Tumour - Large Biopsy 3-6 cm

Biopsy

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Histopathology of mass/tumor.

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Tumour - Large Biopsy 3-6 cm: Comprehensive Medical Test Information Guide

Section 1: Why is it done?
- Purpose and Measurement: This test involves obtaining a tissue sample from a tumour measuring 3-6 cm in diameter using specialized biopsy techniques. The tissue sample is analyzed histopathologically to determine the nature, type, grade, and characteristics of the tumour.
- Primary Indications: Confirms diagnosis of malignancy or benign lesions; Determines tumour histology and cell type; Assesses grade and stage of cancer; Guides treatment planning and prognosis; Identifies specific molecular markers for targeted therapy; Evaluates margins and invasiveness; Rules out metastatic disease
- Clinical Circumstances: After imaging studies (CT, MRI, ultrasound) show a suspicious mass; When imaging findings are inconclusive or show intermediate characteristics; Prior to surgical intervention to confirm diagnosis; In patients with unexplained constitutional symptoms and imaging abnormalities; During initial cancer workup; For recurrent or residual lesions after prior treatment
Section 2: Normal Range
- Normal/Reference Findings: Benign tissue architecture; Normal cellular differentiation; Absence of malignant cells; No evidence of dysplasia; Normal mitotic activity appropriate to tissue type; Intact basement membrane; No invasion into surrounding structures
- Result Interpretation Categories: Benign: Non-neoplastic lesions or benign tumours with no malignant potential; Malignant: Confirmed cancer with specific histological type and grade; Uncertain/Atypical: Findings of unknown significance requiring further evaluation; In situ carcinoma: Malignant cells confined to epithelium without invasion; Invasive carcinoma: Cancer with infiltration into surrounding tissues
- Units of Measurement: Tumour size: 3-6 cm (centimeters); Histological grading: Grade 1-4 (where applicable); Mitotic rate: Number of mitoses per 10 high-power fields; Tumour stage: TNM classification system (Tumour, Node, Metastasis)
- Normal vs Abnormal: Normal findings indicate absence of malignancy and presence of benign pathology, allowing for conservative management or simple excision; Abnormal findings indicate presence of cancer, requiring immediate staging, multidisciplinary treatment planning, and potentially aggressive intervention including chemotherapy, radiation, or surgery based on cancer type and extent
Section 3: Interpretation
- Benign Findings: Examples include fibroadenoma, lipoma, cyst, hamartoma, or inflammatory lesions; Indicates no malignant potential; Routine follow-up or simple excision may be recommended; Generally favorable prognosis with minimal further intervention required
- Low-Grade Malignancy: Well-differentiated malignant cells; Low mitotic rate; Slow growth pattern; Lower risk of metastasis; Requires treatment but often with better prognosis; May involve surgery with or without chemotherapy/radiation depending on stage
- Intermediate-Grade Malignancy: Moderately differentiated cells; Intermediate mitotic activity; Moderate growth rate; Intermediate risk of metastasis; Requires comprehensive multimodal treatment; Prognosis depends on stage and specific cancer type
- High-Grade Malignancy: Poorly differentiated or undifferentiated cells; High mitotic rate; Rapid growth pattern; High metastatic potential; Requires aggressive treatment with surgery, chemotherapy, and/or radiation; More guarded prognosis; Requires urgent treatment planning and possible staging with imaging and tumor markers
- Factors Affecting Results: Sample adequacy and size; Tissue fixation and processing quality; Contamination or crush artifacts; Prior treatments affecting tissue appearance; Inflammation or necrosis within the sample; Operator expertise in biopsy technique; Location of biopsy within heterogeneous tumour
- Clinical Significance Patterns: Presence of specific molecular markers (ER/PR, HER2, EGFR, KRAS, BRAF) guides targeted therapy selection; Lymphovascular invasion indicates higher risk of metastasis; Necrosis suggests aggressive behaviour; Clear margins indicate successful complete excision; Involvement of margins necessitates further treatment; Perineural invasion associated with worse prognosis in certain cancers
Section 4: Associated Organs
- Primary Organ Systems: Skin and subcutaneous tissues; Breast; Lung; Gastrointestinal tract (esophagus, stomach, colon, rectum); Liver; Thyroid; Lymph nodes; Soft tissues and muscle; Bone; Reproductive organs; Any organ system where 3-6 cm tumours may develop
- Associated Medical Conditions: Carcinoma (adenocarcinoma, squamous cell, small cell); Sarcoma (soft tissue and bone); Lymphoma; Melanoma; Hepatocellular carcinoma; Cholangiocarcinoma; Pancreatic cancer; Renal cell carcinoma; Bladder cancer; Gastric cancer; Colorectal cancer
