What Is Biopsy?

Biopsy is a medical test that involves removal of tissue in order to examine it for disease. The tissue samples may be taken from any part of the body. There are several types of biopsies. Some biopsies involve removing a small amount of tissue with a needle while others involve surgically removing an entire lump or suspected tumor. Biopsies may also be performed using imaging guidance such as ultrasound, x-ray, computed tomography (CT), or magnetic resonance imaging (MRI).

A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist involving extraction of sample cells or tissues for examination to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is removed, the Procedure is called an excisional biopsy.

An incisional biopsy or core biopsy samples a portion of the abnormal tissue without attempting to remove the entire lesion or tumor. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy. Biopsies are most commonly performed for insight into possible cancerous and inflammatory conditions.

A biopsy is a procedure to remove a piece of tissue or a sample of cells from your body so that it can be analyzed in a laboratory. If you’re experiencing certain signs and symptoms or if your Doctor has identified an area of concern, you may undergo a biopsy to determine whether you have cancer or some other condition.

While imaging tests, such as X-rays, are helpful in detecting masses or areas of abnormality, they alone can’t differentiate cancerous cells from noncancerous cells. For the majority of cancers, the only way to make a definitive diagnosis is to perform a biopsy to collect cells for closer examination.

Here’s a look at the various types of biopsy procedures used to make a cancer diagnosis.

Uses

We cannot visualize the organs or tissues inside of our body, but a biopsy helps in making a diagnosis by providing a piece of tissue for examination. Biopsies are often associated with cancer, but they can be used to diagnose other conditions and to see how far a disease has progressed. They often help rule out cancer.

Conditions where a biopsy can play a role include:

• Cancer: If the patient has a lump or swelling somewhere in the body with no apparent cause, the only way to determine whether it is cancerous or not is through a biopsy.
• Peptic ulcer: A biopsy can help a doctor determine whether there is ulceration caused by non-steroidal anti-inflammatory drugs (NSAIDs). A small bowel biopsy may be used to assess patients with malabsorption, anemia, or celiac disease.
• Diagnosis of liver disease This can help the doctor diagnose tumors, or cancer, in the liver. It can be used to diagnosis cirrhosis, or liver fibrosis, when the liver is completely scarred from a previous injury or disease, such as long-term alcohol abuse or hepatitis. It can also be used to assess how well the patient is responding to treatment, for, for example, in the case of hepatitis.
• Infection: A needle biopsy can help identify whether there is an infection, and what type of organism is causing it.
• Inflammation: By examining the cells in, for example, a needle biopsy, the doctor may be able to determine what is causing the inflammation.

Sometimes, biopsies are done on transplanted organs to determine whether the body is rejecting the organ, or whether a disease that made a transplant necessary in the first place has come back.

If there is a lump or tumor, this may be removed at the same time, as part of the biopsy procedure.

How does the procedure work?

The type of procedure used to perform the biopsy depends on the location of the tissue that needs to be examined.

Most areas of the body can be biopsied with a needle device. This is the least invasive option, and usually allows for the patient to return home the same day. Imaging guidance with x-ray, ultrasound, CT or MRI allows for accurate placement of the needle to locate the best place to take a tissue sample.

In hard to reach places, biopsies using surgery in a hospital operating room may sometimes be necessary. A surgeon will perform surgery to remove the tissue needed for the biopsy. The surgeon may use an instrument with a camera to help locate the best place to biopsy and remove the tissue sample.

Using imaging guidance, the physician inserts the needle through the skin, advances it into the lesion.

Tissue samples will then be removed using one of several methods.

• In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
• In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with ‘cores’ of tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated several times.
• In a vacuum-assisted biopsy, the needle is placed into the site of abnormality. The vacuum device is activated, pulling the tissue into the needle trough, and then cutting it with the sheath. The tissue is then retracted through the hollow core of the needle. This procedure may be repeated several times.

What are the benefits vs. risks?

• Needle biopsy is a reliable method of obtaining tissue samples that can help diagnose whether a nodule is benign (non-cancerous) or malignant.
• A needle biopsy is less invasive than open and closed surgical biopsies, both of which involve a larger incision in the skin and local or general anesthesia.
• Generally, the procedure is not painful and the results are as accurate as when a tissue sample is removed surgically.
• Recovery time is brief and patients can soon resume their usual activities.
• Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.

Generally a biopsy procedure is safe and causes minimal injury. Complications that may result from biopsies include:

• Bleeding
• Infection
• Accidental injury to adjacent structures such as the bowel during abdominal biopsy or lung parenchyma during renal biopsy

Types of biopsies

Image-guided biopsy.

