examination of the tissues is carried out. For this, sections are exposed to various antitumor sera. The appearance in one of the preparations of yellowish granules, distinguishable with a microscope, indicates that the tumor has exactly the nature against which the serum is directed in a particular section.
Electron microscopy occurs with an increase in organ cells up to 100 thousand times, and allows you to examine the state of pancreatic cell organelles.
Complications and rehabilitation after the procedure
The most dangerous in terms of possible consequences is an intraoperative organ biopsy. After abdominal surgery, the patient is in the intensive care unit, where his condition is gradually normalized. After a while, he was transferred to the surgical department. Within 5-25 days after surgery, the subject is in a hospital.
After the examination with a thin needle, the patient remains under the supervision of doctors for several hours. If during this time he feels normal, he will be allowed to go home, preferably under the supervision of someone close to him.
The rehabilitation period after the diagnosis should take place without smoking and drinking alcohol. Immediately after the procedure, it is not recommended to drive or operate other complex mechanisms.
From 3 to 30 days (depending on the type of diagnosis made), the patient is prohibited from physical activity.
Complications after surgery are the exception rather than the rule. If the procedure was carried out poorly, bleeding, peritonitis, false cysts and fistulas may occur.
A pancreatic biopsy is a complex invasive technique for studying the condition of an organ. In the event that the patient has tumor formations, and all other research methods do not make it possible to determine whether the formations are malignant or benign, it is a tissue biopsy followed by histological and microscopic examination that can give the attending physician the necessary information. As a method for diagnosing pancreatic cancer, it is a biopsy, to date, that gives the most accurate results in 85-95% of cases.