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Biopsy

Overview

In some cases, your doctor may decide that he or she needs a sample of your tissue or your cells to help diagnose an illness or identify a cancer. The removal of tissue or cells for analysis is called a biopsy.

While a biopsy may sound scary, it’s important to remember that most are entirely pain-free and low-risk procedures. Depending on your situation, a piece of skin, tissue, organ, or suspected tumor will be surgically removed and sent to a lab for testing.

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Purpose

Why a biopsy is done

If you have been experiencing symptoms normally associated with cancer, and your doctor has located an area of concern, he or she may order a biopsy to help determine if that area is cancerous.

A biopsy is the only sure way to diagnosis most cancers. Imaging tests like CT scans and X-rays can help identify areas of concerns, but they can’t differentiate between cancerous and noncancerous cells.

Biopsies are typically associated with cancer, but just because your doctor orders a biopsy, it doesn’t mean that you have cancer. Doctors use biopsies to test whether abnormalities in your body are caused by cancer or by other conditions.

For example, if a woman has a lump in her breast, an imaging test would confirm the lump, but a biopsy is the only way to determine whether it’s breast cancer or another noncancerous condition, such as polycystic fibrosis.

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Types

Types of biopsies

There are several different kinds of biopsies. Your doctor will choose the type to use based on your condition and the area of your body that needs closer review.

Whatever the type, you’ll be given local anesthesia to numb the area where the incision is made.

Bone marrow biopsy

Inside some of your larger bones, like the hip or the femur in your leg, blood cells are produced in a spongy material called marrow.

If your doctor suspects that there are problems with your blood, you may undergo a bone marrow biopsy. This test can single out both cancerous and noncancerous conditions like leukemia, anemia, infection, or lymphoma. The test is also used to check if cancer cells from another part of the body have spread to your bones.

Bone marrow is most easily accessed using a long needle inserted into your hipbone. This may be done in a hospital or doctor’s office. The insides of your bones cannot be numbed, so some people feel a dull pain during this procedure. Others, however, only feel an initial sharp pain as the local anesthetic is injected.

Endoscopic biopsy

Endoscopic biopsies are used to reach tissue inside the body in order to gather samples from places like the bladder, colon, or lung.

During this procedure, your doctor uses a flexible thin tube called an endoscope. The endoscope has a tiny camera and a light at the end. A video monitor allows your doctor to view the images. Small surgical tools are also inserted into the endoscope. Using the video, your doctor can guide these to collect a sample.

The endoscope can be inserted through a small incision in your body, or through any opening in the body, including the mouth, nose, rectum, or urethra. Endoscopies normally take anywhere from five to 20 minutes.

This procedure can be done in a hospital or in a doctor’s office. Afterward, you might feel mildly uncomfortable, or have bloating, gas, or a sore throat. These will all pass in time, but if you are concerned, you should contact your doctor.

Needle biopsies

Needle biopsies are used to collect skin samples, or for any tissue that is easily accessible under the skin. The different types of needle biopsies include the following:

  • Core needle biopsies use medium-sized needle to extract a column of tissue, in the same way that core samples are taken from the earth.
  • Fine needle biopsies use a thin needle that is attached to a syringe, allowing fluids and cells to be drawn out.
  • Image-guided biopsies are guided with imaging procedures — such as X-ray or CT scans — so your doctor can access specific areas, such as the lung, liver, or other organs.
  • Vacuum-assisted biopsies use suction from a vacuum to collect cells.

Skin biopsy

If you have a rash or lesion on your skin which is suspicious for a certain condition, does not respond to therapy prescribed by your doctor, or the cause of which is unknown, your doctor may perform or order a biopsy of the involved area of skin. This can be done by using local anesthesia and removing a small piece of the area with a razor blade, a scalpel, or a small, circular blade called a “punch.” The specimen will be sent to the lab to look for evidence of conditions such as infection, cancer, and inflammation of the skin structures or blood vessels.

Surgical biopsy

Sometimes a patient may have an area of concern that cannot be safely or effectively reached using the methods described above or the results of other biopsy specimens have been negative. An example would be a tumor in the abdomen near the aorta. In this case, a surgeon may need to get a specimen using a laparoscope or by making a traditional incision.

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Risks

The risks of a biopsy

Any medical procedure that involves breaking the skin carries the risk of infection or bleeding. However, as the incision is small, especially in needle biopsies, the risk is much lower.

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Preparation

How to prepare for a biopsy

Biopsies may require some preparation on the part of the patient such as bowel prep, clear liquid diet, or nothing by mouth. Your doctor will instruct you on what to do before the procedure.

As always before a medical procedure, tell your doctor what medications and supplements you take. You may need to stop taking certain drugs before a biopsy, such as aspirin or nonsteroidal anti-inflammatory medications.

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Follow-up

Following up after a biopsy

After the tissue sample is taken, your doctors will need to analyze it. In some cases, this analysis can be done at the time of procedure. More often, however, the sample will need to be sent to a laboratory for testing. The results can take anywhere from a few days to a few weeks.

Once the results arrive, your doctor may call you to share the results, or ask you to come in for a follow-up appointment to discuss the next steps.

If the results showed signs of cancer, your doctor should be able to tell the cancer’s type and level of aggression from your biopsy. If your biopsy was done for a reason other than cancer, the lab report should be able to guide your doctor in diagnosing and treating that condition.

If the results are negative but the doctor’s suspicion is still high either for cancer or other conditions, you may need another biopsy or a different type of biopsy. Your doctor will be able to guide you as to the best course to take. If you have any questions about the biopsy prior to the procedure or about the results, don’t hesitate to talk with your doctor. You may want to write down your questions and bring them with you to your next office visit.

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