Some types of biopsies can be image guided. Your doctor may use an image-guided approach when he or she cannot feel a tumor or when the area is deeper inside the body but appears on an imaging scan. During this procedure, your doctor guides a needle to the location with the help of an imaging technique. Your doctor can do an image-guided biopsy using a fine needle, core, or vacuum-assisted biopsy (see below). This depends on the amount of tissue needed, possible diagnoses, and other factors. The type of imaging your doctor uses depends on the location and other factors. He or she may use one of the following imaging scans:

• Ultrasound
• Fluoroscopy
• Computed tomography (CT) scan
• X-ray
• Magnetic resonance imaging (MRI) scan

Fine needle aspiration biopsy.

During this minimally invasive biopsy, the doctor uses a very thin, hollow needle attached to a syringe. He or she collects a small amount of tissue from the suspicious area to examine and test further. Your doctor may use this biopsy for a mass that can be felt through the skin or use it with image-guided biopsy (see below).

Core needle biopsy.

A core needle biopsy uses a larger needle to remove a larger sample of tissue. This type of biopsy is similar to a fine needle biopsy and is also minimally invasive.

Vacuum-assisted biopsy.

This type of biopsy uses a suction device to collect a tissue sample through a specially designed needle. Your doctor can collect multiple or large samples from the same biopsy site with this method. A vacuum-assisted biopsy can sometimes be image guided.

Excisional biopsy.

During an excisional biopsy, your doctor removes the entire suspicious area. This type of biopsy is common for suspicious changes on the skin. Doctors also sometimes use it for a small, easily removable lump under the skin. However, fine needle aspiration or a core biopsy are more common for lumps that cannot be seen or felt through the skin.

Shave biopsy.

For this type of biopsy, the doctor uses a sharp tool to remove tissue from the skin surface.

Punch biopsy.

During a punch biopsy, the doctor inserts a sharp, circular tool into the skin to take a sample from below the surface of the skin.

Endoscopic biopsy.

An endoscope is a thin, lighted, flexible tube with a camera. Doctors use endoscopes to view the inside of the body, including the bladder, abdomen, joints, or gastrointestinal (GI) tract. They insert endoscopes into the body through the mouth or through a tiny surgical incision. The attached camera helps the doctor see any abnormal areas. Doctors also use it to take tiny samples of the tissue using forceps. The forceps are also a part of the endoscope. Find out more about the different endoscopic techniques.

Laparoscopic biopsy. 

This type of biopsy is used for the abdomen. Similar to an endoscopic biopsy, the doctor inserts a thin tube with a video camera called a laparoscope into the abdomen through a tiny incision. The camera helps the doctor see any abnormal areas. Then, doctors can insert a small needle and take a tissue sample.

Bone marrow aspiration and biopsy. 

These two procedures are similar. Doctors often do them at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy removes a small amount of solid tissue using a needle. Doctors use these procedures to find out if a person has a blood disorder or blood cancer. Blood cancers include leukemia, lymphoma, or multiple myeloma.

A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The doctor usually numbs the skin in that area with medication beforehand. Other types of medication to block the awareness of pain, or anesthesia, may be used. Learn more about what to expect during a bone marrow biopsy.

Liquid biopsy.

This minimally invasive procedure can test a blood sample for cancer. During a liquid biopsy, a health care professional collects a routine sample of blood, which is then analyzed in a specific way. Compared to a tissue biopsy, a liquid biopsy has less risks to patients, and doctors can easily perform it multiple times. It may also allow doctors to check the progress of a tumor and see how well a treatment is working. This type of biopsy is still new, and more research is being done to learn about its uses. For now, this type of biopsy is not used for most people with cancer.

Bone marrow biopsy

Your doctor may recommend a bone marrow biopsy if an abnormality is detected in your blood or if your doctor suspects cancer has originated in or traveled to your bone marrow.

Bone marrow is the spongy material inside some of your larger bones where blood cells are produced. Analyzing a sample of bone marrow may reveal what’s causing your blood problem.

Bone marrow biopsy is commonly used to diagnose a variety of blood problems — both noncancerous and cancerous — including blood cancers, such as leukemia, lymphoma and multiple myeloma. A bone marrow biopsy may also detect cancers that started elsewhere and traveled to the bone marrow.

During a bone marrow biopsy, your doctor draws a sample of bone marrow out of the back of your hipbone using a long needle. In some cases, your doctor may biopsy marrow from other bones in your body. You receive a local anesthetic before a bone marrow biopsy in order to minimize discomfort during the procedure.

Endoscopic biopsy

During endoscopy, your doctor uses a thin, flexible tube (endoscope) with a light on the end to see structures inside your body. Special tools are passed through the tube to take a small sample of tissue to be analyzed.

