F. Yvonne Schulman - Veterinarian’s Guide to Maximizing Biopsy Results

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A biopsy is the collection of tissue to be analyzed by the pathologist. It is often the gold standard of diagnosis. Ideally, from the pathologist's perspective, all lesions would be biopsied so that treatment could be based on a confirmed diagnosis. However, as with most decisions, the decision to perform a biopsy should be based on a cost-benefit analysis. The costs include time, biopsy procedure fee, histology fee, pet discomfort, possible infection or spread of disease, and owner inconvenience. The potential benefits are an accurate diagnosis and prognostic information to guide future treatment, decrease patient suffering, and avoid the cost of treating an assumed incorrect condition. There are many steps in the biopsy process that can be optimized to ensure minimizing the cost and maximizing the benefit. This manual is designed to help clinicians submit cost-effective biopsies by providing suggestions for each step of the biopsy submission, separate organ specific biopsy considerations, a step-by-step biopsy submission checklist, and a list of general biopsy dos and don'ts. It is hoped that this manual provides enough detail to be helpful, but not so much that the useful information is obscured, and that it will be consulted often prior to biopsy collection.

I gratefully acknowledge Drs. Thomas Lipscomb and Frances Moore for helpful comments on the manuscript, Dr. Anne Kincaid for helping to collect case material, Ms. Ingrid Style for her advice on the drawings, Mr. Lance Schuette and Ms. Pam Schmidt for scanning slides, Marshfield Laboratory histology technicians for some of the gross photos, Dr. Michelle Fleetwood for help with the literature review, and Julie, Mary, and Charles Lipscomb for their encouragement.

Each step of the biopsy submission process is important and contributes to the accuracy of the diagnosis, but the collection step is critical. While submission form information can be added to or revised at a later date and the correlation between the histologic and clinical assessments can be reassessed as new information is provided, the quality of the biopsy specimen is irrevocably determined by the collection method. One cannot make up for improper collection or fixation with a longer clinical history.

When presented with a single, small lesion, the site selection is straightforward (). Be sure to biopsy any intact vesicles or pustules. For lesions that are too large to excise, multiple biopsies, including all grossly different appearing areas, are recommended in an attempt to submit fully representative specimens.

Solitary mass, viral papilloma, on the nose of a terrier. A single excisional biopsy was diagnostic and curative. (Reproduced by permission of Bass Lake Pet Hospital, New Hope, MN 55428).

Spleen (in the foreground) with a large mass attached to the far side that requires sampling of all grossly different appearing areas to fully evaluate the lesion.

Ulcerated skin lesion (feline squamous cell carcinoma in situ [Bowen's-like disease] in this case). Excisional biopsy or sampling the periphery of the lesion is more likely to be diagnostic than a biopsy of the central ulcerated area. (Reproduced by permission of Whitewater Veterinary Hospital, Whitewater, WI 53190).

While the type of biopsy specimen collected (such as needle, punch, incisional or excisional biopsies (). In other words, the larger the biopsy sample, the more likely it is to be fully representative and diagnostic. When clinically reasonable, excisional biopsies are recommended. Not only are excisional biopsies fully representative of the lesion, but they can also be curative.