BIOPSIESYSTEM

Description

[0001] The present disclosure relates to a biopsy system for taking tissue samples from an organic body, in particular for pathological examination.

[0002] Often, an abnormality is diagnosed during cancer screening or follow-up, or in cases of suspected cancer, using an X-ray, CT scan, ultrasound, or other non-invasive imaging procedure. There are various reasons for performing such an examination, including screening (e.g., screening of the lungs of smokers), follow-up care (e.g., examination of the lungs in follow-up care for colorectal cancer), or an examination for another reason (e.g., examination of a potentially injured lung after an accident with the incidental finding of a nodular lesion).

[0003] Often, the detection of an abnormality must be followed by treatment (therapy). However, a prerequisite for a targeted and effective therapeutic intervention, or the decision as to whether such a therapeutic intervention is even necessary, is the clarification of the exact cause of the abnormality in the examination image. The cause of the shadowing can be of completely different types, e.g., tumor, infection, granuloma, etc. Different causes, however, sometimes require completely different therapeutic approaches (surgical removal, chemotherapy, radiation therapy, hormonal treatment, drug treatment, etc.).

[0004] Such clarification (i.e., the search for the cause of the abnormal appearance, i.e., the shadowing) is performed through an ex situ histopathological examination of the suspicious tissue. For the pathological examination, a piece of tissue from the area of ​​the detected abnormality is required.

[0005] Such a piece of tissue is obtained through a tissue sampling procedure, known as a biopsy. There are essentially different options for performing the tissue sampling procedure. If the procedure is to be as minimally stressful as possible for the patient, the biopsy can be performed percutaneously (e.g., using CT or ultrasound guidance to visualize the suspicious area where the sample is to be taken). This involves inserting a thin, long, rigid biopsy needle from the outside through the skin and the underlying tissue into the affected organ to the abnormality, where a tissue sample is taken from or within the abnormality. Typically, hollow needles of various shapes and designs are used for the percutaneous procedure.

[0006] While images obtained with conventional imaging techniques (CT, ultrasound, etc.) allow for the visualization of suspicious tissue, the degree of tissue differentiation is limited, meaning their specificity is limited.

[0007] An abnormality as such stands out relatively clearly from the surrounding healthy tissue—for example, by a different color tone (a different shade of gray in CT and US images). This allows it to be relatively well detected, and the desired tissue sampling can be performed relatively easily, for example, by guiding the distal end of the biopsy needle into the center of the lesion.

[0008] However, conventional imaging techniques (CT, ultrasound, etc.) cannot determine how or in what form the shadowed tissue has been altered, for example, whether it is benign or malignant. For example, a lesion that has already been treated in the past may continue to appear as a shadow in follow-up CT images, even though it is only fibrous, i.e., non-malignant tissue. A biopsy from the center of the shadow and subsequent pathological examination would confirm this diagnosis.

[0009] Any residual tumor that may still be present (due to, for example, inadequate initial treatment) or even a new tumor formation (recurrence, newly formed after the initial treatment) could not be differentiated in the CT or US image from the surrounding fibrous tissue that is displayed as shadowing and would therefore remain unremarkable.

[0010] A single biopsy from the center of the apparently homogeneous abnormality - there would initially be no reason to biopsy at another location based on the CT or US image - would therefore lead to a serious misassessment because it would not include the residual tumor or the new tumor formation that cannot be differentiated in the CT or US image and, accordingly, the actually required therapy would not be available.

[0011] Furthermore, conventional imaging techniques (CT, US, etc.) cannot guarantee that all of the suspicious tissue will actually be visualized. In addition to specificity, sensitivity is also limited. This means that an abnormality that is sufficiently large and whose tissue is sufficiently altered will stand out relatively clearly as a shadow from the surrounding healthy tissue. In this case, tissue can be removed relatively easily from this area and sent for further pathological examination. However, early malignant changes or small malignant changes often cannot be visualized, or at least not well enough, using conventional imaging techniques (CT, US, etc.). Any additional early malignant changes and small malignant changes that may be located, for example, at the edge of the abnormality or even outside the abnormality would remain invisible in the CT or US image.

[0012] Treatment (based on the histopathological results of the biopsy from the central area of ​​the shadow) would therefore be limited to the area of ​​the shadow and a "safety zone" around it. Any early-stage and small malignant changes in the peripheral area or outside the shadow (invisible on CT or ultrasound images) would be treated inadequately or not at all.

[0013] To solve this problem, it is known to take a large number of biopsies from the entire area of ​​the abnormality and also from the tissue surrounding the abnormality in order to reduce the risk of missing pathologically relevant tissue that must be submitted for pathological examination.

[0014] For example, US 5,938,125 A describes a method and a device for examining subcutaneous tissue using an optical probe inserted through a hollow needle. Following the examination with the optical probe, a biopsy needle is inserted through the hollow needle. DE 10 2011 122 602 A1 describes a device and a method for endoscopic fluorescence detection. US 2016 / 0030022 A1 describes a system and a method for interventional optical molecular imaging for use with a biopsy needle.

[0015] However, multiple biopsies have many disadvantages and place a considerable burden on the patient. Further complicating matters, i.e., further burdening the patient, is the fact that a good (in the sense of a meaningful) tissue sample must be sufficiently large, and therefore the biopsy needle and, directly related to this, the puncture channel must be sufficiently large in diameter.

[0016] Furthermore, taking numerous tissue samples is time-consuming, which, in addition to the strain on the operator and the treatment costs, also places additional strain on the patient, such as longer anesthesia. In addition, radiation exposure increases over time during CT-guided tissue sampling. Since all tissue samples must be histopathologically analyzed, this procedure is also costly.

[0017] It is therefore an object of the present disclosure to provide a biopsy system which allows a diagnosis to be made with fewer biopsies in a faster, more cost-effective and more patient-friendly manner with higher specificity and higher sensitivity.

[0018] According to the present disclosure, to achieve this object, a biopsy system according to claim 1 is provided.

[0019] With such a biopsy system, the tissue can be pre-selected for pathological examination in situ before it is actually removed. This means that tissue that appears undifferentiated and suspicious with conventional non-invasive imaging techniques (CT, US, etc.) can be assessed in situ in a more differentiated manner (e.g. with regard to malignancy), thereby increasing specificity. The fluorescence endoscopy element can stimulate tissue to fluoresce in situ using excitation light. The pathological tissue itself stimulated by the excitation light, or a bacterial accumulation indicative of pathological tissue, can specifically fluoresce and thus be clearly localized compared to the surrounding healthy tissue. Fluorescence endoscopy can be performed, for example, using a photosensitizer or marker substance (e.g. chlorin e6), which selectively accumulates on pathological tissue and fluoresces.However, it is also possible to do without such a photosensitizer and instead detect the fluorescence of tissue-specific dyes (so-called autofluorescence), whereby this fluorescence appears differently depending on the tissue condition.

