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Anal canal biopsy - Large Biopsy 3-6 cm

Biopsy
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Details

Large tissue biopsy of anal canal lesion.

₹666₹951

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Anal Canal Biopsy - Large Biopsy 3-6 cm

  • Why is it done?
    • Detection and diagnosis of malignant or premalignant lesions in the anal canal, including squamous cell carcinoma and anal intraepithelial neoplasia (AIN)
    • Investigation of abnormal anal cytology results from Pap smear screening
    • Evaluation of visible lesions, ulcerations, masses, or suspicious tissue in the anal canal
    • Assessment of chronic inflammatory conditions affecting the anal canal, including inflammatory bowel disease
    • Identification of infectious or sexually transmitted diseases (HPV, HSV, gonorrhea)
    • Monitoring of patients at high risk for anal cancer, including those with HIV/AIDS, history of cervical or other anogenital cancers, or immunosuppression
    • Characterization of anal warts or condylomas, particularly when malignant transformation is suspected
  • Normal Range
    • Normal Result (Negative): No malignant cells, no dysplasia, and no intraepithelial neoplasia present
    • Histopathology Findings: Benign squamous mucosa with intact epithelial architecture, normal flora, and absence of atypia
    • Units of Measurement: Qualitative assessment based on microscopic examination and histologic grading
    • Interpretation: A negative result indicates the sampled tissue is benign and does not contain cancer or precancerous changes; however, negative results do not exclude disease in unsampled areas
    • Reference Standards: Classified according to Bethesda Classification System and WHO histologic grading when applicable
  • Interpretation
    • Negative/Benign Findings: Normal squamous epithelium without dysplasia; indicates no cancer or precancerous cells in the biopsied tissue; repeat screening typically recommended based on risk factors
    • Anal Intraepithelial Neoplasia (AIN) Grade 1 (Low-grade): Mild dysplasia with abnormal cells confined to lower third of epithelium; may regress spontaneously or progress; close surveillance recommended with repeat biopsies or cytology every 6-12 months
    • Anal Intraepithelial Neoplasia (AIN) Grade 2 (Moderate dysplasia): Abnormal cells extend into middle third of epithelium; increased risk of malignant transformation; treatment or close surveillance is typically recommended
    • Anal Intraepithelial Neoplasia (AIN) Grade 3 (High-grade/Carcinoma In Situ): Severe dysplasia with abnormal cells through full thickness of epithelium; high risk for progression to invasive cancer; treatment is recommended, including surgical excision, laser therapy, or topical agents
    • Squamous Cell Carcinoma (Invasive): Malignant cells infiltrating beyond epithelium into submucosa or deeper; indicates invasive cancer requiring staging studies (CT, MRI) and multidisciplinary treatment planning including chemotherapy, radiation, and/or surgery
    • Other Malignancies: Adenocarcinoma, melanoma, lymphoma, or other rare histologic types may be identified; histologic type and grading guide treatment decisions
    • Infection: HPV presence (especially high-risk types 16, 18, 31, 33), herpes simplex virus, or other pathogens may be identified; immunohistochemistry or molecular testing can confirm specific organisms
    • Inflammation: Acute or chronic inflammation consistent with inflammatory bowel disease, infectious proctitis, or other inflammatory conditions; grading and extent helps guide management
    • Factors Affecting Results: Sampling technique and location (lesions may be focal); tissue fixation and processing; pathologist experience; immunosuppression status; presence of HPV or other risk factors; previous treatments or biopsies
  • Associated Organs
    • Primary Organ System: Anoderm (anal canal mucosa) and lower gastrointestinal tract
    • Commonly Associated Conditions with Abnormal Results:
    • Anal squamous cell carcinoma - most common malignancy of anal canal
    • Anal intraepithelial neoplasia - precancerous condition associated with HPV infection
    • Human papillomavirus (HPV) infection - primary risk factor for anal dysplasia and cancer
    • HIV/AIDS - significantly increases risk of anal cancer and dysplasia
