Anatomical Pathology

A biopsy is a procedure in which a small sample of tissue or cells is collected for laboratory analysis. The sample is subsequently examined by a pathologist, helping to confirm or rule out diagnoses and guide the clinical management plan.

There are different types of biopsy, depending on the location and characteristics of the lesion, including needle biopsies, incisional biopsies, excisional biopsies, endoscopic biopsies, and surgical biopsies. The collected material may be assessed by histopathology, cytology, immunohistochemistry, or molecular pathology, depending on the clinical indication.

Histopathology is the microscopic examination of tissues to identify disease-related changes, allowing not only the characteristics of individual cells to be assessed but also how they are organised within the tissue.

This examination is essential for diagnosing a wide range of conditions, including inflammatory, infectious, autoimmune, and neoplastic diseases. In oncology, histopathology helps distinguish between benign and malignant lesions and assess the tumour type, grade, extent and, where applicable, surgical margins.

Cytology is the analysis of individual cells or small groups of cells obtained using different methods.

• Gynaecological cytology (Pap smear): a screening test for cervical cancer that can detect abnormal cells before cancer develops. It can be performed using conventional cytology or liquid-based cytology.

• Fine-needle aspiration cytology (FNAC): a minimally invasive technique in which a fine needle is used to aspirate cells from suspicious nodules or lesions. It is often ultrasound-guided to improve accuracy.

• Exfoliative cytology: a simple and painless technique involving the collection and analysis of cells that naturally shed or are gently scraped from surfaces such as mucous membranes and skin.

Unlike histopathology, which evaluates tissue architecture, cytology focuses primarily on the characteristics of individual cells, such as their shape, size, and nuclear changes. It can be used to investigate suspicious lesions, inflammatory processes, infections, and cancer.

Immunohistochemistry is a complementary technique that uses antibodies to identify specific proteins in cells and tissues. These markers help the pathologist confirm diagnoses, distinguish between different types and subtypes of disease, and obtain relevant information to guide treatment.

It is particularly used in the study of tumours, helping to assess the cellular origin and biological characteristics of a lesion and, in some cases, markers with prognostic value or predictive value for treatment response.

Molecular Biology and Molecular Pathology enable the study of genetic and molecular alterations present in cells and tissues, contributing to more accurate and personalised diagnoses. These techniques are particularly relevant in oncology, helping to identify biomarkers associated with diagnosis, prognosis, and the selection of targeted therapies.

Using methods such as DNA and RNA analysis, genetic sequencing, and the study of specific molecular alterations, it is possible to better characterise certain tumours and support more individualised clinical decision-making.

Flow cytometry is a laboratory technique performed using a flow cytometer that allows specific characteristics of cells to be analysed, helping to identify different cell populations through specific markers. In Anatomical Pathology, it is particularly useful as a complementary test in the study of haematological and lymphoproliferative diseases, such as leukaemia and lymphoma.

This test contributes to diagnosis, classification, prognosis, and monitoring of treatment response, and is often used in conjunction with histological analysis and other methods, such as immunohistochemistry.

Immunofluorescence is a specialised technique that uses antibodies labelled with fluorescent substances to identify proteins, immunoglobulins, or immune deposits in tissues. The sample is examined using a fluorescence microscope, allowing specific patterns to be identified that can aid in diagnosis.

This technique is frequently used in the investigation of renal, dermatological, and autoimmune diseases, including certain blistering skin disorders, lupus, vasculitis, and glomerulonephritis.

The frozen section examination, also known as an intraoperative examination or frozen section, is performed during surgery to provide a rapid assessment of a tissue sample. Its purpose is to support the surgical team’s decision-making in real time, for example, by assessing surgical margins, identifying pathological tissue, or providing a preliminary confirmation of a diagnosis.

This examination is particularly useful in oncological surgery, but it has technical limitations, as freezing can produce artefacts and not all tissues are suitable for immediate analysis. The definitive diagnosis is generally confirmed later through conventional histological examination.

The examination of surgical specimens consists of the macroscopic and microscopic analysis of tissues or organs removed during surgery. This process allows for the characterization of lesions, assessment of the extent of disease, evaluation of surgical margins, and identification of factors relevant to diagnosis and therapeutic guidance.

During the macroscopic examination, the specimen is carefully inspected, measured, described, and sampled. Subsequently, the selected tissue fragments are processed for microscopic examination and may be supplemented by additional techniques, such as immunohistochemistry, immunofluorescence, or molecular studies, when clinically indicated.

Pathological Anatomy is the medical specialty that analyzes organs, tissues, and cells to reach an accurate diagnosis, particularly in cases of suspected inflammation, infections, benign lesions, or cancer. At Joaquim Chaves Saúde, this area supports clinical decision-making through tests such as histology, cytology, immunohistochemistry, and molecular techniques.

The turnaround time depends on the type of biopsy, the complexity of the sample, and whether additional techniques, such as immunohistochemistry, are required. At our Laboratory, urgent biopsies can be reported within 8 hours, but turnaround times should be confirmed at the time of sample submission or appointment scheduling.

Cytology analyzes individual cells or small groups of cells collected through scraping, shedding, or aspiration. Histology analyzes tissue or organ samples, allowing the lesion’s architecture to be assessed and making it easier to distinguish between benign and malignant changes.

Cervical cytology can be performed as part of the cervical cancer screening programme promoted by the Portuguese National Health Service (SNS). Joaquim Chaves Saúde performs Cytopathology tests, including Cervico-Vaginal Cytology (Pap smear), also using liquid-based cytology.

Fine-needle aspiration biopsy is generally a quick, minimally invasive procedure performed using a fine needle. However, it may cause mild discomfort, pressure, or temporary local pain. When necessary, local anaesthesia or measures to reduce discomfort may be used.

You can consult the Joaquim Chaves Saúde network of clinical analysis collection units, which has around 400 locations in Portugal, and check where to submit samples or undergo related tests. The Joaquim Chaves Saúde Pathology Laboratory is located in the CORE building in Carnaxide.

Immunohistochemistry helps to further characterize the cells in a biopsy by identifying specific markers that support diagnosis, prognosis, and treatment selection.

Liquid-based cytology is a technique in which the cell sample is placed in a special liquid, helping to preserve the material for analysis. It is used, for example, in gynaecological cytology, allowing a sample to be obtained in better laboratory conditions.

A negative HPV result means that no high-risk HPV was detected in the sample analyzed, reducing the likelihood of cervical cancer-related lesions at that time. However, you should continue with the follow-up recommended by your doctor or by the screening programme, according to your age, medical history, and current guidelines.

Histological examination is the microscopic analysis of a tissue sample obtained through a biopsy or surgery. It is used to identify the type of lesion, determine whether it is benign or malignant, and, in many cases, guide treatment.

Flow cytometry assesses the physical and chemical characteristics of cells, allowing specific cell populations to be identified. It is widely used in Haematology and Oncology, particularly in the study of leukaemias, lymphomas, and disorders of the immune system.

Anatomical Pathology evaluates changes in cells and tissues, primarily through microscopic examination. Molecular Pathology studies genetic or molecular changes associated with disease, complementing the diagnosis and helping to select more personalized treatments.

After a breast biopsy, it is common to experience mild pain, bruising, or slight swelling. As a general rule, you should keep the dressing clean and dry, apply ice if advised, avoid strenuous activity for the first 24 to 48 hours, and contact your doctor if you experience bleeding, severe pain, fever, discharge, or significant swelling.