- Diagnostic Diseases: Primary malignant tumours of various organs; Secondary/metastatic lesions; Lymphoproliferative disorders; Mesothelioma; Neuroendocrine tumours; Germ cell tumours; Stromal tumours; Benign tumours requiring differentiation from malignancy
- Potential Complications of Abnormal Results: Metastatic spread to distant organs (lung, liver, bone, brain); Lymph node involvement; Organ dysfunction or failure related to tumour mass; Paraneoplastic syndromes; Psychological impact of cancer diagnosis; Treatment-related complications including organ toxicity; Recurrent or residual disease; Compromised quality of life and mortality risk
Section 5: Follow-up Tests
- Immediate Staging Investigations: Computed tomography (CT) of chest, abdomen, and pelvis; Magnetic resonance imaging (MRI) for specific organ assessment; Positron emission tomography (PET-CT) for metabolic activity assessment; Bone scan or skeletal survey for bone involvement; Specialized imaging based on tumour type (endoscopy, colonoscopy, bronchoscopy)
- Molecular and Genetic Testing: Immunohistochemistry (IHC) for hormone receptors, growth factor receptors, and other markers; Fluorescence in situ hybridization (FISH); Next-generation sequencing (NGS) for mutation analysis; Gene expression profiling; Chromosomal analysis; Mismatch repair status assessment
- Laboratory Studies: Complete blood count (CBC); Comprehensive metabolic panel; Liver function tests; Renal function tests; Lactate dehydrogenase (LDH); Tumour-specific markers (PSA, CEA, AFP, CA-125, etc. based on cancer type); Coagulation studies if planning for surgery
- Re-biopsy Scenarios: Initial sample inadequate or inconclusive; Suspected sampling error from non-representative tissue; Clinical suspicion remains high despite negative results; Apparent change in lesion characteristics on follow-up imaging; Recurrent or residual disease assessment; For prognostic molecular testing if not performed initially
- Monitoring and Surveillance Frequency: During treatment: Regular assessments every 4-8 weeks; After completion of primary therapy: Every 3-6 months for first 2 years; Year 3-5: Every 6-12 months; Beyond 5 years: Annually or as clinically indicated; Frequency may be intensified for high-grade or advanced stage malignancies; Surveillance includes clinical examination, imaging studies, and laboratory markers as appropriate
- Complementary Diagnostic Tests: Surgical margins assessment if excision performed; Lymph node biopsy if clinically indicated; Sentinel lymph node biopsy for staging; Repeat imaging at defined intervals; Circulating tumour cell (CTC) analysis; Circulating tumour DNA (ctDNA) testing; Core needle biopsy if large biopsy finding requires confirmation
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is NOT required for tumour biopsy procedures. The biopsy itself does not require blood work with fasting restrictions.
- Pre-Procedure Fasting Instructions: If sedation or general anesthesia will be used (typically for deep biopsies): Fasting required for 6-8 hours prior to procedure; No food after midnight before morning procedure; Clear liquids may be permitted up to 2 hours before procedure (confirm with facility); Follow specific institutional guidelines provided at time of scheduling
- Medications to Avoid or Adjust: Anticoagulants (warfarin, apixaban, rivaroxaban): Hold 3-5 days prior; Consult physician regarding discontinuation; Antiplatelet agents (aspirin, clopidogrel): Hold 5-7 days prior; NSAIDs (ibuprofen, naproxen): Hold 1 week prior; Herbal supplements with anticoagulant properties (ginger, ginseng, garlic): Hold 1 week prior; Continue essential medications (blood pressure, cardiac, seizure medications) unless otherwise instructed
- Pre-Procedure Patient Preparation: Undergo coagulation studies (PT/INR, aPTT, platelet count) 7-10 days prior; Complete physical examination and imaging review; Provide history of bleeding disorders or previous adverse reactions to anesthesia; Inform about active infections or recent fever; Discontinue alcohol consumption 24-48 hours prior; Arrange transportation as procedure may affect alertness; Wear loose, comfortable clothing allowing access to biopsy site; Shower or bathe night before or morning of procedure; Arrive 1-2 hours before scheduled time for registration and preparation
- Post-Procedure Instructions: Resume normal diet once alert (if sedation used); Avoid heavy or spicy foods for first 24 hours; Maintain hydration with adequate fluid intake; Apply ice packs to biopsy site as directed (typically 15-20 minutes); Keep dressing clean and dry; Avoid strenuous activity and heavy lifting for 24-48 hours; Sleep with head elevated if facial/neck biopsy; Contact physician if severe pain, excessive bleeding, signs of infection, or allergic reaction occurs; Arrange follow-up appointment to discuss pathology results

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