[0020] The fluorescence endoscopy element can therefore be used to very precisely localize pathological tissue. Once the fluorescence endoscopy element has localized tissue relevant for biopsy based on fluorescence, the fluorescence endoscopy element can be withdrawn from the introducer sleeve, leaving the introducer sleeve in the body. The biopsy needle can then be guided through the introducer sleeve to the exact location where the fluorescence endoscopy element identified the tissue to be examined. This biopsy system can therefore be used to localize more—ideally all—relevant areas in the organ in question, e.g., early malignant and malignant lesions, in situ, without having to take random biopsies of irrelevant tissue, which is stressful for the patient. This results in significantly higher sensitivity.

[0021] The number of tissue samples that ultimately need to be taken and pathologically examined ex situ is greatly reduced with this biopsy system, making diagnosis significantly faster, more patient-friendly, and more cost-effective.

[0022] A further advantage of this biopsy system is that it reduces the risk that the extracted tissue sample, which is examined pathologically as a relevant piece of tissue and determines the subsequent therapeutic approach, is actually taken from the exact site preselected in situ as relevant (highly likely to be early malignant / malignant). In other words, this biopsy system reduces the risk of mishandling the sampling instrumentation (punch, forceps, biopsy needle, etc.).

[0023] Optionally, the introducer sleeve can be more rigid than the distal section of the fluorescence endoscopy element. Preferably, the distal section of the fluorescence endoscopy element can be designed to be considerably thinner than the biopsy element. It can be advantageous if the introducer sleeve is inserted into the body together with the fluorescence endoscopy element, for example percutaneously, and guided in the direction of the tissue to be examined. The introducer sleeve can then stabilize the distal section of the fluorescence endoscopy element, particularly when piercing firm tissue, e.g., skin and muscle. The introducer sleeve can, but does not have to, extend axially into the tissue to be examined. The distal section of the fluorescence endoscopy element can be inserted through softer tissue beyond the distal end of the introducer sleeve into the tissue to be examined.The distal section of the fluorescence endoscopy element should be at least sufficiently rigid that it bends little or not at all when penetrating softer tissue. The length of the introducer sheath can be adjusted to the organ to be examined, or an organ-specific introducer sheath with a specific length can be selected for the examination of a specific organ.

[0024] Alternatively, the fluorescence endoscopy element itself can be relatively rigid; for example, the distal section of the fluorescence endoscopy element can be guided in a thin-walled tube that reinforces the distal section of the fluorescence endoscopy element. The insertion process of the distal section of the fluorescence endoscopy element can then initially take place without the aid of the introducer sheath. However, once the final removal position has been found using the fluorescence endoscopy element, the introducer sheath can be pushed proximally over the distal section of the fluorescence endoscopy element and inserted distally with the distal section of the fluorescence endoscopy element in situ. Once the introducer sheath is finally positioned in situ, the distal section of the fluorescence endoscopy element is withdrawn proximally, leaving the introducer sheath in its final position in situ.Once the distal portion of the fluorescence endoscopy element has been completely withdrawn from the introducer sheath, the biopsy element is guided through the introducer sheath into or onto the tissue to be examined for tissue sampling.

[0025] Optionally, the introducer sleeve can be folded distally over the distal section of the fluorescence endoscopy element on the proximal side. This is particularly advantageous when the fluorescence endoscopy element itself is relatively rigid and does not require the introducer sleeve to stabilize the distal section of the fluorescence endoscopy element during insertion into the tissue. In this case, the insertion of the introducer sleeve can be held back until the final positioning of the fluorescence endoscopy element has been found. For example, an optical component connected proximally to the distal section of the fluorescence endoscopy element can then be disconnected in order to fold or slide the introducer sleeve, which in this case can be even more flexible than the reinforced distal section of the fluorescence endoscopy element, distally over the distal section of the fluorescence endoscopy element on the proximal side.The introducer sheath is then further inserted into the tissue with the distal portion of the fluorescence endoscopy element already inserted, widening the tissue opening. This is a particularly tissue-sparing procedure, allowing a thicker biopsy needle to be inserted into the tissue later through the introducer sheath with the distal portion of the fluorescence endoscopy element retracted.

[0026] According to the invention, the biopsy element has a larger radial extent than the distal section of the fluorescence endoscopy element, and the inner diameter of the insertion sleeve is adjustable to selectively accommodate the distal section of the fluorescence endoscopy element and the biopsy element. This is particularly advantageous because pre-selection of tissue using the fluorescence endoscopy element is less invasive than inserting the biopsy element. During pre-selection, it may happen that no malignant tissue is detected with the fluorescence endoscopy element, and the search must be continued elsewhere. In this case, the comparatively stressful procedure of taking tissue with the biopsy element at an irrelevant location is avoided. Inserting the thinner distal section of the fluorescence endoscopy element at an irrelevant location, in contrast, is more gentle on the patient.

[0027] Optionally, the introducer sleeve can be axially slit and expandable, preferably over its entire length. The introducer sleeve is preferably largely elastically expandable and made of metal, for example. Spreading the introducer sleeve during insertion of the biopsy element is more gentle on the patient than a direct puncture with the biopsy element.

[0028] Optionally, the introducer sleeve for receiving the distal section of the fluorescence endoscopy element can be designed with a circumferential overlap. The overlap is reduced or eliminated when the biopsy element is inserted. This can reduce the risk of tissue entrapment.

[0029] Optionally, the introducer sleeve can have an inner sleeve and an outer sleeve, wherein the inner sleeve can be removed proximally from the outer sleeve to accommodate the biopsy element. Thus, the introducer sleeve can have at least two parts to accommodate the distal section of the fluorescence endoscopy element, namely at least one inner sleeve and one outer sleeve, which can be plugged into one another, detachably from one another, and displaced relative to one another.

[0030] Optionally, the inner sleeve has an inner diameter that essentially corresponds to the outer diameter of the distal section of the fluorescence endoscopy element, and the outer sleeve has an inner diameter that essentially corresponds to the outer diameter of the biopsy element. Strictly speaking, the inner diameter of the inner sleeve is slightly larger than the outer diameter of the distal section of the fluorescence endoscopy element, and the inner diameter of the outer sleeve is slightly larger than the outer diameter of the biopsy element. The inner sleeve can be longer than the outer sleeve if necessary. The outer sleeve only needs to be inserted deep enough to ensure its position in the tissue is stable.If significant fluorescence is detected, the distal section of the fluorescence endoscopy element can be withdrawn from the outer sleeve together with the inner sleeve while maintaining the position of the outer sleeve. The biopsy element can be inserted into the outer sleeve and advanced to the site of the significant fluorescence. Radial expansion of the introducer sleeve is therefore not necessary in the two-part design of the introducer sleeve.