What type of endoscopic biopsy you undergo depends on where the suspicious area is located. Tubes used in an endoscopic biopsy can be inserted through your mouth, rectum, urinary tract or a small incision in your skin. Examples of endoscopic biopsy procedures include cystoscopy to collect tissue from inside your bladder, bronchoscopy to get tissue from inside your lung and colonoscopy to collect tissue from inside your colon.

Depending on the type of endoscopic biopsy you undergo, you may receive a sedative or anesthetic before the procedure.

Needle biopsy

During a needle biopsy, your doctor uses a special needle to extract cells from a suspicious area.

A needle biopsy is often used on tumors that your doctor can feel through your skin, such as suspicious breast lumps and enlarged lymph nodes. When combined with an imaging procedure, such as X-ray, needle biopsy can be used to collect cells from a suspicious area that can’t be felt through the skin.

Needle biopsy procedures include:

• Fine-needle aspiration. During fine-needle aspiration, a long, thin needle is inserted into the suspicious area. A syringe is used to draw out fluid and cells for analysis.
• Core needle biopsy. A larger needle with a cutting tip is used during core needle biopsy to draw a column of tissue out of a suspicious area.
• Vacuum-assisted biopsy. During vacuum-assisted biopsy, a suction device increases the amount of fluid and cells that is extracted through the needle. This can reduce the number of times the needle must be inserted to collect an adequate sample.
• Image-guided biopsy. Image-guided biopsy combines an imaging procedure — such as X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) or ultrasound — with a needle biopsy.

Image-guided biopsy allows your doctor to access suspicious areas that can’t be felt through the skin, such as abnormalities on the liver, lung or prostate. Using real-time images, your doctor can make sure the needle reaches the correct spot.

You’ll receive a local anesthetic to numb the area being biopsied in order to minimize the pain.

Skin biopsy

A skin (cutaneous) biopsy removes cells from the surface of your body. A skin biopsy is used most often to diagnose skin conditions, including melanoma and other cancers. What type of skin biopsy you undergo will depend on the type of cancer suspected and the extent of the suspicious cells. Skin biopsy procedures include:

• Shave biopsy. During a shave biopsy, the doctor uses a tool similar to a razor to scrape the surface of your skin.
• Punch biopsy. During a punch biopsy, the doctor uses a circular tool to remove a small section of your skin’s deeper layers.
• Incisional biopsy. During an incisional biopsy, the doctor uses a scalpel to remove a small area of skin. Whether you receive stitches to close the biopsy site depends on the amount of skin removed.
• Excisional biopsy. During an excisional biopsy, the doctor removes an entire lump or an entire area of abnormal skin. You’ll likely receive stitches to close the biopsy site.

You receive a local anesthetic to numb the biopsy site before the procedure.

Surgical biopsy

If the cells in question can’t be accessed with other biopsy procedures or if other biopsy results have been inconclusive, your doctor may recommend a surgical biopsy.

During a surgical biopsy, a surgeon makes an incision in your skin to access the suspicious area of cells. Examples of surgical biopsy procedures include surgery to remove a breast lump for a possible breast cancer diagnosis and surgery to remove a lymph node for a possible lymphoma diagnosis.

Surgical biopsy procedures can be used to remove part of an abnormal area of cells (incisional biopsy). Or surgical biopsy may be used to remove an entire area of abnormal cells (excisional biopsy).

You may receive local anesthetics to numb the area of the biopsy. Some surgical biopsy procedures require general anesthetics to make you unconscious during the procedure. You may also be required to stay in the hospital for observation after the procedure.

Biopsy analysis and results

After your doctor obtains a tissue sample, it’s sent to a laboratory for analysis. The sample may be chemically treated or frozen and sliced into very thin sections. The sections are placed on glass slides, stained to enhance contrast and studied under a microscope.

The results help your doctor determine whether the cells are cancerous. If the cells are cancerous, the biopsy results can tell your doctor where the cancer originated — the type of cancer.

A biopsy also helps your doctor determine how aggressive your cancer is — the cancer’s grade. The grade is sometimes expressed as a number on a scale of 1 to 4 and is determined by how cancer cells look under the microscope.

Low-grade (grade 1) cancers are generally the least aggressive and high-grade (grade 4) cancers are generally the most aggressive. This information may help guide treatment options. Other special tests on the cancer cells also can help to guide treatment choices.

In certain cases, such as during surgery, a pathologist examines the sample of cells immediately and results are available to your surgeon within minutes. But in most cases, the results of your biopsy are available in a few days. Some samples may need more time to be analyzed. Ask your doctor how long to expect to wait for your biopsy results.

What to expect

In most cases, a biopsy is an outpatient procedure, and the patient may go home immediately or very soon after it is completed.

