Soft tissue biopsies under ultrasound guidance

Soft Tissue Biopsies Under Ultrasound Guidance

Biopsy is a minimally invasive diagnostic procedure involving the collection of biological material from tissues suspected of pathological changes. The material is collected either as a tissue sample or by aspiration, which involves suction. The collected material is then examined histopathologically or cytopathologically under a microscope.

Indications for Performing Biopsy Under Ultrasound Guidance

Performing a targeted biopsy under ultrasound guidance and obtaining material from the lesion for examination allows for determining the type of disease and helps define the necessary treatment approach.

Biopsy is primarily associated with determining whether a lump is malignant. However, it can also identify the cause of other diseases or localized tissue changes.

The main indication for biopsy is suspicion of a neoplastic disease, often based on imaging studies – ultrasonography, computed tomography, or magnetic resonance imaging – which allow precise localization of pathological changes.

Biopsy also enables diagnosis of certain connective tissue immunological diseases, benign tissue proliferations, or disorders involving the deposition of abnormal substances in organs.

The organs most commonly examined by biopsy under ultrasound guidance include:

• thyroid gland
• breasts
• lymph nodes
• salivary glands
• other soft tissues

Types of soft tissue biopsies under ultrasound guidance

For collecting material for cytopathological and histopathological examination, we use the following types of biopsies performed under ultrasound guidance:

Fine needle aspiration biopsy (FNAB – fine needle aspiration biopsy)

Ultrasound-guided fine needle aspiration biopsy is a minimally invasive diagnostic method of collecting cytological material – in the form of cells – by puncturing the examined organ with a thin needle under ultrasound imaging control. The aspirated material during the fine needle biopsy is then evaluated by a cytopathologist under a microscope. This method allows the diagnosis of diseases with both benign and malignant courses. An advantage of this method is the ability to obtain material for cytological assessment from tumors located deep within tissues in a minimally invasive way, without the need for general anesthesia or tissue excision. Fine needle biopsy is widely used for evaluating changes in lymph nodes, salivary glands, thyroid, and other soft tissues.

Core needle biopsy

Ultrasound-guided core needle biopsy is a minimally invasive method of obtaining tissue material (not just cells as in fine needle biopsy) that allows not only the diagnosis of cancer but also the determination of its type and biological characteristics. The procedure involves excising a tissue fragment from the tumor using a special needle approximately 3 mm in diameter for histopathological examination. The biopsy is performed under local skin anesthesia, where the skin is incised, and the needle is inserted into deeper tissues through this incision. An advantage of this method is the ability to obtain material for assessment in a minimally invasive way, without general anesthesia or the need for tissue excision. Core needle biopsy is performed, among others, in breast cancer diagnostics.

Mammotomic biopsy

Ultrasound-guided mammotomic biopsy, i.e., vacuum-assisted core needle biopsy (VAB), is a modern diagnostic method that combines the effectiveness of surgical biopsy, providing a definitive diagnosis based on histopathological examination, with the subtlety of core needle biopsy, as it leaves no visible scar on the skin. It is performed using special equipment – a mammotome. If necessary, this method allows the doctor to leave a small 2 mm marker at the biopsy site, which facilitates quick localization of the biopsy site during subsequent mammographic examinations. This method enables the removal of breast lesions up to 2 cm in diameter, usually benign lesions such as fibroadenomas, microcalcifications, adenomas, fibromas, and other non-cancerous changes. Mammotomic biopsy is performed, among others, in the diagnosis of breast tumors.