[0031] Optionally, both the fluorescence endoscopy element and the biopsy element can have length markings and / or an axially positionable stop for a defined, reproducible relative axial position of the distal section of the fluorescence endoscopy element or of the biopsy element to the insertion sleeve. For example, the fluorescence endoscopy element and the biopsy element can each have a length scale which indicates the distance to the distal tip of the distal section of the fluorescence endoscopy element on the fluorescence endoscopy element and the distance to the distal tip of the biopsy element on the biopsy element. This then makes it easy to precisely reproduce the axial position relative to the insertion sleeve (i.e., in the longitudinal direction of the insertion sleeve) that the distal section of the fluorescence endoscopy element previously had using the biopsy element. The length markings preferably comprise markings of specific axial positions.For example, the length of the introducer sheath may be specifically indicated so that an operator can see whether and how much the distal end of the distal portion of the fluorescence endoscopy element and / or the biopsy element extends beyond the distal end of the introducer sheath.

[0032] Optionally, the introducer sheath has a flange at one proximal end of the introducer sheath. The flange can prevent handling of the introducer sheath and complete penetration of the skin. The stop can hit the skin when the introducer sheath is inserted and thus determine the maximum penetration depth of the introducer sheath. The length of the introducer sheath is preferably specially selected for an organ to be examined so that at the maximum penetration depth of the introducer sheath, with the proximal stop of the introducer sheath hitting the skin, the distal end of the introducer sheath does not penetrate into the tissue to be examined, but ends proximally before it. The actual puncture into the tissue to be examined is then only carried out with the distal end of the distal section of the fluorescence endoscopy element or the fluorescence endoscopy element protruding beyond the distal end of the introducer sheath.with the distal end of the biopsy element extending beyond the distal end of the introducer sheath.

[0033] Optionally, the fluorescence endoscopy element can be configured to selectively couple a first excitation light and a second excitation light proximally, wherein the first excitation light is, on average, shorter-wavelength than the second excitation light, and wherein the fluorescence endoscopy element is configured to selectively generate a first image or a first fluorescence signal from a first tissue region from first fluorescence light excited by the first excitation light and to record a second image or a second fluorescence signal from a second tissue region from second fluorescence light excited by the second excitation light. Since the penetration depth of the short-wavelength first excitation light can be less than the penetration depth of the longer-wavelength second excitation light, the first tissue region is preferably smaller than the second tissue region.The localization of pathological tissue is thus achieved with a higher spatial resolution using the first excitation light. Since the penetration depth of the longer-wavelength second excitation light can be greater, the detected fluorescence signal can also originate from a correspondingly larger second tissue region. The localization of pathological tissue using the second excitation light is thus achieved with a lower spatial resolution, but a larger volume is captured. Thus, a larger second tissue region can first be preselected more coarsely using the longer-wavelength second excitation light, and then a smaller first tissue region, which is preferably part of the second tissue region, can be examined more closely using the shorter-wavelength first excitation light.

[0034] Optionally, the fluorescence endoscopy element can have an optical component that is detachably coupled or permanently coupled to the distal section of the fluorescence endoscopy element on the proximal side. The optical component has a beam splitter with an image path side and an illumination path side. An image sensor, a photodiode, or the like is detachably coupled or permanently coupled to the image path side for coupling out the fluorescence light. A light source is detachably coupled or permanently coupled to the illumination path side for coupling in the excitation light. The light source is preferably at least one LED or at least one laser output. The beam splitter can, for example, have a pair of prisms that together form a beam splitter block and at least largely separate the excitation light and the fluorescence light from one another, so that the fluorescence light is transmitted or reflected to the image path side.Conversely, the prism pair can reflect or transmit the excitation light to the illumination path side. Preferably, the image path side and the illumination path side of the beam splitter are located on sides of the beam splitter arranged at an angle, preferably of approximately 90°, to each other. Preferably, the image path side is located on the proximal side, so that fluorescent light is essentially transmitted from the distal entrance side of the beam splitter to the image path side. The illumination path side is preferably located on the lateral side, so that excitation light is essentially reflected from the lateral entrance side to the distal exit side.

[0035] It should be noted at this point that the term "image path" here is not limited to generating an image from the coupled fluorescent light. The image path can merely transmit a coupled fluorescent signal, the properties of which are then determined. Coupling fluorescent light using an image sensor, photodiode, or similar device does not necessarily have to be used to generate an image. To decide whether the fluorescent signal is abnormal or not, i.e., whether a biopsy should be taken or not, it is often sufficient to determine only one property of a fluorescent signal, such as its amplitude or intensity. For example, the abnormality can be reflected in a higher or lower fluorescence intensity compared to the surrounding tissue or compared to a reference value.

[0036] Optionally, the optical component can comprise an optical long-pass filter that transmits the fluorescent light more strongly toward the image path side than the excitation light, and / or an optical short-pass filter that reflects the fluorescent light more strongly toward the image path side than the excitation light. For example, the long-pass filter or the short-pass filter can be arranged between a pair of prisms acting as a beam splitter and / or implemented as a layer on one or both of the mutually facing sides of the prisms. This is particularly useful when the excitation light has a shorter wavelength than the fluorescent light.

[0037] Optionally, the fluorescence endoscopy element may comprise an operating unit that is signal-connected or connectable to the image sensor, the photodiode or the like and / or the light source, wherein the operating unit comprises an optical and / or acoustic display component, a control and supply component and an operating component.

[0038] Optionally, the fluorescence endoscopy element or the optical component can be provided with a handle or a comparable ergonomic component so that it can also be used as a handling device for inserting the distal section of the fluorescence endoscopy element into the skin and the underlying tissue. Therefore, such a handling device can be dispensed with as a separate and additional unit, which must be removed again from the distal section of the fluorescence endoscopy element after the light guide has been inserted into the tissue in order to be able to couple the optical component.

[0039] Optionally, the biopsy system can further comprise a template that can be positioned and fixed relative to the body and has at least one opening for selectively receiving the introducer sleeve and the biopsy element. The introducer sleeve and / or the biopsy element are secured in the at least one opening by the template to prevent lateral displacement and tilting. This is particularly useful if the patient's skin at the site to be penetrated is not firm enough to securely fix the introducer sleeve relative to the tissue to be examined. The template can be used alternatively or in addition to the skin to fix the introducer sleeve or the biopsy element.

[0040] Such a template can be a flat or three-dimensional structure that is rigid or at least significantly stiffer than a patient's skin. The template can, for example, be glued or strapped onto the patient's skin and thus fixed relative to the tissue to be examined. Alternatively or additionally, the template can be fixed relative to a reference point, for example on an operating table. The patient can then also be fixed relative to this reference point, for example on the operating table. The template can be specifically designed to fit an organ to be examined, so that the at least one opening allows the operator only one degree of freedom of movement for the distal section of the fluorescence endoscopy element or the biopsy element, namely the puncture depth. The lateral positioning and orientation are determined by the at least one opening in the template.The introducer sleeve then no longer needs to be inserted into the patient's body, but only into the perforation, where it merely serves as a kind of adapter to compensate for the differences in thickness between the distal section of the fluorescence endoscopy element and the biopsy element.

[0041] Optionally, the introducer sleeve can have a first part and a second part, wherein the first part fixes the distal section of the fluorescence endoscopy element in the at least one opening against lateral displacement and tilting, and wherein the second part fixes the biopsy element in the at least one opening against lateral displacement and tilting. The two parts can be designed in the form of an inner and outer sleeve that fit into one another, or they can each fix the distal section of the fluorescence endoscopy element and the biopsy element separately. If the introducer sleeve is designed as a one-piece, the opening itself can take on the function of the second part and have a corresponding guide surface, so that only the first part of the introducer sleeve is required.

