Monday, September 23, 2019

Avoid the risks of unnecessary BIOPSIES

By: Dr. Robert L. Bard
Edited by: Darleen Garza, CSW

When it comes to finding abnormalities in a patient's exam, many conventional-minded doctors tend to tread on the side of caution... but usually at YOUR expense! Finding an unusual spot that appears questionable often warrants the automatic response- "cut it out and send it to the lab for a BIOPSY". As with all invasive surgical procedures (however large or small) conducting a biopsy may carry risks such as bleeding, infections, post-surgical scars and potential damage to nearby tissues and organs -- and others can also fall into further complications.

The year is 2019- the era of the non-invasive tech movement!  For over 20 years, biotech developers have invested tremendous resources into subdermal imaging where identifying what's under the skin is (now) most often the first course of action over cutting into it. The age of robotics, artificial intelligence (AI), highly developed laser applications and advanced sonic diagnostic protocols are all fast replacing the age-old scalpel as part of risk reduction, time/cost advantages and increased performance in the world of clinical diagnostics and medical treatment.

Imaging technologies like the 3D & 4D Power Doppler Ultrasound™ is recognized in many countries to accurately and successfully scan, study and fully diagnose cancer tumors in all stages of malignancy. More radiologists and clinicians stand on the side of innovation as they confidently rely on the most current devices to deliver the most accurate readings while bringing significant reduction to patient stress under a scan- many of them perform successfully within mere minutes!

BIOPSY Defined + Cancer Risks
The first biopsy was performed in 1875 by M. M. Rudnev. [1]  According to the national Cancer Institute, A BIOPSY is defined as the removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures.

There are 3 types of biopsies:  (1) INCISIONAL biopsy, in which only a sample of tissue is removed surgically; (2) EXCISIONAL biopsy, also surgical- where an entire lump or suspicious area is removed; and (3) NEEDLE biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Removal of living tissue surgically or through aspiration of cells from the tumor (w/ needle) carry the risk of seeding tumor cells either into the interstitial tissue fluid from where they are carried to lymph nodes, or into the veins draining the tissue from where they enter the vasculature and may travel to lodge into any organ or tissue. There is also a risk of dragging cells along the surgical incision or needle track leading to the possibility of increasing the spread of cancer through biopsy.[2]

Bye-bye Biopsies?
Advances in Medical Imaging (Source: NIH)

Nearly 200,000 Americans are hospitalized each year for chronic liver disease. Typically, a biopsy is used to diagnose and evaluate the liver for signs of stiffening, or fibrosis. For a biopsy, the doctor uses a needle to take a tiny sample of liver tissue and then examines it under the microscope for scarring or other signs of disease.

As an alternative to liver biopsies, NIH-funded investigators led by Richard Ehman at the Mayo Clinic have developed Magnetic Resonance (MR) elastography, a noninvasive MRI approach that can measure the amount of stiffness in a very small amount of tissue. The noninvasive detection of fibrosis by MR elastography offers patients multiple advantages over biopsy examination, including less discomfort, a much lower risk of complications, and a decrease in expense.

Elastograms of patient with normal liver (left) and patient with diseased liver (right). Red and yellow mark hardened tissue in the liver (area inside dotted lines).Mayo Clinic
According to Dr. Ehman, MR elastography has already made a substantial difference in patient care. One example is a patient with hemophilia who previously contracted hepatitis C from a blood transfusion. Liver biopsy was contraindicated because of the hemophilia, but MR elastography was used to determine if there was fibrosis associated with the hepatitis. In this case, the results showed fibrosis and the individual was started on antiviral therapy.

Early results show this same technique might also be used to improve the detection of breast cancer and help distinguish a benign mass, such as fibrocystic disease, from cancer.


Through the use of advanced 3D Doppler Ultrasound technology, we can eliminate the need for surgical procedures when diagnosing a tumor and taking the guesswork out of targeting the proper area for a fine needle biopsy.

Fig A: indicates a large irregular mass (yellow circle) but only one quarter of it (red / 27% Vessel Density) is filled with cancerous active tumor vessels.  This is the site where you want to insert a biopsy needle for best diagnostic results of cancer cells. The rest of the area outside the red circle is filled with debris or dead tumor or necrotic debris- bringing confusing results because there's no active cancer.

Fig. B:  This view is from another angle of a 3D Histogram Scan.  Inserting the needle into the 1% (undesired- red circle) area gives you mostly dead tissue or degenerating inactive cancer tissue.Whereas the orange flame-like area outside the red circle and inside the yellow clearly indicates a high volume of tumor vessels.

Fig. C: The photo shows the palpable axillary lymph node measures approx. 2.5". Without image guidance, one might target the needle in the bottom of the bulging mass (near the red scar)- and as per Fig A and B, you're going to get no cells or fluid, only dead cells.

Fig. D:  Doppler Ultrasound technology provides accurate reading - showing quantitative measurement of the tumor vessels. This gives a benchmark or a baseline, with which to measure treatment.  As an example, if the Vascularization Index reads 20 or 10%, treatment is a working option- whereas a reading of 30 or 40% indicates treatment would fail. This is a guideline.

Cancer Screening from Simple Blood Test: Introducing the "LIQUID BIOPSY"
(Source: PR Newswire LAM)

On May 15, 2019, Laboratory for Advanced Medicine (LAM), a commercial-stage medical technology company focused on developing innovative technologies for the early diagnosis of cancers, announced positive results from a new study that evaluated DNA methylation-based marker panel for early diagnosis of nasopharyngeal carcinoma (NPC).

The results of the study show an overall sensitivity of 97% and a combined specificity of 100%, demonstrating the high analytical potential of the IvyGene Test. The study was conducted using samples obtained from 168 subjects, including 59 subjects diagnosed with NPC (Stage I to IV), 14 subjects diagnosed with benign nasopharyngeal disease and 43 healthy subjects. From the 59 subjects diagnosed with NPC, a total of 57 subjects were correctly identified (sensitivity of 97%), with little difference between the sensitivity of detecting Stage I to Stage IV NPC (range 92% to 100%). Additionally, for subjects diagnosed with other cancers, a total of 86% of subjects were correctly identified as negative for NPC. Finally, all 43 samples drawn from healthy donors and all 14 samples drawn from subjects diagnosed with benign nasopharyngeal disease were correctly identified as negative for NPC (combined specificity of 100%).

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