A biopsy can often be done in an outpatients’ clinic.

Preparation depends on the type of biopsy. For a fine needle biopsy that is done in the doctor’s office, there will be no special preparation.

The patient will need to sign a consent form to say they agree to the procedure, and they may have to wear a gown instead of their own clothes.

In some cases, the patient should not eat or drink beforehand, and they should check with the doctor whether or not they should take their usual medications or supplements.

Sometimes, a local anesthetic will be used, with or without a medication to aid relaxation during the process.

If a sample is to be taken from an internal organ, the patient may need a general anesthetic and may have to stay in hospital overnight. Otherwise, a local anesthetic may be used.

Scraping a tissue sample from, for example, the inside of the mouth usually requires no anesthesia, but the area may feel sore for a while.

Sometimes, an incision needs to be stitched and a dressing may be necessary.

A patient who has a sample taken from a major organ, such as the liver or kidneys, may have to rest in hospital for a few hours before they can go home.

After a sample is taken from the womb lining or cervix, there may be slight vaginal bleeding.

Getting ready for a biopsy

Preparation for a biopsy depends on the type of biopsy you will have. For example, there is little preparation for a fine needle biopsy performed in a doctor’s office. In some cases, you will need to remove your clothing and wear a gown.

Before your biopsy:

• Ask your doctor or nurse whether you can eat or drink anything before the biopsy procedure.
• Also ask if you should take your regular medications that day. For certain biopsies, your doctor will want to know if you are taking blood thinners or aspirin. Tell your doctor about all medications and supplements you are taking.
• Tell your doctor about any drug allergies or other medical conditions you may have.
• A member of your health care team will explain the procedure to you.
• You will be asked to sign a consent form that states you understand the benefits and risks of the biopsy and agree to have the test done.
• Talk with your doctor about any concerns you may have.

During the procedure

Depending on the part of your body the doctor will biopsy, you may lay on your stomach or back or sit up during the procedure. For some types of biopsies, you may need to hold your breath while a biopsy needle is inserted or remain still. Your health care team will let you know ahead of time what to expect during the procedure.

Before the procedure, you will usually receive a type of anesthesia to block the awareness of pain. The type of anesthesia the doctor uses depends on the type of procedure and where in the body the biopsy is needed. The following types of anesthesia may be used:

• Local anesthesia is an injection that numbs the area where a procedure is being done. You may feel some stinging pain when the doctor injects a local anesthetic by needle to numb the area.
• Conscious sedation or monitored anesthesia care uses medication to relax you. It is usually given through an intravenous (IV) tube and is often combined with a local or regional anesthesia.
• General anesthesia makes you unconscious during a major procedure, such as surgery. If you receive a general anesthetic, you will not be aware of the procedure.

After the procedure

Your recovery period depends on the type of biopsy:

• The least invasive procedures require no recovery time. You may be able to go back to your normal activities immediately after the procedure.
• More invasive procedures may require a longer recovery time.
• If you receive sedation as part of the anesthesia, you will usually need someone to drive you home after the procedure.

After a biopsy, talk with your doctor or nurse about taking care of the biopsy area. Also, be aware of the potential complications from the procedure. Contact your doctor’s office if you experience infection, severe pain, fever, or bleeding.

Getting your results

The amount of time it will take for you to receive the results of the biopsy depends on how many tests are needed on the sample to make a diagnosis. Based on this analysis, a pathologist determines whether the tissue removed contains a tumor and what type it is.

A tumor can be benign or malignant:

• A benign tumor is not cancerous.
• A malignant tumor is cancerous and can possibly spread to other parts of the body.

A result can often be given within 2 to 3 days after the biopsy. A result that requires a more complicated analysis can take 7 to 10 days. Ask your doctor how you will receive the biopsy results and who will explain them to you.

FAQ

• Why do you recommend I have a biopsy?
• What are the risks of not having the test?
• When will I learn the results of the biopsy? How will I receive the information? Who will explain the results to me?
• What will happen during the biopsy?
• Who will perform the biopsy?
• How long will the procedure take?
• Will I receive local or general anesthesia?
• Will it be painful?
• Is there a risk of infection, bleeding, or other side effects after the biopsy?
• Will the biopsy leave a scar on my body?
• Will the biopsy be performed in the clinic or in the hospital? If in the hospital, will I need to stay

• How do I need to prepare for the biopsy? Are there any restrictions on what I may eat or drink the day before?
• What specific care, if any, is required for the biopsy site after the procedure?

in the hospital after the biopsy?

• Will I need to avoid any activities after the biopsy? If yes, for how long?
• Will I need to have someone drive me home afterward?
• Will I need to undergo any additional tests or procedures?