[0042] Optionally, the template can have a plurality of perforations, which are optionally available for receiving the introducer sheath and the biopsy element. The template preferably has a grid of perforations so that an operator can search for malignant tissue with the less traumatic fluorescence endoscopy element by selecting the perforation and the selected puncture depth, before using the more traumatic biopsy element. Multiple fluorescence endoscopy elements can also be used simultaneously. Once a site for the biopsy has been identified by a conspicuous fluorescence signal, the operator simply has to reproduce the puncture depth with the biopsy element using length markings. The perforations can be aligned essentially parallel to one another or at an angle to one another. For large organs that may be larger than the template, a parallel alignment can be useful.Especially for organs smaller than the template, such as the prostate, the perforations can be angled to each other so that they point toward the organ from different directions. The template is therefore preferably precisely tailored to the organ or, if necessary, even individually adapted to individual patients or specific patient groups.

[0043] Preferably, a grid dimension, i.e. the spacing of the openings in the template, is adapted to the penetration depth of the fluorescence excitation light. This means that the openings in the template are preferably at most far enough apart that every volume element of the organ to be examined can be reached and recorded with regard to the detection of fluorescence signals. This means that an operator knows that they can capture and pre-examine the entire organ without gaps using fluorescence if they simply use all of the openings. However, this also means that the openings in the template are not placed arbitrarily close to one another in order to minimize both the strain on the patient and the time required for the examination by reducing the number of puncture channels.

[0044] The terms "distal" and "proximal" are used herein to mean a relative position that is distal or proximal, respectively, from an operator of the system as a reference position. The terms "distal" and "proximal" are used herein to mean positions on a distal or proximal side of an object, respectively. The terms "distal" and "proximal" are used herein to mean directions that extend distally or proximally, respectively.

[0045] The disclosure is explained in more detail below with reference to exemplary embodiments illustrated in the drawings. They show: Fig. 1a-c three schematic longitudinal sectional views of a first exemplary embodiment of a biopsy system disclosed herein, each in different phases of use; Fig. 2a-c three further schematic longitudinal sectional views of the first exemplary embodiment of a biopsy system disclosed herein in further phases of use; Fig. 3a-c three schematic longitudinal sectional views of a second exemplary embodiment of a biopsy system disclosed herein, each in different phases of use; Fig. 4a-c three further schematic longitudinal sectional views of the second exemplary embodiment of a biopsy system disclosed herein in further phases of use; Fig. 5a-c schematic cross-sectional representations of the first, second, and third exemplary embodiments of a biopsy system disclosed herein, in different phases of use; Fig. 6a-c , 7a , b , 8a-c and 9schematic longitudinal sectional views of a third exemplary embodiment of a biopsy system disclosed herein in different phases of use; Fig. 10 a schematic longitudinal sectional view of a problem of the first, second and third exemplary embodiments of the biopsy system disclosed herein; Fig. 11 a schematic representation of a fourth exemplary embodiment of a biopsy system disclosed herein for solving the problems described in Fig. 10 shown problem; and Fig. 12a-c , 13a-c , 14a,b and 15 a,b schematic longitudinal sectional views of the fourth exemplary embodiment of a biopsy system disclosed herein in different phases of use; and Fig. 16 a schematic representation of a fluorescence endoscopy element according to an example of a biopsy system disclosed herein,

[0046] Figuren 1a-c show a biopsy system in the first three stages of an application. In an organ 1 in the body of a patient, there is tissue 3 to be examined, which appears conspicuous in an X-ray CT and / or US image, for example, as a shadow. For a more precise diagnosis, a tissue sample is to be taken from the tissue 3 to be examined in order to be able to examine it ex situ pathologically. The biopsy system used here for the tissue sample collection (biopsy) has a distal section 5 of a Fig. 16 shown fluorescence endoscopy element 27, which can be inserted percutaneously through the skin 9 of the patient in the direction of the tissue 3 to be examined by means of an insertion sleeve 7. As in Fig. 1a As shown shortly before the puncture, the distal section 5 can be guided through the introducer sleeve 7 and positioned axially relative to the introducer sleeve 7. The axial position of the distal section 5 can be adjusted and fixed as desired, for example by manual lateral pressure or other clamping (not shown). The distal section 5 has a distal tip 11 which protrudes beyond the distal end of the introducer sleeve 7 during the puncture in order to make the puncture as atraumatic as possible. The introducer sleeve 7 can stabilize the distal section 5 against bending, particularly when passing through healthy, firm skin and / or muscle tissue 9. The handling of the distal section 5 is also facilitated by the introducer sleeve 7 located around the distal section 5. The puncture is preferably carried out in conjunction with a CT or US image so that it can be observed whether the puncture is correctly positioned and aligned.

[0047] In Figur 1b the distal section 5 and the insertion sleeve 7 are already finally positioned. A proximal stop 13 on the insertion sleeve 7 rests against the skin 9 on the outside, so that the insertion sleeve 7 has reached a position of maximum penetration depth. The length of the insertion sleeve 7 is selected such that it does not extend into the organ 3 itself, but ends proximally from it. The insertion sleeve 7 therefore primarily supports the distal section 5 on its way through firm skin tissue 9. The distal section 5, on the other hand, has been pushed further distally in the insertion sleeve 7, so that the distal tip 11 penetrates the organ 1 and the tissue 3 to be examined. As in Fig. 16 Explained in more detail, the distal section 5 is part of the fluorescence endoscopy element 27 of the biopsy system and can have a light guide or a light guide bundle for coupling out excitation light and / or coupling in fluorescence signals, and for optically transmitting the signal. The distal section 5 has a proximal coupling of excitation light into the light guide and, at the distal tip 11, a distal coupling of the excitation light from the light guide. Furthermore, the distal section 5 has, at the distal tip 11, a distal coupling of fluorescence light into the light guide and a proximal coupling of the fluorescence light from the light guide.This means that during the puncture and axial positioning of the distal section 5 relative to the insertion sleeve 7, excitation light can be coupled distally at the distal tip 11, and simultaneously, fluorescent light can be captured proximally via the distal tip 11. The excitation light can have a shorter wavelength than the fluorescent light. Alternatively or in addition to a light guide or light guide bundle, the distal section 5 of the fluorescence endoscopy element 27 can have an LED on the distal side for coupling out the excitation light and, also on the distal side, an image sensor or a photodiode for coupling in the fluorescence signal, and can transmit the fluorescence signal electronically.

