The Importance of Biopsy in Tumor Diagnosis

Abstract

In the differential diagnosis of tumors, experience has shown how little one can depend on purely clinical methods for accuracy. Transillumination, x-ray examination, or x-ray in combination with the injection of radiopaque substances or air have been discussed in the past, particularly in connection with the diagnosis of breast tumors. In the final analysis, however, we must turn to the pathologist, for his corroborative evidence is by far the most important. How to obtain this evidence with the least danger to the patient is the problem. Of the methods in use, we have the frozen-section biopsy, various types of punch biopsy, and aspiration biopsy. Without going into a discussion of the merits of each one at the present time, it will be conceded that, until now, the aspiration biopsy has been the simplest and least traumatizing. Its general acceptance, however, has been hampered considerably by the fact that, save in the hands of a very few, it has failed to yield material for a positive diagnosis with sufficient regularity. And, second, even in successful cases the material obtained is so scanty that pathologists have often been unwilling to make a positive statement one way or the other. It was because of these difficulties that interest was aroused in trying to improve the efficiency of the aspiration biopsy without increasing the amount of trauma. For the past year we have been using a biopsy needle, devised by one of the writers (I. S.), at the Caledonian Hospital, Brooklyn, which consists of two parts. One is an ordinary outer needle of 14 gauge, and the other an inner needle of 17 gauge which is fitted loosely, is split longitudinally in half, and protrudes for half an inch beyond the point of the outer needle (Fig. 1). This instrument differs slightly in size from the one described in the original article. With this biopsy needle it has been possible to obtain a specimen with uniformity and of sufficient size for routine microscopic sections. The results have been so enthusiastically acclaimed by those who have seen this needle used that it was deemed advisable to report some of our more recent experiences, to show photomicrographs of some of the sections obtained, and to evaluate more clearly the place of needle biopsy in the diagnosis of tumors. A great variety of neoplasms have been subjected to biopsy, including tumors of the breast, neck, lymph nodes, retroperitoneal growths, abdominal masses, liver metastases, and lung tumors. The last three regions were approached with greatest care and no difficulties were encountered either during or after the procedure. In the case of the lung tumors, it was found advisable to use the fluoroscope to help locate the area desired. Figure 1 shows the appearance of the biopsy needle in use at the present time, with a photograph of the size of the specimen which is usually removed.