Biopsy is a procedure to take a sample for testing under a microscope. Most people associate biopsy with cancer though it can diagnose various other diseases like tuberculosis, infections and inflammatory conditions.
Although clinical examination may lead a doctor to suspect cancer, biopsy is mandatory for the diagnosis of the disease. If cancer is confirmed, it causes great emotional trauma for any individual irrespective of economic or social status. It can change the course of life.
If the biopsy report is correct, the treatment is appropriate. If it is incomplete, the treatment will be inadequate. Patients have the right to take a second opinion of the biopsy report as the entire treatment depends on it. The biopsy slides and paraffin blocks can be submitted for review.
Various misconceptions exist regarding biopsy:
- Biopsy is harmful and can spread the disease. This is incorrect.
- Cancer treatment can be started without biopsy. This is not feasible.
- The idea that biopsies are expensive is not always true. Routine biopsies are affordable but special biopsies may be costly.
Fighting spirit
Informing a person that the biopsy report confirms cancer is a difficult proposition for any oncologist. It can demoralise even the toughest of individuals. The diagnosis of cancer does create a huge social impact beyond the medical issues.
However, the fightback and positive thinking by the majority of patients is exemplary. There are many patients who get cured and lead a normal life.
In the Hrishikesh Mukherjee film Anand, released in 1971, the cancer patient acted by superstar Rajesh Khanna had “lympho sarcoma of the intestine”. This cannot be a clinical diagnosis and must have been based on a biopsy report. The character lived life to the fullest till the last day.
Cancer is curable if detected early.
Techniques
There are various ways by which samples for biopsy can be collected. If a fine needle is used to aspirate fluid or cells, it is called FNAC. A positive report is considered as cancer but a negative report cannot rule out cancer. If there is clinical suspicion, the test needs to be repeated.
A tumour can also be removed partly or fully for biopsy. Biopsy is commonly done during endoscopy. The method of biopsy is decided by the treating oncologist.
However, some special types of biopsy are necessary at certain situations:
- Frozen section: A special form of biopsy during surgery where report is provided instantly to guide the surgeon.
- Sentinel lymph node biopsy: This is also performed during operation to determine the extent of surgery required. Commonly performed in oral and breast cancers.
- CT scan or Ultrasound Guided Trucut or core biopsy: This is done to get adequate tissue for detailed diagnosis. Sometimes complications can occur requiring urgent admission. Such biopsies should not be done in centres where there are no facilities of admission.
Oncopathology
This speciality deals with the diagnosis of cancer. Oncopathologists undergo rigorous training to achieve excellence in this field. The Tata Memorial Hospital (TMH), Mumbai, introduced a three-year-course (DM in oncopathology) in 2018 for advanced training in the diagnosis of cancer.
Usually, a biopsy report is available 10 days after onco-surgery. The format of detailed reporting is evidence based. Such reports help the treating oncologist. Diagnostic biopsy reports are available earlier to start treatment.
Accreditation
To maintain healthcare quality, accreditation of laboratories and hospitals performing biopsies are essential. This provides confidence to the patient.
National Accreditation Board for Testing and Calibration Laboratories (NABL) evaluates the quality of performance. Thus achieving NABL is a national recognition for any laboratory.
International accreditation like the Joint Commission International (JCI) is difficult to achieve.
Tata Memorial Hospital, Mumbai, evaluates the quality of biopsy results by the external quality assurance scheme (EQAS) in the National Cancer Grid programme.
Transportation of biopsy samples outside the state may be a problem. Maintaining proper conditions during transport and delayed reporting is an issue.
Advanced biopsies
Molecular diagnostics and biopsy add value to cancer treatment. Tumour DNA is tested for any alteration. It helps in the prediction of prognosis and probable treatment outcomes.
Unfortunately, most cancer centres in our city do not have a fully equipped molecular laboratory.
Various genetic testing is also done. Hollywood actress Angelina Jolie was detected to have mutation of the BRCA 1 gene, which is associated with breast and ovarian cancer. Since some of her family members died of cancer, she had her breasts and ovaries removed prophylactically. She considered this step as right for her. Although BRCA 1 gene mutations may not result in cancer in all individuals, the chances are higher.
Liquid biopsy analyses blood for circulating tumour DNA. However, the absence of standardisation has limited its use. It may be useful when cancer has spread.
It must be remembered that tissue biopsy remains the gold standard for cancer diagnosis and special biopsies can only enhance it.
The number of oncopathologists trained in premier institutions are few. Society may fail to recognise them but cancer treatment is dependent on their reports.