    • Inflammatory bowel disease (Crohn's disease, ulcerative colitis) - increased malignancy risk
    • Anal condylomas (warts) - potential for malignant transformation
    • History of cervical, vulvar, or penile cancer - increased anal cancer risk
    • Infectious proctitis (HSV, gonorrhea, chlamydia, syphilis) - may present with ulceration or inflammation
    • Potential Complications or Risks Associated with Abnormal Results:
    • Progression from dysplasia to invasive carcinoma if untreated
    • Metastatic spread of invasive cancer to lymph nodes, liver, lung, and other sites
    • Sphincter dysfunction and fecal incontinence from tumor invasion or treatment complications
    • Sepsis or systemic infection from severe proctitis or perforation
    • Rectal stricture or stenosis from chronic inflammation or radiation therapy
  • Follow-up Tests
    • For Negative Results:
    • Repeat anal cytology (Pap smear) at intervals based on risk stratification (every 1-3 years for at-risk populations)
    • Follow-up high-resolution anoscopy (HRA) if cytology remains abnormal
    • HPV testing or p16 immunohistochemistry if not previously performed
    • For AIN Grade 1 (Low-grade Dysplasia):
    • Repeat anal cytology every 6-12 months or repeat HRA/biopsy in 6-12 months
    • Consider topical imiquimod or other immune-modulating agents if persistent
    • Counseling regarding HPV transmission and safe sexual practices
    • For AIN Grade 2-3 (Moderate to High-grade Dysplasia/Carcinoma In Situ):
    • Definitive treatment: Surgical excision, laser ablation (CO2 or KTP laser), or topical chemotherapy (5-FU or imiquimod)
    • Post-treatment surveillance with anal cytology every 3-6 months for 2 years, then annually
    • Repeat HRA if cytology becomes abnormal again during follow-up
    • For Invasive Squamous Cell Carcinoma:
    • CT chest, abdomen, and pelvis for staging and assessment of metastatic disease
    • MRI pelvis for local staging and surgical planning
    • PET-CT for detection of regional and distant metastases
    • Baseline carcinoembryonic antigen (CEA) level if indicated
    • Multidisciplinary tumor board consultation for treatment planning (typically Nigro protocol: concurrent chemotherapy and radiation therapy)
    • Regular surveillance imaging and clinical examination during and after treatment
    • For Infectious Causes:
    • Culture or molecular testing (PCR) for specific infectious agents (HSV, gonorrhea, chlamydia, syphilis serology)
    • HPV genotyping to identify high-risk strains
    • Appropriate antimicrobial therapy based on pathogen identification
    • HIV testing and CD4 count if status unknown
    • For Inflammatory Findings:
    • Colonoscopy with biopsy if inflammatory bowel disease suspected
    • Laboratory studies: Complete metabolic panel, inflammatory markers (ESR, CRP), albumin
    • Appropriate medical management based on underlying inflammatory diagnosis
  • Fasting Required?
    • Fasting Status: No fasting required for the biopsy procedure itself
    • Bowel Preparation: Rectal enema (fleet enema or similar) typically performed 1-2 hours before procedure to clear stool and debris for visualization
    • Medications:
    • Anticoagulants (warfarin, apixaban, rivaroxaban) should generally be continued, but consult with prescribing provider and proceduralist
    • Aspirin and NSAIDs may need to be held 3-5 days prior to procedure; consult physician
    • Antibiotics not routinely required unless patient has history of infective endocarditis or specific cardiac conditions
    • Continue regular medications including blood pressure and cardiac medications as directed
    • Anesthesia/Sedation: Conscious sedation or topical anesthesia typically used; fasting 4-6 hours may be recommended if intravenous sedation planned (follow institutional guidelines)
    • Other Patient Preparation:
    • Informed consent required; discussion of risks (bleeding, infection, perforation, pain) and benefits
    • Arrangement for transport home if sedation used; patient should not drive or operate machinery for 24 hours after conscious sedation
    • Patient education regarding procedure, expected sensations, and post-procedure care
    • Removal of jewelry and metallic objects from anal area
    • Emptying bladder before procedure

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