Biopsy - What to Expect

A biopsy is a medical procedure that is almost always required to make a definitive cancer diagnosis; it provides the most accurate analysis of tissue. Often, doctors will recommend a biopsy after a physical examination or imaging study, such as an x-ray, has identified a tumor. During the biopsy, a doctor removes a sample of tissue, which is then specially processed and examined under a microscope by a pathologist. The pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) will determine if the sample is benign or cancerous.

About the procedure

Because tissue samples can be taken from skin, areas just below the skin, or internal organs, a biopsy can be a simple procedure performed in a doctor's office, as an outpatient surgical procedure, or invasive surgery requiring hospitalization.

Types of biopsies include:

• Fine needle aspiration biopsy. A fine needle biopsy may be the first type of biopsy done on tumors that can be felt by the doctor. The doctor uses a very thin, hollow needle in a syringe to gather a small amount of fluid and cells from the suspicious area.
• Core needle biopsy. The size of the syringe needle used in a core needle biopsy is larger than the one in a fine needle biopsy, so that a cylinder of tissue can be obtained. If a fine needle biopsy cannot provide a definitive diagnosis, the doctor may want to do a core needle biopsy. Core biopsies are often performed instead of fine needle aspiration biopsies because they provide more tissue to review.
• Vacuum-assisted biopsy. Vacuum pressure (suction) is used to pull the sample tissue through a specially designed hollow needle in this biopsy method. This gives the doctor the ability to collect multiple or larger samples from the same biopsy site without having to insert the needle more than once.
• Image-guided biopsy. An image-guided biopsy is a procedure in which the doctor uses imaging technology, such as ultrasound, fluoroscopy, CT scan, x-ray, or MRI scan, to determine the exact location from which the tissue sample will be removed for analysis. A needle is used to obtain a sample of the tissue from the site; the needle type used may be a fine needle, core needle, or vacuum-assisted needle. An image-guided biopsy may be used when a tumor appears on an imaging scan, such as an x-ray, but cannot be felt by the doctor, or when the area is located deeper inside the body. The type of imaging technology used depends on the location of the biopsy site and other factors.
• Surgical biopsy. Unlike the needle methods described above, in a surgical biopsy, a surgeon makes an incision in the skin and removes some or all of the suspicious tissue. It is often used after a needle biopsy shows cancer cells, or it can be used as the first method to obtain tissue for diagnosis. There are two main categories of surgical biopsies:
• Incisional biopsy removes a piece of the suspicious area for examination. An incisional biopsy may be used for soft tissue tumors, such as those arising from muscle or fat, to distinguish between benign lumps and cancerous tumors called sarcomas.
• Excisional biopsy removes the entire lump. An excisional biopsy, which was more common prior to the development of fine needle aspiration, may be used for enlarged lymph nodes or breast lumps or in situations where the lump is small enough to be easily completely removed in one procedure.
• Endoscopic biopsy. Endoscopes are tubes with cameras that doctors use to view the inside of body, including the bladder, abdomen, joints, or gastrointestinal (GI) tract. Endoscopes can be inserted through the mouth or a tiny surgical incision. Using an endoscope, the doctor can see any abnormal areas and pinch off tiny samples of the tissue using forceps that are part of the endoscope. Many common medical procedures, such as a cystoscopy to examine the bladder and colonoscopy to examine the colon, use endoscopic techniques.
• Bone marrow biopsy. The doctor uses a large, rigid needle to go through a bone, often the back of the hip bone, and into the marrow in order to gather a sample. A core biopsy of the bone may also be performed at the same time. A bone marrow biopsy is used to determine if a person has a blood disorder or a blood cancer, including leukemia and multiple myeloma. It can also be used to find out if a cancer that originated in another part of the body has spread to the bone marrow.

The medical team

Because there are different types of biopsies, members of the medical team involved in the procedures may vary. Most incisional and excisional biopsies are performed by surgeons. Less invasive biopsies, such as fine needle aspirations and endoscopic biopsies, can be performed by a surgeon, radiologist (a doctor who diagnoses diseases by obtaining and interpreting medical images), oncologist (a doctor who specializes in cancer), gastroenterologist (a doctor who specializes in the function and disorders of the gastrointestinal tract, including stomach, intestines, and associated organs), pathologist, or other specialist.

Questions to ask your doctor

Before having a biopsy, consider asking your doctor the following questions:

• What will happen during the biopsy?
• Who will perform the biopsy, and who else will be in the room?
• How long will the procedure take?
• Will it be painful?
• Will I be given general or local anesthesia?
• Is there a risk of infection, bleeding, or other adverse effects after the biopsy?
• What are the risks of not having the test?
• Will the biopsy have a cosmetic effect on my body?
• Will I need to stay in the hospital after the biopsy?
• Will I need to avoid any activities after the biopsy?
• Will I need to have someone drive me home after the biopsy?
• When will I learn the results of the biopsy? How will they be communicated to me?
• What further tests will be necessary if the results are positive (indicates cancer)? What if they are negative?

Preparing for the procedure

Preparation for a biopsy depends on the type of biopsy you will have. A fine needle biopsy, for example, may be performed in a doctor's office. An incisional or excisional biopsy, which involves surgery, will require more extensive preparations. Depending on the type of biopsy you will need to take off all or most of your clothing. You will be given a gown to wear during the biopsy.  Review with your doctor or nurse what you should or should not eat or drink before your biopsy, and whether you should take your regular medications that day. In addition, tell your doctor about all medications you are taking, as well as any drug allergies or other medical conditions you have.

You will have the procedure explained to you by your doctor or nurse. 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 have about the biopsy.

During the procedure

Depending on the part of your body where the biopsy will be performed, you may be lying on your stomach or your back, or sitting up, for the procedure. You may be asked to hold your breath while a biopsy needle is inserted. You will need to be still for the duration of the procedure.

You may feel some amount of pain or discomfort during a biopsy, including slight, stinging pain when a local anesthetic is injected by needle, pressure and dull pain where the biopsy needle is inserted, discomfort from lying still for an extended period of time, and soreness at the biopsy site. If a general anesthetic is used, you will feel minimal pain during the procedure because you will be asleep.

After the procedure

Your recovery period will depend on the type of biopsy performed. The least invasive procedures require no recovery; after the procedure, you will be able to resume your normal activities. If you have a surgical biopsy, you will be observed for a variable period after the procedure to be sure that you are fully awake and you may need to stay in the hospital to recover.

Following a biopsy, be aware of any symptoms that indicate a complication from the procedure. Severe pain, fever, or bleeding are signs that you should be seen by your doctor or nurse. Talk with your doctor or nurse about taking care of the area where the biopsy was performed.