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All right, so let's begin.

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So biopsies at a glance. So what exactly is a biopsy

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a biopsy is a specialized procedure where we

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obtain tissue samples for the purposes of pathological diagnosis.

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So we've all heard about biopsies and

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different settings whether that be in the realm of Dermatology in

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which we perform punch biopsies of the skin

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or dermatologist rather perform punch bopsies of skin.

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We know of open biopsies which are performed by the surgeons where

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an incision is made tissue is excavated and

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then there are image guided or percutaneous biopsies

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where we go through the skin through the soft tissues

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and then to the side of interest and this is the realm

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in which we will be focused on within the realm of

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radiology or Interventional Radiology. And what is

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the benefit of this it is this minimally invasiveness. This

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is the key that allows us to essentially minimize more

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Amity that usually can be experienced

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and can be risk to the patient and then realm

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of surgical biopsies.

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So let's understand a little bit more of the types of

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image guided biopsies. There's a focal biopsy

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where we're targeting specific lesion of

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Interest whether that be a lesion suspected to

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be a tumor a lesion suspected to be a site of

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infection and then they're non-focal biopsies. These

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are often termed random or parenchymone biopsies,

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and then there's fluid sampling specific area

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of fluid of Interest a needle

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suspected to be placed in that in order to

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sample that fluid of Interest. So let's unpack these

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one by one.

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So a focal biopsy as mentioned is in

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the setting of a discrete lesion a lesion is

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seen.

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It's targeted.

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And the goal is really to ascertain. What is the underlying

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histology represented by this lesion?

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We have tumors. We have masses things

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of that nature that may be an organs or other sites

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or there may be an area that may be

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suspected to be infection.

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In which case we're targeting this for the purpose of sending for

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surgical pathology analysis or for microbiology

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analysis. Here is an example of a discrete

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lesion in the liver.

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And then we have non-focal biopsies as mentioned. These

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would be diffuse processes.

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Processes examples would be in the setting

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of a patient coming in with nephrotic syndrome.

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Suspected organ dysfunction in that setting and so

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a random or parenchymal biopsy would be

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afforded in the case of a patient with elevated liver

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function tests or a transaminitis. Then

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we can perform a biopsy of the liver random or

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parenchymal biopsy in that setting.

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Course, we have examples heart failure myocardial biopsies in

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that particular setting hemochromatosis or glommelon nephritis

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would be examples of conditions in situations

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in which we would perform a non-focal biopsy.

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And then we have fluid sampling.

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Here there is an area of fluid that is deemed

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to be suspicious for one reason or another.

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Could this be in the setting of a malignancy?

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Could this be in a setting of fluid in the abdomen in the

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case of ascites deemed to meet malignant Societies in

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which case sampling of that fluid is necessary

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in order to evaluate for cytology or

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in that same patient where there is fluid in the

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abdomen in the form of societies, perhaps that fluid which

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previously was found out to be malignant. There's

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concern for a super infection in the case

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of spontaneous bacterial peritonitis. In which case

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we would send that fluent in that case for microbiology analysis. So

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again looking for malignancy

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Or excluding benignity or identifying

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infection.

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We discussed society as an example but a plural effusion could

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also be another example and of course tapping a

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joint would be obviously another area where we

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would determine whether or not perhaps there's a septic joint

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in that particular setting.

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So a question for you when performing a biopsy

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which part of the lesion should be targeted for sample collection.

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Is it the center of the lesion?

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Is it the periphery of the lesion?

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Is it adjacent to healthy parenchyma, or is it

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all parts of the lesion as well as the surrounding parenchyma?

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Well, if you said the periphery of the lesion you would

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be spot-on. So what we know is that the central

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portion of a targeted lesion often undergoes necrosis

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because it outgrows its blood supply during growth. This

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can result in poor tissue lead, of course

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in Iron Diagnostics sample for pathological analysis

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leading to need for repeat biopsy. Of

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course, the periphery of the lesion is sort of the Leading

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Edge as the lesion expands and grows

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and is more likely to contain intact tissue.