Biopsy

Introduction

A biopsy is a medical procedure that involves taking a small sample of tissue so that it can be examined under a microscope.

A tissue sample can be taken from almost anywhere on, or in, your body, including the skin, stomach, kidneys, liver and lungs.

The term biopsy is often used to refer to both the act of taking the sample and the tissue sample itself.

What is a biopsy used for?

Biopsies are used to identify abnormal cells and to help diagnose many different health conditions or to find out a specific type or cause of a disease. In cases where a condition has been diagnosed, a biopsy can be used to measure how severe it is or what stage it’s at.

For example, a biopsy can often help to diagnose or rule out:

Cancer
Peptic ulcers – ulcers that affect the digestive system
Hepatitis – inflammation of the liver
Kidney disease
Endometriosis – where cells that usually line the womb are found elsewhere in the body

Biopsies are commonly used to check whether a breast lump is non-cancerous (benign) or cancerous (malignant).

Types of biopsy

There are various types of biopsy that can be used to help identify a wide range of health conditions. Types of biopsy include:

Scraping cells – removing cells from the surface layer of tissue, such as from the inside of the mouth, or from inside the cervix (neck of the womb) as part of a cervical screening test
A punch biopsy – is for diagnosing skin conditions by using a special instrument to punch a small hole in the skin to obtain a skin sample
A needle biopsy – a special hollow needle, guided by ultrasound, is used to obtain tissue from an organ or from tissue beneath the skin
An endoscopic biopsy – an endoscope is used to take a tissue sample, such as from the stomach during a gastroscopy (a diagnostic procedure of the stomach or upper gastrointestinal tract)
An excisional biopsy – surgery is used to take a larger section of tissue
Perioperative biopsy – if consent is given, a perioperative biopsy can be performed during surgery; the sample will be tested within minutes so that the surgeon can be given the diagnoses and progress with appropriate treatment

How a biopsy is carried out will depend on where the tissue sample is being taken from.

After the tissue sample has been taken, the tissue will be closely examined under a microscope to see whether it appears abnormal. If it does, the pathologist examining the sample will try to identify the nature of the problem. This often means that a definite diagnosis is made.

The tissue may also be tested using various chemicals to see how it responds and to find out what it contains. The type of tests that are used will depend on the medical conditions being investigated.

Recovery

Most biopsies will only require local anaesthetic, which means that you won’t need to stay in hospital overnight. However, a general anaesthetic may be needed for surgery, in which case you may have to stay in hospital overnight.

You shouldn’t usually feel pain after having most types of biopsy, although this depends on where from your body the biopsy is taken; you may feel a dull ache. This can be treated with painkillers on the advice of Dr. B C Shah.

Some types of biopsy may involve staying in hospital for a few hours or having stitches or a dressing applied before you leave.

Getting your results

How quickly you get the results of a biopsy will depend on the urgency of your case and the hospital where you had the procedure.

If a serious condition is suspected, your results may be available within a few days. However, this is difficult to predict because there may be further tests needed after the first examination of the sample. A cervical smear test result usually takes 10 to 14 days.

A different processing method is used when a biopsy is performed during surgery. This means that a result is often available within minutes, which enables the appropriate treatment to be given while the surgery is in progress.

Dr. B C Shah or practice nurse will give you your results and explain what they mean. Sometimes, a biopsy won’t be conclusive, which means that it hasn’t produced a definitive result. If this is the case, the biopsy may need to be repeated or you may need to have other tests to double-check your diagnosis.

Why a biopsy is necessary

Biopsies are often used to investigate the cause of a person’s symptoms or to confirm a diagnosis.

A biopsy can also measure how severe a condition is for example, how severely an organ, such as the liver, is inflamed.

Biopsies are used to diagnose a wide range of health-related conditions, including cancer. If you have a lump or growth on your skin or inside your body, it’s impossible to tell whether it is cancerous (malignant) or non-cancerous (benign) just by looking at it or feeling it. A biopsy can provide that information.

Testing a tissue sample

After a tissue sample has been taken, it will be sent to a laboratory so that it can be examined under a microscope and the tissue’s cells can be tested.

Cells are the building blocks that make up your body. By closely examining them, scientists can see whether they’re normal or abnormal. Cancerous cells, for example, look and behave differently from normal cells.

As well as looking at the tissue sample, chemical or genetic tests can also be carried out. For example, a chemical test is sometimes used to help diagnose cystic fibrosis. A chemical reaction will occur if the gene for cystic fibrosis is present in the tissue cells.

Chorionic villus sampling

Tests for cystic fibrosis and other genetic conditions can even be carried out on a cell sample that’s taken from an unborn baby. The cell sample is taken from the placenta using a pre-natal biopsy called chorionic villus sampling (CVS).

During CVS, a small piece of the placenta is removed using a fine needle that’s passed through the abdomen and guided by ultrasound.

It usually takes 10 to 14 days for CVS test results to become available. The results can help parents decide whether they wish to terminate a pregnancy or continue with it.

How a biopsy is performed

There are many different ways of getting a tissue sample. The method used will depend on the type of tissue being collected and where in the body it’s being taken from.

Scraping cells

In some cases, scraping cells from the surface layer of tissue, such as inside the mouth, is enough to provide a suitable sample for examination. This type of ‘scraping biopsy’ can be slightly uncomfortable but it’s not painful, so anaesthetic isn’t required.