[0048] To ensure that malignant tissue 3 can be clearly distinguished from healthy tissue through its fluorescence, a photosensitizer or marker substance can be administered to the patient prior to the biopsy. If necessary, the administration of a photosensitizer or marker substance can be omitted. The fluorescence of endogenous dyes, which are present in varying concentrations depending on the tissue condition (autofluorescence), is then detected. The level of detected fluorescence is also a measure of the tissue condition. The conspicuousness of the fluorescence signal can, for example, be demonstrated by a fluorescence signal that is either amplified or attenuated compared to healthy tissue. Thus, based on the amplitude of the captured fluorescence, it can be determined in situ whether the distal tip 11 is located in malignant tissue 3 or not. It is also possible that tissue 3, which appears as a shadow in the CT or US image, actually shows no abnormality in fluorescence.In this case, a biopsy of tissue 3 would be unnecessary.

[0049] However, if a conspicuous fluorescence signal is detected, the size or axial center of the fluorescent tissue 3 can be determined by axially moving the distal tip 11 by positioning the distal tip 11 so that the received fluorescence signal is maximally conspicuous. An operator can then read or mark the axial position of the distal section 5 relative to the insertion sleeve 7, for example, using a length marking on the distal section 5. The distal section 5 can then be pulled proximally out of the insertion sleeve 7, leaving the insertion sleeve 7 in place.

[0050] In Fig. 1c For the actual biopsy, a biopsy element 15, for example in the form of a hollow biopsy needle, is now attached to the introducer sleeve 7. The biopsy element 15 has a beveled distal end 17 which forms a distal hollow chamber 19 for receiving tissue samples. If the distal end 17 is pierced into tissue and / or this is exfoliated by back and forth movement, a tissue sample remains in the distal hollow chamber 19 and can be removed with the biopsy element 15. For example, the operator can determine from which axial point in the tissue a tissue sample is taken using a distally beveled cylinder which fills the hollow chamber 19 and can be moved back and forth by the operator from the proximal side, thus blocking or releasing the hollow chamber in a controlled manner.The biopsy element 15 described above and its functionality are examples of a possible procedure for tissue sampling. Other forms of tissue sampling, e.g., via laterally placed notches at the distal end of the biopsy element 15, are also possible.

[0051] The insertion sleeve 7 now has the effect that the biopsy element 15 can be positioned precisely at the location where the fluorescence endoscopy element has detected a conspicuous fluorescence signal. It also assists the biopsy element 15 in penetrating the skin tissue 9. The insertion of the biopsy element 15 is thus significantly less traumatic. As shown in the Figuren 5a-c As shown, the biopsy element 15 can be considerably thicker than the distal section 5 in order to obtain a sufficiently large tissue sample for pathological examination. In this case, the introducer sleeve 7 can preferably expand radially to accommodate the biopsy element 15. Radial expansion is less traumatic than direct insertion of the biopsy element 15. The read or marked axial position of the distal section 5 relative to the introducer sleeve 7 can now be reproduced using corresponding length markings on the biopsy element 15.

[0052] In Fig. 2a The reproduced axial position of the biopsy element 15 is shown. The distal end 17 of the biopsy element 15 projects by the same length beyond the distal end of the insertion sleeve into the tissue 3 to be examined in the organ 1. As a result, a tissue sample 21 of the tissue 3 to be examined is captured in the distal hollow chamber 19 as soon as this is released by the operator through a corresponding axial movement of the solid cylinder (not shown) in the hollow chamber 19 in the proximal direction. Fig 2b It is shown how the biopsy element 15 with the tissue sample 21 is withdrawn proximally from the insertion sleeve 7. The removed tissue sample 21 can now be pathologically examined ex situ. Finally, as in Fig. 2c shown, the introducer sleeve 7 is pulled proximally out of the patient's body again.

[0053] In the Fig. 3a-c and Fig. 4a-c In the embodiment shown, the distal section 5 is more rigid than the previously described embodiment, for example, reinforced by a thin-walled tube. As a result, the distal section 5 does not require the insertion sleeve 7 as a puncture aid through the firm skin tissue 9, but is itself rigid enough for this purpose. A coupling and uncoupling handling device 23 can be provided, as here, to ensure the manual handling, positioning, and alignment of the distal section 5. Preferably, an optical component 29 for coupling fluorescent light is integrated into the handling device 23 as part of the fluorescence endoscopy element.

[0054] The insertion sleeve 7 is only used when a final position of the distal section 5 with its distal tip 11 in the center of the tissue 3 to be examined has actually been found and adjusted using the fluorescence signal. The handling device 23 or the optical component 29 can then be decoupled (see Fig. 3b ), so that the insertion sleeve 7 can be pushed from proximal over the distal section 5 (see Fig. 3c ). As soon as the insertion sleeve 7 with the stop 13 is in contact with the skin 3 and is thus finally positioned, the distal section 5 can be pulled out proximally and, as in Figuren 4a-c shown, the actual biopsy is carried out with the biopsy element 15 as described above. The last described procedure, ie the procedure as shown in the Fig. 3a-c and 4a-c shown, has compared to the Fig. 1a-c and 2a-c The procedure described has the advantage that, firstly, conspicuous tissue can be detected more quickly and, secondly, with less stress on the patient (i.e., less traumatic), since the introducer sleeve 7 is not yet inserted for this procedure. This advantage is particularly important when the distal section 5 must be punctured at several different locations in the skin 9 to detect conspicuous fluorescence.

[0055] Fig. 5a-c show three embodiments of the insertion sleeve 7. In the Figuren 5a-c On the left, the insertion sleeve 7 with inserted distal section 5 is shown, and on the right, the insertion sleeve 7 with inserted biopsy element 15. The biopsy element 15 is thicker here than the distal section 5, thus has a larger radial extent. In the embodiments according to Fig. 5a,b The insertion sleeve 7 is radially expandable and slotted. In the first embodiment according to Fig. 5a a slit 25, which extends substantially over the entire length of the introducer sleeve 7, expands when the thicker biopsy element 15 is inserted and contracts elastically when the thinner distal section 5 or nothing is inserted.

[0056] In the Fig. 5b In the second embodiment shown, the insertion sleeve 7 is designed to overlap in the circumferential direction when the thinner distal section 5 or nothing is inserted. The overlap is smaller when the biopsy element 15 is inserted or, as in Fig 5b shown on the right, is no longer present. If the difference in radial dimensions between the distal section 5 and the biopsy element 15 is large enough, it may also be that the insertion sleeve 7 is designed to overlap with the inserted distal section 5, as in Fig. 5b shown on the left and with the biopsy element 15 inserted, widened with the widened slit 25 as in Fig. 5a shown on the right.

[0057] In the Fig. 5c In the third embodiment shown, the insertion sleeve 7 has at least two separate parts, namely an inner sleeve 7a and an outer sleeve 7b, which can be plugged into one another, detachably from one another and displaced relative to one another (see also Fig. 6a-c , 7a , b , 8a-c and 9). As long as the thinner distal section 5 is still inserted into the body, the inner sleeve 7a is also inserted into the outer sleeve 7b in order to guide the distal section 5, i.e. to give it support in the radial direction. In order to insert the thicker biopsy element 15 and create the necessary space in the radial direction, the inner sleeve 7a is pulled proximally out of the outer sleeve 7b, whereby the outer sleeve 7b remains in place. The subsequently inserted, thicker biopsy element 15 is then guided by the outer sleeve 7b, i.e. it receives support from it in the radial direction. The wall thickness of the inner sleeve 7a is designed such that it essentially corresponds to the difference between the outer diameter of the biopsy element 15 and the outer diameter of the distal section 5.

