Biopsy Needles Can Be Divided Into Three Categories

(1) Preoperative biopsy

A biopsy taken before a therapeutic operation or before other treatments, such as radiation or chemotherapy. Generally, a small part of the lesion tissue (for example, the lesion is small and located on the body surface often all the lesions) is sent to pathological biopsy. After fixation with formaldehyde, embedding in paraffin, sectioning, and HE staining, the diagnostic report can be issued in 3-7 days. The aim is to make a definite diagnosis so that the appropriate surgical or other treatment measures can be taken. Such a biopsy is usually performed in the outpatient clinic, and only small pieces of tissue are taken, so it is also called "small biopsy" or "outpatient small material". In recent years, the material of some internal organs obtained by endoscopic forceps is more typical ultra-small biopsy, such as gastric mucosal lesions obtained by gastroscopy and pulmonary lesions obtained by fiberoptic bronchoscopy, in order to confirm whether cancer is diagnosed, and then surgical treatment.

The advantage of this kind of preoperative biopsy is that it is less invasive and can generally be done in the outpatient department. Most of them can help the clinical diagnosis and provide a definite basis for the next treatment plan. Its disadvantages are: for some deep lesions in the site is difficult to take samples; Small biopsies should be taken carefully in the few lesions that can cause bleeding or spreading. It is easy to make diagnosis difficult or miss diagnosis if the samples are not standardized or the lesions are not obtained. Patients and clinical patients have to wait a long time (more than 3 days) for a diagnosis report, which is not applicable to those who need a clear diagnosis.

(2) Intraoperative biopsy

A biopsy performed during a therapeutic or exploratory operation, usually within 20 to 30 minutes, to make a qualitative diagnosis and guide how to proceed. The most widely used technique is rapid freezing. Fresh specimens without fixation are rapidly frozen to below -18 ℃ for section and HE staining for observation and diagnosis. Therefore, it is also called "intraoperative freezing", "rapid freezing", or "cryosectioning", and sometimes rapid paraffin sectioning or cytology can be used.

The objectives of intraoperative biopsy are:

① Determine the nature of the lesion in order to decide the surgical plan. For a lesion of unknown nature, take the lesion on the operating table for examination and wait 20-30 minutes. If the frozen section is diagnosed as inflammatory or benign tumor, the scope of operation is very small. In case of malignancy, radical resection with extended resection is performed immediately.

② Understand the lesions, especially the growth and spread of malignant tumors, such as the extent and depth of invasion, whether there is lymph node metastasis, and whether the marginal tissue of surgical resection has tumor cells, to determine the scope of surgery.

③ Determine whether the specimen contains predetermined tissues and organs or lesions. If the parathyroid gland is to be removed, but it is not clear in the operation field, it can be confirmed by freezing biopsy.

The greatest advantage of intraoperative biopsy is that during the operation, it can confirm the lesion of unknown nature, so that the clinical treatment can be determined immediately, and avoid the second therapeutic operation. Patients can avoid a second operation, medical staff can save the burden of another operation. Secondly, it plays the role of placing a hundred-fold magnifying glass for the surgeon, which can know how deep and far the lesion is invaded, and whether there are tumor cells in the incision margin.

The downside is that rapid freezing has major limitations:

① Not all biopsy materials are suitable for rapid freezing examination. It is only suitable for surgical exploration of surface organs (such as breast and thyroid gland) or internal organs, and it should be used when benign and malignant. However, it is not applicable to some complicated diseases and tumors (such as lymphoma) that require the identification of cellular microstructures. ② Limited by sampling, often false negative (missed diagnosis).

(3) Due to the short time of preparation and staining, thick section, clearer tissue and cell structure than ordinary paraffin section, and the need to complete observation, analysis and diagnosis within a few minutes, there is no more time to think, not to mention no time to find literature, so the diagnosis is difficult, often need experienced pathologists.

④ Due to the above reasons, and its accuracy rate is only about 90%, the failure rate and false negative rate are high, and the false positive rate can also occur. Therefore, rapid frozen biopsy is only an emergency preliminary qualitative diagnosis. After that, the frozen biopsy materials need to be made into ordinary paraffin sections for pathological examination before the final diagnosis is made. In case of missed diagnosis or misdiagnosis of intraoperative cryopreservation, a second operation or other remedial measures should be performed.

10 (3) Postoperative biopsy

It refers to a more comprehensive pathological examination of the lesions and related tissues and organs removed by therapeutic surgery. Different from preoperative biopsy, the resection is often sent for examination of the entire lesion and may be accompanied by involved or enlarged resection of tissues and organs, as well as lymph nodes (such as radical surgery for malignant tumors). Therefore, all lesions and specimens submitted for examination should be taken from multiple places according to the standard, and conventional formaldehyde fixation, paraffin embedding and HE staining should be performed. During pathological diagnosis, not only the name and nature of the disease should be determined, but also the classification should be given as far as possible, and the degree of invasion, dissemination and surgical margin lesion should be pointed out. It takes 3-7 days to issue a diagnostic report. Because this kind of examination is mostly for patients who are hospitalized in the ward for elective surgery, it is also often called "big biopsy" or "ward big material".

The purpose of postoperative biopsy is to determine the nature, type, severity of the disease, whether the resection is complete, whether there is dissemination, to determine whether the preoperative or intraoperative diagnosis is correct, whether the surgical treatment is complete, whether the need for further adjuvant therapy and prognosis orientation.

The advantages of postoperative biopsy are comprehensive and detailed examination and more reliable diagnosis, which can further provide more information and basis for the treatment and prognosis of the disease. Its limitation is that it cannot be comprehensively diagnosed for diseases that are not suitable for surgical treatment or that are found to be unresectable during surgery. Although there are relevant standards, comprehensive examination of materials, but due to subjective and objective limitations, there are about 1% of the missed, misdiagnosis rate

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