Today it is already impossible to imagine a full-value treatment of malignant formation without histological examination. However, few people have a clear idea of this method of diagnosis. In the article we will talk about how the histological examination is carried out and why it is needed. Also we will talk about the use of diagnostics of this kind in gynecology.
Histological method for the study is to examine internal tissues of the patient, which are taken as a small sample. Often the material is obtained through biopsy. In the diagnosis of cancer and the evaluation of drug therapy histological study is one of the most important stages.
Objectives of the
Such a diagnosis is carried out to clarify or confirm a previously diagnosed diagnosis. It also helps to determine the disease correctly in disputed situations. Histological examination of the patient's material makes it possible at an early stage to identify the presence of malignant formation, to study the dynamics of its growth (to determine whether growth, increase, spread of the tumor). In addition, with the help of it, differential diagnostics of pathological processes is carried out and the changes occurring during treatment in tissues are analyzed.
Importance in medicine
At present, before the chemotherapy or radiation treatment of patients with malignant tumors, a histological examination of the tumor is mandatory. Also, no surgical operation associated with oncology is performed without it. In addition, a careful study of the tissues of patients is necessary in order to timely detect even the slightest changes in the tumor process and take timely measures.
But in the treatment of not only cancer patients, histological examination is used. Biopsy is extremely important when choosing the optimal treatment program for patients with diseases, which are studied in such branches and sections of medicine as gynecology, gastroenterology, urology, pulmonology, otorhinolaryngology, hematology, nephrology, thoracic and abdominal surgery, etc.
Execution of material intake
The material required for the study can be obtained from any tissues and internal organs of the patient. Today there are many ways to perform this procedure:
- Excision of the necessary number of tissues during surgical operation (excisional biopsy).
- Puncture of the cavity of the affected organ or malignant tumor formations with a special long needle. Such needles are presented in various designs and types. Through the needle biopsy is carried out, for example, histological examination of the liver.
- Cutting out or cutting off of the removed internal organs of small pieces of fabric.
- Biting special tissue with the necessary amount of tissue when performing endoscopic manipulations: colonoscopy, bronchoscopy, esophagogastroduodenoscopy. This method is called gipps biopsy.
- Suction of a small amount of material from the hollow internal organs (aspiration biopsy).
- Curettage of internal walls of pathological and natural cavities. In this way, for example, histological examination of the cervix and osteomyelitis cavity is performed.
Features of the procedure
To obtain the most reliable and correct results, it is necessary to strictly follow the rules for sampling biological material. Samples of tissue, as already mentioned, can be taken during a surgical operation, when, for example, a part of the organ is removed, either entirely, or as a result of a biopsy. Most doctors prefer the second method of sampling material, it is much more common.
Histological examination can be carried out through the study as a whole nodule, and a small column of tissue. Often biopsy is performed using a very long and thin needle, which is intended for intramuscular injection. But in some cases, use a needle of larger diameter – this makes the procedure more painful but also more effective, as experts have the opportunity to spend more and immunohistochemical analysis.
There are two methods of performing a histological study - traditional and accelerated. In the first case, the obtained tissue samples are first filled with molten paraffin, and then cut into plates of 1-8 microns thick and subjected to staining. With this method, the analysis data will be ready in five to ten days.
When using the accelerated technique, the result of histological examination can be obtained within an hour. In this case, the biological material taken from the patient is immediately frozen, and then the layered finest sections are made in it and carefully studied under a microscope. Such a method is indispensable when the surgeon needs to urgently make a decision as to whether to remove the organ of the patient or to save.
If the histological examination is planned to be performed not in the near future, but later, the tissues are filled with alcohol, a formalin solution or osmic acid to preserve the structure. As for solid matter, they are carefully softened.
Histological methods has high precision. This is because the tissue of the affected organ are studied under the microscope, and are not addressed through other tissues and organs, as occurs during an x-ray or ultrasound. For this reason, histological analysis is considered the most important for setting the final diagnosis. In addition, due to microscopy and staining of the tissues of the patient, doctors are able to obtain the most accurate data about the current state of the affected organ. Knowing the approved standards of the structure of tissues and organs in a healthy condition, the doctor can easily assess pathological changes and to quickly establish the presence of disease and its degree.
