Forceps biopsy

Stockmann M, Gitter AH, Sorgenfrei D, Fromm M, Schulzke JD (1999) Low edge damage container insert that adjusts intestinal forceps biopsies into Ussing chamber systems. Eur J Physiol 438 107-112. 

Granulomas are generally distributed focally throughout the liver, mostly within the liver lobules and less frequently in the portal fields. As a rule, the normal lobular architecture is not affected. Granulomas located on the surface can be visualized laparoscopically as small, greyish-white foci, which can be conveniently collected by forceps biopsy for histological examination. 

Laparoscopy Laparoscopy should be used to confirm the diagnosis morphologically. This technique provides photodocumentary findings and also affords the possibility of targeted thick-needle, fine-needle or forceps biopsy. Tumour biopsy is only deemed necessary prior to palliative therapy. Moreover, explorative laparoscopy offers a much better overview of the whole abdominal area than does explorative laparotomy - and the risk involved is considerably lower. Carrying out laparotomy staging prior to liver transplantation is, in our opinion, also far less efficient and thus not indicated instead, laparoscopy should be the technique of choice, (s. pp 150, 155, 161, 781)... 

Type III carcinoma is a diffusely infiltrating lesion dominated by a large ulcer of several centimetres in diameter. This may partly be surrounded by normal mucosa that explains the difficulties of obtaining representative forceps biopsies. Again, multiple specimens from all around the ulcer edge are recommended. These tumours are seen in up to 15% and have a poor five-year survival rate of less than 15%. 

Histopathology is crucial in establishing the correct diagnosis. Multiple forceps biopsies maybe supplemented by brush cytology to cover an extended suspicious area. As gastric lymphoma infiltrates superficially, there is a high reward from tissue biopsy and brush cytology (Fork et al. 1985). 

The technique of transfemoral liver biopsy using flexible forceps was described by M.w. Mewissen et al. in 1988. Some studies have shown this to be just as safe and efficient as the transjugular method. (74,80,89, 95, 155)... 

The combined examination with laparoscopy and directed biopsy (thick- or fine-needle biopsy or use of Robbers forceps) yields the greatest diagnostic accuracy at 97-100%. This has been impressively confirmed in children as well. Foci not visible by laparoscopy can be... 

Unfortunately, biopsy sampling using AFB-LIFE may remove entire patches of clonal cells [69]. Many lesions were <1.5 mm in diameter and about 50% of these lesions were smaller than the biopsy forceps. Twenty-seven of the 69 paired biopsies obtained at 6-month intervals showed one or more molecular changes in the initial biopsy specimens, 86% had no abnormality after re-biopsy and 24% lacked the initial changes found after repeat biopsy. So, the natural history of minute lesions cannot be studied because of complete mechanical removal during baseline sampling. 

AFB-LIFE biopsies show minute pre-cancerous lesions <1.5 mm in size, 50% of which are smaller than the biopsy forceps [69]. This may explain the spontaneous regression rate, especially regarding low-grade dysplastic lesions [76-78]. 

Obtain testicular biopsy and remove tubules with forceps in 2.2% sodium citrate in a petri dish. Thoroughly tease the tubules to completely remove their contents and allow material to settle for 15 min. 

Glutaraldehyde is also used for high-level disinfection of biopsy forceps [301], peak flow meters [302] and, as an alternative to formaldehyde, of hae-modialyzers [303-305], though there is continued criticism of the latter practice due to an increased risk of infection and chronic exposure of patients to aldehydes [303, 306]. Glutaraldehyde is the only chemical found to be effective in the disinfection of composite polishing instruments in dentistry [307],... 

A telesurgjcal robotic system for the transurethral resection of bladder tumors has been reported previously [48]. The slave system consists of a distal dexterous manipulator that is basically a continuum robot composed of two serially-stacked multibackbone sections. The slave is equipped with a pair of biopsy forceps, a fiberscope, and a laser cautery fiber and is deployed through a standard resectoscope. Each multibackbone section is actuated by three actuators and provides 2 DOFs that, along with a translation, provide a total of 5 DOFs at the tip. The system was evaluated in an ex vivo bovine bladder. The results demonstrated that better intra-vesicular dexterity and submiUimeter accuracy could be achieved by using the system. 

Flexible endoscopes incorporate fiberscopes that enable the physician to view and examine organs and tissues inside the body. In addition, an endoscope may include ancillary channels through which the physician can perform other tasks. A schematic cross section of an endoscope is shown in Fig. 7. One open channel serves for inserting biopsy forceps, snares, and other instruments. Another channel may serve for insufflation with air or for injection of transparent liquids to clear the blood away and to improve visualization. A separate channel may also serve for aspiration or suction of liquids. Many endoscopes have some means for flexing the distal tip to facilitate better viewing. 

Figure 15 Artist s impression of a Raman guided biopsy forceps. (Adapted from Ref. 52 by permission from Georg Thieme Verlag.)... 

A third dye, methylene blue, is absorbed by the cytoplasm of cells that have undergone intestinal metaplasia. The result may be difficult to interpret even for an experienced endoscopist, as the grade of absorption is unpredictable. A combination of Lugol s solution with methylene blue following water rinsing maybe helpful for aiming the biopsy forceps at potential dysplastic areas. 

A truly superficial neoplastic lesion, i.e. one limited to the mucosa may be successfully removed by the endoscopic route. The lesion is checked hy chromoendoscopy and its borders marked out with small burns from a heater probe or hot biopsy forceps. The mucosectomy starts with injection of submucosal, 2-ml aliquots of saline around the lesion. When elevated sufficiently it is ensnared with an open polypectomy snare and removed, preferably in one piece. The specimen should then be mounted on a cork plate so that the histopathologist can scrutinise the cut surface for any sign of tumour infiltration. If this is present the patient should have a final surgical removal. 

Fig. 3.29. A problem gastric ulcer. Initial biopsies were benign, and the benign part of the ulcer is healing with folds converging and clubbing close to the elongated ulcer scar. A new set of biopsies at this stage revealed an EGC. The explanation is that whilst the benign part of the ulcer heals, the malignant one increases in relative size, and is therefore easier to catch with the biopsy forceps...

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