Core biopsy

Biopsy of suspected lymph node(s)—either open lymph node biopsy or core biopsy preferred over fine-needle aspiration. 

For all newly diagnosed patients with leukemia, an aspirate of the liquid marrow and a bone marrow core biopsy are obtained.5 Morphologic and cytochemical analysis of these samples distinguishes three subtypes of ALL (LI, L2, and L3) and eight subtypes of AML (M0-M7) as classified by the French-American-British (FAB) scheme. See Tables 92-2 and 92-3 for the FAB classification of acute myelogenous leukemia and acute lymphocytic leukemia. 

Biopsy -Proven, LABC,Inoperable+,Informed Consent, Staging (CT Chest Abdomen And Pelvis)Placement Of Central Line. First Pre-Treatment Tumor Core Biopsies Start c.i. 5-FU, 200 mg/ m /day for 2 weeks. 

Day 14, Second core biopsy Start RT50 Gy 2Gy/fraction... 

Fig. 3. (A andB) Breast carcinoma, in a core biopsy of a patient, pretreatment. Hematoxylin-eosin (H E)-stained histological sections show a poorly differentiated ductal carcinoma with evident nuclear pleomorphism and numerous mitotic figures. (A) H E, magnification x200 (B) H E, magnification x400.

There is also a trend toward performing minimally invasive biopsy techniques such as needle/core biopsies and fine needle aspirates (FNAs). The amount of material available from such techniques, even if the bulk (non-microdissected) sample were to be used, can be very small. Traditional DNA microarray analysis requires a fairly substantial amount of material for analysis some 5-10 p.g of total RNA is usually required for analysis in the absence of amplification. In order to obtain this quantity of RNA from typical epithelial cells, as many as 5 x 10 or 1 x 10 cells are required. Clearly, this total RNA requirement poses a challenge when studying microdissected samples, but it also presents a challenge when using small, unique clinical samples, such as FNA biopsies. 

Fig. 13.8. Left shows an example of a core biopsy specimen (H E stained) with high grade DCIS (marked by a consultant histopathologist) and right a white light image of the selected duct as imaged on Raman microspectrometer...

Figure 2. (a) Needle core biopsy of infiltrating ductal carcinoma of the breast fixed for 8 hours in buffered formalin stained strongly for estrogen receptor, (b) The same tumor in the mastectomy specimen that was immersed in buffered formalin for 48 hours failed to stain for the same antigen. 

Whole-animal studies assess the percent of the applied dose absorbed into the body using classic techniques of bioavailability, where absorbed chemical is measured in the blood, urine, feces, and tissues with mass balance techniques. Recently, methods have been developed to assess absorption by measuring the amount of chemical in the stratum comeum because it is the driving force for diffusion. Cellophane tape strips are collected 30 minutes after chemical exposure and the amount of drug assayed in these tape strips correlates to the amount systemically absorbed. If the focus of the research is to determine the amount of chemical that has penetrated into skin, core biopsies may be collected and serially sectioned, and a profile of the chemical as a function of skin depth may be obtained. 

Transjugular venous liver biopsy was first described by w. Hanafee et al. in 1967. It has been successfully performed (monitoring by ECG ) with few complications in high-risk patients (e. g. ascites, bleeding tendency, severe adiposity, massive intra-abdominal adhesions), both adults and children. Furthermore, the biopsy material obtained by this method (albeit shorter than in percutaneous biopsy) has generally been rated as adequate for assessment. The modified 15 G or 16 G Ross needle, but also an 18 G automated core biopsy needle, are considered preferable over the Trucut needle. The technique is deemed to be safe and reliable, and the complication rate is acceptable, (s. tab. 7.9) (4, 13, 14, 21, 31, 33, 34, 45, 47, 58, 69, 74, 80, 101, 112, 133, 136, 168, 182)... 

Bruzzi, J.F., O Connell, M.J., Thakore, H., O Keane, C., Crowe, J., Murray, J.G. Transjugular liver biopsy assessment of safety and efficacy of the Quick-Core biopsy needle. Abdom. Imag. 2002 27 711-715... 

Dinkel, H.-R, Wittchen, K., Hoppe, H., Dufour, X-F., Zimmermann, A., Triller, X Transjugular liver core biopsy indications, results and complications. Fortschr. Rontgenstr. 2003 175 1112-1119... 

Breast cancer is the most common cancer affecting women in Western societies. In the past decade, the incidence has risen by 25% and the lifetime risk (from 0 to 74 years) for white women developing breast cancer is around 7-8%.77 A combination of physical examination, mammography and fine needle aspiration cytology or needle core biopsy (triple assessment) is currently the most sensitive method for preoperative diagnosis of clinically and radiographically detected breast lesions. 

Fix and process resections and core biopsies in an identical manner. 

Note that fixation is 8 to 72 hours for both core biopsies and resections. 

FIGURE 19.4 DCIS is heavily obscured with lymphocytes, but smooth-muscle myosin heavy chain clearly reflects the presence of myoepithelial cells (A). Another case in which myoepithelial cells are easy to see with p63 in spite of heavy lymphoid infiltrate on core biopsy, which confirms a lack of invasion (B). 

FIGURE 19.5 This infiltrative-appearing breast core biopsy is clearly invasive carcinoma, as seen with complete lack of smooth-muscle myosin heavy chain. A blood vessel serves as positive internal control. 

Caution is advised in diagnosing invasion based on MEC antibodies in a papillary lesion on a core biopsy. Recommend complete excision for assessing invasion. 

Non-carcinomatous spindle cell proliferation in a breast core biopsy sample includes fibromatosis, myofibroblastoma, stromal component of phyllodes tumor, or rare primary sarcomas. 

The positive predictive value and specificity for detection of breast carcinoma with GCDEP15 have been reported to be up to 99%. The sensitivity for the GCDFP15 antibodies has been reported to be as high as 75% for tumors with apocrine differentiation, 732 the overall sensitivity is 55%, and only 23% for tumors without apocrine differentiation. The sensitivity is even worse when it comes to core biopsy, since the pattern of staining for GCDFP15 is often patchy. 

Phyllodes tumor stroma is CD34 positive, a finding that is useful in the workup of spindle cell lesion in a core biopsy. 

Prompt fixation of breast tissue, with both resections and core biopsies requiring 8 to 72 hours of 10% neutral buffered formalin fixation with processing by conventional (not microwave-enhanced) tissue processors. 

Progesterone nuclear staining by the IHC method is more heterogeneous than ER and may be a cause of false-negative results, especially in core biopsies or needle aspirates. We have seen similar results on some core biopsies as a result, if a negative ER and PR result on a core biopsy specimen is obtained, one should repeat the test on the excisional breast specimen. 

Hormone receptor analysis should be repeated on a resection specimen if the tumor was double negative on core biopsy sample. 

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