According to the results of the study, the expert gives an opinion. It may be an indicative or final diagnosis, and in some cases only a descriptive answer is given, allowing only to state the nature of the pathology (in the absence of clinical information or material).
An indicative diagnosis makes it possible to determine the range of diseases for performing a differential study, and the final answer serves as the basis for the formulation of a clinical diagnosis.
Many patients are interested in the question of whether erroneous results can be obtained by histological examination. This happens, as a rule, if the doctor incorrectly performed the sampling of the biomaterial. For example, he took many healthy tissues, and almost completely missed the affected area of the organ. Also, the error may be caused by improper storage conditions of the patient's tissues or serious violations committed during their preparation for storage.
In addition, to obtain reliable result of great importance is the number of slices – the more, the better, because if the slices are insufficient, the affected area of the fabric may be omitted, in this case, careful examination is not performed.
Often mistakes in the implementation of such a diagnosis are due to the lack of qualification of the histologist and the lack of mutual understanding between him and the doctor who is treating the patient.
Histological studies in gynecology
In this field of medicine, the diagnostic method under consideration is of great importance. In gynecology, all histopathological types of research have been used. Their use makes it possible to establish a diagnosis with the greatest degree of certainty in the case of various pathologies of the female reproductive system. Particularly important is the histological examination of the uterus, its appendages, as well as the cervix. Such diagnostics allows to detect oncological diseases, as well as to determine the causes of frozen pregnancies and spontaneous miscarriages.
Histological examination of the endometrium
Such a diagnosis in gynecology gives an opportunity to correctly assess the functioning of the ovaries and to identify in time any pathological processes taking place in them. If a woman still has a menstrual cycle, histological examination of the endometrium is carried out approximately three days before the start of the next monthly period. In the event that the patient has dysfunctional bleeding, scraping is required to be taken directly during bleeding.
The biological tissues obtained by diagnostic curettage for staining are stained with hematoxylin or eosin. In some cases, Van Gieson's technique is used. After staining, the structure of the stroma and glands is determined by analysis, revealing all the features of the endometrium. During the luteal phase of the menstrual cycle, the healthy glands differ in sawing shape, they are slightly widened. The cells of the glandular epithelium themselves have a light cytoplasm and pale nuclei, and a secret is necessarily found in the glands.
Histology of the cervix
Diagnosis is carried out by taking a small number of tissues from the lower segment of the genital organ. If, during the analysis, minor pathological changes are detected in them, then it can be affirmed that the patient has a benign formation or inflammatory disease. In the event that a lot of cells with pathological changes are identified, they speak of the development of a malignant tumor or a precancerous condition.
Histology of the uterus
Histological examination of the genitals is carried out solely according to the testimony. This diagnosis is performed if, for example, a woman suffering from pains in the lower abdomen or she observed prolonged uterine bleeding if the tumor is detected when probing the stomach and so on.
Biological material is taken for research during a diagnostic hysteroscopy is a minimally invasive examination of the inner surface of the reproductive organ by means of a hysteroscope – a special optical device. It should be noted that the procedure is quite complicated, it is often performed under General anesthesia (rarely used local anesthesia). Tools that are part of a hysteroscope, a specialist takes pieces of fabric, which is then sent for histological examination, in which it is possible to determine exactly what caused the symptoms. This diagnostic also allows to distinguish the benign (e.g., myoma) and malignant.
Histology of the ovaries
In this case, the collection of biological material for histological analysis is performed by means of a puncture biopsy (a puncture of the anterior abdominal wall is made). Now such procedure is carried out under the control of ultrasonic research - it gives the chance to receive a fabric directly from those sites which cause suspicion. Carrying out such diagnostics makes it possible to distinguish a benign tumor and a cyst from ovarian cancer.