Histopathological analysis plays an important role in the diagnosis of malignant diseases, since 70% of those are diagnosed microscopically. Besides setting the diagnosis, histopathology findings provide clear direction in addressing further patient treatment.
One of the methods that allows fast diagnosis is cytology i.e. puncture biopsy. It is an orientation method which allows determining whether the corresponding change which was previously seen on the ultrasound, on x-ray or by the naked eye, is benign or malignant. The puncture is an easy and painless method of extracting cells from the change with a fine needle under vacuum when a swab is made. The puncture is performed under ultrasound control, ensuring the sample is from the exact point of change. Cells from the change can be seen under the microscope and based on the cytological finding the report can be classified in 5 groups:
- Group 1 - the change is benign;
- Group 2 – the change is benign and inflammatory in character;
- Group 3 - the change is most probably benign but contains atypical cells which can result in reactive changes in the tissue, or are very well differentiated tumor cells. Such finding must be proved by tissue biopsy in order to reject (or confirm) the assumption of tumor presence;
- Group 4 –the change is most probably malignant, but there is a small number of cells in the swabs which don’t meet the criteria for definitive confirmation of the presence of a malignant tumor. In this case, the puncture is either repeated or tissue biopsy is performed;
- Group 5 – the puncture change contains malignant cells and the tumor must be removed.
Tissue biopsy is an important procedure in proving the presence of tumors or changes in organs and tissues. It consists of extracting a piece of tissue which is then observed under a microscope.
Frequently at biopsies, additional special and immunohistochemical examinations are are performed in order to confirm the suspicion of a tumor presence. This procedure is called diagnostic immunohistochemistry.
In biopsic findings there are several further options:
If the material obtained by the biopsy is inadequate, the procedure is repeated;
If the material is adequate (at well-performed biopsies), the result indicates whether the tumor is benign or malignant;
If the tumor is benign it is surgically removed;
If the tumor is malignant, the surgeon evaluates whether the tumor can be removed;
If the tumor cannot be surgically removed, the patient is sent to further cancer treatment (chemotherapy, radiotherapy, etc.).
Determination of the stage of the disease
One of the important aspects in the diagnosis of malignant tumors is determining the stage of the disease. The decision whether the patient needs an oncology treatment depends on the stage the finding was detected. Additional immunohistochemical tests are performed in order to confirm the diagnosis and allow the oncologist to prescribe the correct therapy. This procedure is called therapeutic immunohistochemistry.