A cervical screening test is a procedure in which a spatula, or small brush-like instrument, is used to gently remove a sample of cells from the neck of a woman’s womb (cervix). The cells are examined under a microscope for any abnormal changes (dysplasia).

If the cells display abnormal changes, it may mean that they’re cancerous or that there’s an increased risk that they will become cancerous.

Punch biopsy

A punch biopsy can often help to investigate skin conditions, such as deep spots and sores. During a punch biopsy, a special surgical instrument is used to make a small hole in your skin and remove samples of the top tissue layers. If you have a punch biopsy, you are usually given a local anaesthetic to numb the area.

Alternatively, a scalpel (a sharp medical knife) may be used to remove a small amount of surface skin. The wound will be closed using stitches. As with a punch biopsy, a local anaesthetic will be used for this procedure.

Needle biopsy

A fine-needle aspiration (FNA) biopsy is often used to take tissue samples from organs or from lumps that are below the surface of the skin. When a larger sample is needed, a core needle biopsy (CNB) may be used instead.

To obtain the sample, a special, hollow needle is inserted through your skin and into the area being examined. Ultrasoundor X-rays will be used to help the doctor or surgeon guide the needle to exactly the right place.

When the needle is in position, it will ‘suck out’ a sample of tissue. If you have a needle biopsy, a local anaesthetic will usually be used to numb the area so that you won’t feel any pain or discomfort.

Breast lumps

A needle biopsy can be used in most cases to get more information about a breast lump. The needle is inserted into the lump and a sample of tissue is taken for testing. A core needle biopsy (CNB) is often used to gain a larger sample of tissue. In some cases a fine needle aspiration (FNA) biopsy may be used to drain a cyst.

Organs

A thicker, hollow needle is used for taking biopsies of organs, such as the liver or kidneys. You will be asked to breathe in and hold your breath while the needle is inserted into your abdomen. It takes a few seconds for a small sample of tissue to be taken. A local anaesthetic will usually be used for this type of biopsy because you need to be awake to breathe in.

Bone marrow

A thick needle is also used to take samples of bone marrow (the soft, jelly-like tissue that’s found in the hollow centre of all large bones). Bone marrow biopsies are carried out for different reasons, including:

To find out why you have a low or high number of red blood cells (anaemia)
To find out why you have a low or high number of white blood cells (leucopenia)
To find out why you have a low or high number of platelets (blood-clotting cells)

A number of different health conditions may be responsible for these types of blood abnormalities, such as leukaemia (cancer of the bone marrow and white blood cells).

Samples of bone marrow are also sometimes taken to check how well treatment for leukaemia is working, or to tell how far certain types of cancer have progressed (what stage it’s at).

Bone marrow biopsies are usually taken from the top of the pelvis bone, just below your waist. You will usually have a local anaesthetic to numb the area, and may also be given a sedative (medication) to help you relax and cope with any discomfort, nerves or anxiety.

Endoscopic biopsy

An endoscope is a medical instrument that’s used to look inside your body. It’s a thin, flexible tube that has a light and a camera at one end. Tiny cutting tools can also be attached to the end of an endoscope to allow the surgeon to take a tissue sample.

An endoscope can be inserted through your throat, back passage (anus) or through small cuts made by the surgeon.

Depending on the area of the body being investigated and the entry point of the endoscope, either local or general anaesthetic may be used.

Excisional biopsy

An excisional biopsy is where surgery is used to remove a larger area of tissue, such as a lump, for closer examination.

Depending on where in the body the lump is located, an excisional biopsy may be performed under either a local or a general anaesthetic.

Perioperative biopsy

Sometimes, a biopsy is performed during surgery that is being carried out for another, unrelated reason. A tissue sample is taken during surgery and is checked immediately so that the surgeon gets the results quickly and can decide how to progress with treatment.

A lump that’s found during surgery may be removed completely if the patient is still under anaesthetic and has previously given their consent (approval).

Recovering from a biopsy

Biopsies are usually straightforward and carried out as outpatient procedures using local anaesthetic. In such cases, you won’t need to stay in hospital overnight.

However, some types of biopsy, such as those that involve taking a tissue sample from an internal organ, will require a general anaesthetic, which means you may need to stay in hospital overnight.

After having a biopsy, you won’t usually feel any pain. However, if you’ve had a tissue sample taken from a major organ, such as your liver or from your bone marrow, you may feel a dull ache or a slight discomfort. Your doctor or surgeon will be able to advise you about the painkillers that you can take to help relieve this.

If an incision (cut) is required to remove a tissue sample – e.g. during an endoscopic biopsy or an excisional biopsy – the wound may need to be closed using stitches, or a dressing may need to be put on the wound.

If tissue is removed from an internal organ such as your liver or kidneys, you’ll need to stay in hospital for a few hours after the procedure. This is so that you can rest and hospital staff can ensure that there’s no internal bleeding. It’s rare for serious bleeding to occur following a biopsy but if it does, you may need to have an operation or a blood transfusion.

Women who have had samples taken from their reproductive system, such as the lining of the neck of the womb (cervix), may have some light vaginal bleeding for a short while. Men who have had a prostate biopsy may have blood in their urine temporarily.