Today it is impossible to imagine the full treatment of malignant tumors without histological examination. However, few people have a clear idea of this method of diagnosis. The article will tell about how the histological examination is carried out, and why it is necessary. We will also talk about the use of diagnostics of this kind in gynecology.
What is a
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.
Such diagnostics is carried out to clarify or confirm a previously made diagnosis. It also helps to correctly identify the disease in controversial situations. Histological examination of the patient's material makes it possible at an early stage to detect the presence of a malignant tumor, to study the dynamics of its growth (to determine whether there is an overgrowth, an increase, the spread of a tumor). In addition, using it, differential diagnosis of pathological processes is carried out and changes in the course of treatment in the tissues are analyzed.
Value in medicine
Currently, prior to chemotherapy or radiation treatment of patients with malignant tumors, histological examination of the tumor is required. Also, no oncology-related surgical operation is performed without it. In addition, a careful examination of the tissues of patients is necessary in order to detect in time 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 that are studied by such branches and branches of medicine as gynecology, gastroenterology, urology, pulmonology, otorhinolaryngology, hematology, nephrology, thoracic and abdominal surgery, etc.
Perform material sampling
The material necessary 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 amount of tissue during surgery (excision 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 forceps with the right amount of tissue when performing endoscopic procedures: colonoscopy, bronchoscopy, esophagogastroduodenoscopy. This method is called a gable biopsy.
- Extraction of a small amount of material from the hollow internal organs (aspiration biopsy).
- Curettage of the inner walls of the 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 the collection of biological material. Tissue samples, as already mentioned, can be taken in the course of a surgical operation, when, for example, a part of an organ or its entire body is removed, 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 for performing histological research - traditional and accelerated. In the first case, the obtained tissue samples are first poured with molten paraffin, and then cut into plates with a thickness of 1-8 μm and subjected to staining. When applying 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 urgently frozen, and then thin layers of thin sections are made in it and carefully examined under a microscope. This method is indispensable when the surgeon urgently needs to decide whether to remove the patient’s body or keep it.
If the histological study is planned to be performed not in the near future, but later, in order to preserve the structure, tissues are poured with alcohol, formalin solution or osmic acid. As for solid matter, they are thoroughly 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 specialist gives a conclusion. It can be indicative or conclusive diagnosis, and in some cases only a descriptive answer is given, allowing only to make an assumption about the nature of the pathology (with insufficient 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 is the basis for formulating 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 a lot of healthy tissue, and almost completely missed the affected part of the organ. Also, the wrong storage conditions for the patient’s tissues or serious disturbances made during their preparation for storage may also be the cause of the error.
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, errors in the implementation of such a diagnosis are explained by the insufficient qualifications of the histologist and the lack of understanding between him and the doctor who is treating the patient.
Histological studies in gynecology
In this branch of medicine, the diagnostic method under consideration is of great importance. All histopathological studies have found their application in gynecology. Their use makes it possible to establish the diagnosis with the greatest degree of reliability in the case of various pathologies of the female reproductive system. A particularly important role is played by histological examination of the uterus, its appendages, as well as the cervix. Such diagnostics allows detecting oncological diseases, as well as determining the causes of missed abortions and miscarriages.
Histological examination of the endometrium
Such a diagnostic option in gynecology makes it possible to correctly evaluate the functioning of the ovaries and timely detect any pathological processes occurring in them. If the woman still has a menstrual cycle, a histological examination of the endometrium is performed approximately three days before the start of the next menstrual period. In the event that the patient has dysfunctional bleeding, scraping is required to take directly during the bleeding.
Biological tissues obtained by diagnostic curettage are stained with hematoxylin or eosin for examination. In some cases, the technique used by Van Gieson. After staining by analysis, determine the structure of the stroma and glands, reveal all the features of the endometrium. During the luteal phase of the menstrual cycle, healthy glands have a sawn-shaped shape, they are slightly enlarged. The cells of the glandular epithelium themselves have a bright cytoplasm and pale nuclei, and a secret is necessarily found in the glands.
Histology of the cervix
Diagnosis is carried out by collecting a small amount of tissue from the lower segment of the reproductive organ. If during the analysis they reveal minor pathological changes, then it can be argued that the patient has a benign tumor or an inflammatory disease. If there are a lot of cells with pathological changes, they say about 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 sampling of biological material for histological analysis is performed by puncture biopsy (make a puncture of the anterior abdominal wall). Currently, this procedure is carried out under the control of ultrasound - it gives the opportunity to get tissue directly from those areas that are suspicious. Carrying out such a diagnosis makes it possible to distinguish a benign tumor and cyst from ovarian cancer.