[0058] Preferably, the inner sleeve 7a has a conical end piece 17a distally to enable a largely atraumatic insertion into the tissue. The upper left image of the Fig. 5c shows a longitudinal section through the distal end of the inner sleeve 7a.

[0059] The third embodiment has the advantage over the two previous embodiments that virtually any desired difference in radial dimensions between distal section 5 and biopsy element 15 can be accommodated by simply making the wall thickness of inner sleeve 7a correspondingly thick, i.e., adapting it to the diameter difference, and designing it with a correspondingly pointed and, in this sense, correspondingly atraumatic end piece 17a. In contrast, the expansion of the insertion sleeve 7 in the previous embodiments is restricted due to the limited elasticity of the insertion sleeve 7. This allows the advantage of the biopsy system described here, namely finding and biopsying many lesions with as little tissue damage as possible, to be implemented in the best possible way.With a very thin distal section 5, a thorough and close search for conspicuous fluorescence can be performed, yet patient-friendly, because a very thin distal section 5 causes minimal damage to healthy tissue. Subsequently, with a comparatively thick biopsy element 15, which only needs to be placed at the site of conspicuous fluorescence, a relatively large and thus valuable tissue sample can be obtained for the pathologist.

[0060] The third embodiment has the further advantage over the two previous embodiments that no force has to be applied to widen the insertion sleeve 7 when inserting the biopsy element 15 and also no frictional force has to be overcome when advancing the biopsy element compared to the insertion sleeve 7 present in the previous embodiments.

[0061] As in the second embodiment according to Fig. 3a-c and 4a-c is also in the Fig. 6a-c , 7a , b , 8a-c and 9 In the third embodiment shown, the distal section 5 is stiffened by a thin-walled tube, so that no puncture aid through the solid skin tissue 9 is required. In this third embodiment, too, the optical component 29 is preferably designed such that it performs the tasks of the handling device 23 from the Fig. 3a-c and a separate additional handling device 23 is not required. The insertion sleeve 7, here designed as a double sleeve, consisting of outer sleeve 7b and inner sleeve 7a, is also only used when the final position of the distal section 5 has actually been reached, see Fig. 6c .

[0062] First, both sleeves 7a and 7b are brought into position, ie inserted into the tissue until their stops 13a and 13b are in contact with the skin tissue, see Fig. 7a . Subsequently, the distal section 5 together with the inner sleeve 7a is pulled out of the human body, ie out of the outer sleeve 7b, see Fig. 7b to create access for the thicker biopsy element 15.

[0063] The thicker biopsy element 15 can then be inserted into the lumen thus provided (see Fig. 8a ) to finally take a tissue sample 21 (see Fig. 8b ). The biopsy element 15 is then removed from the body or the outer sleeve 7b together with the tissue sample 21 in order to be taken to the pathologist (see Fig. 8c ). Finally, the outer sleeve 7b is removed (see Fig. 9 ).

[0064] In Fig. 10 A problem is shown that can occur with the three previously described embodiments of the biopsy system. The skin 9 may be so flexible at one point on the patient's body that laterally acting non-axial forces F exert leverage forces on the insertion sleeve 7, which can change the orientation and / or position of the insertion sleeve 7 relative to the tissue 3 to be examined. However, if the insertion sleeve 7 does not maintain the correct orientation and / or position relative to the tissue 3 to be examined, there is a risk that the biopsy element 15 will puncture past the tissue 3 to be examined. This is in Fig. 10 shown.

[0065] Fig. 11 , 12a-c , 13a-c , 14a , b and 15a,b show various versions of a fourth embodiment of the biopsy system, which further comprises a template 28. The template 28 is shown here as a perforated plate with a plurality of apertures 30 distributed in a grid-like manner. The template 28 is preferably rigid, at least significantly stronger than the skin 9 and fixed relative to the body 32 of the patient. For this purpose, it can be glued to the skin 9 and / or, as in Fig. 11 shown, be fixed on an operating table 34 on which the patient's body 32 has a defined position. The template 28 is preferably in direct contact with the skin 9 of the patient's body 32. The template 28 can be positioned via a positioning unit 36, preferably translationally and / or rotationally, in three different spatial directions, i.e., with six degrees of freedom, and can be fixed in a selected position and orientation relative to the operating table 34.

[0066] In Fig. 12a-c It shows how conspicuously fluorescent tissue 3 is found in organ 1 using the fluorescence endoscopy element 27, which has the distal section 5 and an optical component 29 including the handling device 23. The operator is no longer completely free to decide on the insertion position and angle, but rather selects an opening 30 in the template 28 for the insertion of the distal section 5. The selected opening 30 completely determines the insertion position and angle, and the operator only has one degree of freedom of movement with the insertion depth. Since the openings 30 in the template 28 must be large enough to allow the thicker biopsy element 15 to fit through later, the insertion sleeve 7 acts as an adapter between the distal section 5 or biopsy element 15 and the template 28.The introducer sleeve 7 is no longer pierced into the patient's skin 9, which further protects the patient.

[0067] In this variant, the insertion sleeve 7 has two parts, a first part 7c as an adapter between the distal section 5 and the template 28 and a second part 7d (see Fig. 13 a-c ) serves as an adapter between the biopsy element 15 and the template 28. The first introducer sleeve part 7c fixes the distal section 5 laterally in the selected opening 30 in the template 28 and rests against the template 28 with a flange acting as a stop 13c. Closure means such as a bayonet lock or Luer connection can also be provided for a temporary positive and / or force fit between the first introducer sleeve part 7c and the template 28.

[0068] The distal section 5 is as in Fig. 12b shown, through the insertion sleeve part 7c and through the skin 9 into the organ 1 to be examined in order to search for a conspicuous fluorescence 38 at different insertion depths. If a conspicuous fluorescence 38 is found at a insertion depth d (measured at the proximal end of the first insertion sleeve part 7c), the insertion depth d can be read and noted using a length marking on the distal section 5. Alternatively or additionally, a movable marking element can be pushed to the proximal end of the first insertion sleeve part 7c and fixed axially to the distal section 5. Then, as in Fig. 12c shown, the distal section 5 together with the first introducer sleeve part 7c is pulled out of the template 28 proximally.

[0069] The actual biopsy is in Fig. 13a-c shown. The biopsy element 15 is now inserted into the same opening in which the distal section 5 was previously located, with a second insertion sleeve part 7d acting as an adapter between the biopsy element 15 and the template 28. The second insertion sleeve part 7d here has the same outer diameter, adapted to the opening, as the first insertion sleeve part 7c. However, since the biopsy element 15 is thicker than the distal section 5, the inner diameter of the second insertion sleeve part 7d is correspondingly larger than the inner diameter of the first insertion sleeve part 7c. The axial length is the same for the first insertion sleeve part 7c and the second insertion sleeve part 7d. The biopsy element 15 can now be inserted into the organ 1 by the noted insertion depth d in order to take a tissue sample 21 from the tissue 3 to be examined in the area of ​​the conspicuous fluorescence 38.

[0070] A second variant of the fourth embodiment of the biopsy system is shown in Fig. 14a,b shown, where Fig. 14a the localization using the fluorescence endoscopy element 27 and Fig. 14b shows the biopsy using the biopsy element 15. In contrast to the previously described variant according to Fig. 12a-c and 13a-c Here, the two parts of the insertion sleeve 7 are designed as an inner sleeve 7e and an outer sleeve 7f. The outer diameter of the inner sleeve 7e is adapted to the inner diameter of the outer sleeve 7f and to the outer diameter of the biopsy element 15. The inner diameter of the inner sleeve 7e is adapted to the outer diameter of the distal section 5. The outer diameter of the outer sleeve 7f is adapted to the inner diameter of the openings 30 in the template 28. When inserted into one another, the inner sleeve 7e and the outer sleeve 7f function as a suitable adapter between the distal section 5 and the template 28. The outer sleeve 7f alone, when the inner sleeve 7f is pulled out proximally, serves as a suitable adapter between the biopsy element 15 and the template 28.

[0071] A third variant of the fourth embodiment of the biopsy system is shown in Fig. 15a,b shown, where Fig. 15a the localization using the fluorescence endoscopy element 27 and Fig. 15b showing the biopsy using the biopsy element 15. Here, the insertion sleeve 7 is designed as a single piece, or rather, it consists only of an inner sleeve that serves as an adapter between the distal section 5 and the template 28. A separate outer sleeve for guiding the biopsy element 15 is not required here, since the inner diameter of the openings 30 is already adapted to the outer diameter of the biopsy element 15, and the template 28 has a guide element 40 for the biopsy element 15 in a proximal extension around the openings 30. Alternatively, the guide element 40 can be formed by the opening 30 itself, given a certain axial thickness of the template 28.

[0072] If the grid dimension is designed to be sufficiently small with regard to the penetration depth of the fluorescence excitation light, ie if the openings 30 are sufficiently close to one another so that when the distal section 5 is sequentially inserted into the openings 30, each volume element of the organ to be examined is reached with fluorescence excitation light and if, in addition, each opening 30 is actually used over the entire organ depth during an examination, then it is also ensured that each volume element of the organ to be examined has been pre-examined using fluorescence technology, i.e. no volume element has been ignored or forgotten.

[0073] Fig. 16shows the fluorescence endoscopy element 27 in more detail schematically. The fluorescence endoscopy element 27 has the distal section 5, an optical component 29, and an operating unit 31, wherein the optical component 29 preferably assumes the function of a previously described handling device 23. The distal section 5 can be coupled or is permanently coupled to the optical component 29 on the proximal side, whereby a proximal coupling of fluorescent light from the light guide of the distal section 5 into the optical component 29 and a distal coupling of excitation light from the optical component 29 into the light guide is achieved. The distal tip 11 of the distal section 5 can be designed as a transparent needle tip, which serves to couple excitation light out of the light guide and to couple fluorescent light into the light guide.To reinforce the tip 11 and to reduce tissue trauma caused by the penetration of the distal portion 5, the tip 11 may be provided with a spike 33, as shown, which may project beyond the distal needle tip.

[0074] The optical component 29 has a beam splitter 35 in the form of a beam splitter block formed by a pair of prisms. The prisms each lie adjacent to one another with optical interfaces extending at an angle of approximately 45° to the optical axis. A long-pass filter 37 is arranged between, or at least at, or on one of the optical interfaces. This filter essentially transmits longer-wavelength fluorescent light and reflects short-wavelength excitation light. Essentially coaxial with the optical axis, the beam splitter 35 therefore has an image path side on which an image sensor 39, a photodiode, or the like is arranged. Laterally, the beam splitter 35 has an illumination path side on which a light source 41, for example, in the form of an LED or a laser output, is arranged. The long-pass filter 37 reflects the excitation light distally toward the distal section 5.Preferably, the optical component 29 is integrated into a handle or a similar ergonomic component, which can be securely yet releasably locked to the distal section 5, so that it can also assume the tasks / functions of the handling device 23. This makes it possible, firstly, to fluorescence-optically monitor the entire movement process of the distal section 5 in the tissue with a view to searching for pathologically relevant tissue, and secondly, to dispense with the handling device 23 as such and its replacement with the optical component 29.

[0075] The fluorescence endoscopy element 27 is preferably configured to selectively couple a first excitation light and a second excitation light proximally, wherein the first excitation light has, on average, a shorter wavelength than the second excitation light. Furthermore, the fluorescence endoscopy element 27 is preferably configured to selectively generate a first image or a first fluorescence signal from a first tissue region from the first fluorescence light excited by the first excitation light, and to record a second image or a second fluorescence signal from a second tissue region from the second fluorescence light excited by the second excitation light, wherein the first image or the first fluorescence signal originates from a smaller tissue volume than the second image or the second fluorescence signal, but thereby has a higher spatial resolution.

[0076] The operating unit 31 is signal-connected or connectable to the image sensor 39, the photodiode, or the like, and the light source 41 via a cable connection 43. The light source 41 can be controlled via the operating unit 31, and the signals from the image sensor 39, the photodiode, or the like can be received, processed, and visualized by the operating unit 31. For this purpose, the operating unit has an optical and / or acoustic display component 45, a control and supply component 47, and an operating component 49.

[0077] The numbered designations of the components or directions of movement as "first," "second," "third," etc., are chosen purely arbitrarily to distinguish the components or directions of movement from one another and can be used in any way. This does not imply any significance. The designation of a component or technical feature as "first" should not be misunderstood to imply that there must be a second component or technical feature of this type. Furthermore, any process steps can be performed in any order and / or partially or completely overlapping in time, unless explicitly stated otherwise or absolutely necessary.

[0078] Equivalent embodiments of the parameters, components, or functions described herein that would appear obvious to a person skilled in the art in light of this description are intended to be included herein as if explicitly described. Accordingly, the scope of protection is intended to encompass such equivalent embodiments as long as they fall within the scope of claim 1. Features designated as optional, advantageous, preferred, desirable, or similar are to be understood as optional and not as limiting the scope of protection.

[0079] The described embodiments are to be understood as illustrative examples and do not constitute an exhaustive list of possible embodiments. Each feature disclosed in an embodiment may be used alone or in combination with one or more other features, regardless of the embodiment in which the features were described. While at least one embodiment is described and shown herein, modifications and alternative embodiments that would appear obvious to a person skilled in the art in light of this description are intended to be encompassed by the scope of this disclosure, as long as they fall within the scope of claim 1. Furthermore, the term "comprising" herein is not intended to exclude additional other features or method steps, nor is "a" or "an" intended to exclude a plurality. List of reference symbols:

[0080] 1 Organ 3 Tissue to be examined 5 Distal section of the fluorescence endoscopy element 7 Introducer sleeve 7a, f Inner sleeve 7b, e Outer sleeve 7c First introducer sleeve part 7d Second introducer sleeve part 9 Skin / skin tissue 11 Distal tip of the distal section of the fluorescence endoscopy element 13 Stop of the introducer sleeve 13a, e Stop of the inner sleeve 13b, f Stop of the outer sleeve 13c Stop of the first introducer sleeve part 13d Stop of the second introducer sleeve part 15 Biopsy element 17 Distal end of the biopsy element 17a Conical end piece 19 Hollow chamber of the biopsy element 21 Tissue sample 23 Handling device 25 Slit 27 Fluorescence endoscopy element 28 Template 29 Optical component 30Perforations 31Operating unit 32Patient's body 33Mandrel 34Operating table 35Beam splitter 36Positioning unit 37Long-pass filter 38Conspicuous fluorescence 39Image sensor, photodiode, or similar.40Guide element 41Light source 43Cable connection 45Display component 47Control and supply component 49Operating component.

Claims

1. A biopsy system comprising - a fluorescence endoscopy element (27), - a biopsy element (15) for taking, from an organic body, a sample (21) of the tissue (3) to be examined, and - an insertion sleeve (7) for placing a distal end (11, 17) of the fluorescence endoscopy element (27) and of the biopsy element (15) in or on the tissue (3) in the organic body to be examined, wherein the fluorescence endoscopy element (27) has a distal portion (5) where excitation light is distally coupled out and fluorescent light is distally coupled in, wherein the distal portion (5) of the fluorescence endoscopy element (27) can be axially movably positioned relative to the insertion sleeve (7) and can be removed proximally from the insertion sleeve (7), wherein the biopsy element (15) can be placed in or on the tissue (3) in the organic body to be examined through the insertion sleeve (7) when the distal portion (5) of the fluorescence endoscopy element (27) is removed, characterised in that the biopsy element (15) has a larger radial extent than the distal portion (5) of the fluorescence endoscopy element (27) and an inner diameter of the insertion sleeve (7) is adjustable to selectively receive the distal portion (5) of the fluorescence endoscopy element (27) and the biopsy element (15).

2. The biopsy system according to claim 1, wherein the insertion sleeve (7) is more flexurally resistant than the distal portion (5) of the fluorescence endoscopy element (27).

3. The biopsy system according to claim 1 or 2, wherein the insertion sleeve (7) can be drawn proximally in the distal direction over the distal portion (5) of the fluorescence endoscopy element (27).

4. The biopsy system according to any one of the preceding claims, wherein the insertion sleeve (7) is axially slotted and expandable.

5. The biopsy system according to claim 4, wherein the insertion sleeve (7) is designed to receive the distal portion (5) of the fluorescence endoscopy element (27) in an overlapping manner in the circumferential direction, wherein the overlap is smaller or no longer exists when the biopsy element (15) is received.

6. The biopsy system according to any one of claims 3 to 5, wherein the insertion sleeve (7) has an inner sleeve (7a, e) and an outer sleeve (7b, f), wherein the inner sleeve (7a, e) can be removed in the proximal direction from the outer sleeve (7b, f) to receive the biopsy element (15).

7. The biopsy system according to claim 6, wherein the inner sleeve (7a, e) has an inner diameter that corresponds substantially to an outer diameter of the distal portion (5) of the fluorescence endoscopy element (27), and the outer sleeve (7b, f) has an inner diameter that corresponds substantially to an outer diameter of the biopsy element (15).

8. The biopsy system according to any one of the preceding claims, wherein both the distal portion (5) of the fluorescence endoscopy element (27) and the biopsy element (15) have longitudinal markings and / or an axially positionable stop for an axial position of the distal portion (5) or the biopsy element (15) relative to the insertion sleeve (7) that can be reproduced in a defined manner.

9. The biopsy system according to any one of the preceding claims, wherein the fluorescence endoscopy element (27) is set up to couple in proximally a first excitation light and a second excitation light selectively, wherein the first excitation light has shorter waves on average than the second excitation light, and wherein the fluorescence endoscopy element (27) is set up to generate a first fluorescence signal of a first tissue region from first fluorescence light excited with the first excitation light and to receive a second fluorescence signal of a second tissue region from second fluorescence light excited with the second excitation light.

10. The biopsy system (1) according to any one of the preceding claims, wherein the distal portion (5) of the fluorescence endoscopy element (27) has a light guide where excitation light is proximally coupled out and / or fluorescent light is proximally coupled out, wherein the distal end (11, 17) of the fluorescence endoscopy element (27) functions as a means for distally coupling out the excitation light from the light guide and / or as a means for distally coupling in the fluorescence light into the light guide.

11. The biopsy system according to claim 10, wherein the fluorescence endoscopy element (27) has an optical component (29) that can be releasably coupled or is fixedly coupled proximally to the distal portion (5) of the fluorescence endoscopy element (27), wherein the optical component (29) has a beam splitter (35) with an image path side and an illumination path side, wherein an image sensor (39) or a photodiode can be releasably coupled or is fixedly coupled to the image path side to couple out the fluorescence light, and wherein a light source (41) can be releasably coupled or is fixedly coupled to the illumination path side to couple in the excitation light.

12. The biopsy system according to claim 11, wherein the optical component (29) has an optical longpass filter (37), which transmits the fluorescence light more heavily to the image path side than the excitation light, and / or an optical shortpass filter, which reflects the fluorescence light more heavily to the image path side than the excitation light.

13. The biopsy system according to any one of claims 11 or 12, wherein the fluorescence endoscopy element (27) has an operating unit (31) that is connected or connectable to the image sensor (39) or the photodiode and / or the light source (41) for signal exchange, wherein the operating unit (31) has an optical or acoustic display component (45) a control and supply component (47) and an operating component (49).

14. The biopsy system according to any one of the preceding claims, further having a template (28), which can be positioned and can be fixed relative to the organic body and has at least one aperture (30) for selectively receiving the insertion sleeve (7) and the biopsy element (15), wherein the insertion sleeve (7) and / or the biopsy element (15) is fixed in the at least one aperture (30) against lateral displacement and tilting by the template (30).

15. The biopsy system according to claim 14, wherein the insertion sleeve (7) has a first part (7c, f) and a second part (7d, e), wherein the first part (7c, f) fixed the distal portion (5) of the fluorescence endoscopy element (27) in the at least one aperture (30) against lateral displacement and tilting, and wherein the second part (7d, e) fixes the biopsy element (15) in the at least one aperture (30) against lateral displacement and tilting.

16. The biopsy system according to claim 14 or 15, wherein the template (28) has a multiplicity of apertures (30), which are available selectively for receiving the insertion sleeve (7) and the biopsy element (15).

17. The biopsy element (1) according to any one of the preceding claims, wherein the distal portion (7) of the fluorescence endoscopy element (27) has distally an LED for coupling out excitation light and / or distally an image sensor or a photodiode for coupling in fluorescence light.