Biopsies

Written by: 
Dr Paola Accalai

This page covers:

What is a biopsy?

A biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is a small sample of tissue that is taken from the body for examination under a microscope, to diagnose or evaluate a variety of conditions. The word biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is also used for the procedure of obtaining this sample, hence 'having a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.'.

The procedure involved, as well as the preparation and after-effects, may be very different according to the part of the body being biopsied

Why are biopsies taken?

Biopsies may be used to determine whether or not a condition is present, or to assess the severity of a known condition. While the word is most often associated with cancer, it can in fact give valuable information in a wide variety of conditions, including:

  • Inflammation of the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. (hepatitis)
  • Inflammation of the kidneys (glomerulonephritis)
  • Inflammatory bowel disease
  • A disorder of the muscleTissue made up of cells that can contract to bring about movement. of the heart known as cardiomyopathy.

What does having a biopsy involve?

In most cases, having a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. does not involve an overnight stay in hospital - an outpatient visit is usually sufficient. However, if the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. needs to be taken under general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body., an overnight hospital stay will probably be needed. Biopsies can be taken from almost any part of the body. The procedure involved, as well as the preparation and after-effects, may be very different according to the part of the body being biopsied. If an incision is made, a small number of stitches may be necessary.

Careful assessment is important before a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. can be taken. For example, it is important to check that bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clotting is normal in order to minimise risk of bleeding from the procedure. Sometimes antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. are given to lower any risk of infectionInvasion by organisms that may be harmful, for example bacteria or parasites..

The particular site of the body can involve specific considerations. For example, an endometrial biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is a sample of tissue taken from the lining of the uterus. This should not be done in women who are pregnant or those who have an infectionInvasion by organisms that may be harmful, for example bacteria or parasites. of the cervixAny neck-like structure; most commonly refers to the neck of the uterus. (the neck of the uterus) or vagina.

It is important to note that biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. results do not always give a definite answer and further tests may be needed, or even a repeat biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.

Types of biopsy

There are a number of different procedures that can be used to obtain a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. depending on which part of the body the tissue sample is being taken from. Different types of biopsies include:

Needle biopsy

Needle biopsies are usually performed under local anaestheticA medication that reduces sensation in a part of the body.. A needle is inserted beneath the skin to take a small sample from a lump, or from an organ such as the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. or kidneys. Often, this type of biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is performed with the guidance of a scan such as ultrasound or X-ray to help guide the physician to the precise area under evaluation.

Needle biopsies are named according to the type of needle used. So fine needle aspiration is a type of needle biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. that uses a thin, hollow needle, whereas a thicker needle is used in needle core biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.. The first type is often used to assess breast lumps, while the second may be used to take samples from, for example, the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats. or bone marrowTissue within the bones where blood cells are formed..

As well as being used to assess whether lumps in the breast might be cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body., needle biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. can also give valuable information for people who have already been diagnosed with breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. Ultrasound-guided biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. can be used to see whether the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. has spread to the lymph nodesSmall swellings along the lymphatic system that filter lymph, a fluid derived from the blood, and produce antibodies and a type of white blood cells, lymphocytes. in these patients, and so help determine further treatment.

Endoscopic biopsy

The upper gastrointestinal tractThe gut, which begins at the mouth and ends at the anus. can be examined by passing a long, flexible tube with a camera at the end of it (endoscope) through the mouth, down the oesophagusThe gullet, the part of the gastrointestinal system that extends down from the mouth cavity to the stomach. and into the stomach (gastroscopy). Similarly, an endoscope can passed up via the anusThe external opening of the back passage, the rectum. to examine the colonThe large intestine. (colonoscopyExamination of the colon and rectum with a colonoscope, an imaging instrument that is inserted through the anus.), or down the airways to examine the lungs (bronchoscopy). These procedures also enable a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. to be taken of the area under examination; endoscopic biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.. One example is a jejunal biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself., taken from the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus.. This is the standard method of diagnosing coeliac diseaseSensitivity of the lining of the intestine to the protein gliadin, resulting in poor intestinal absorption with stunted growth., a condition that causes malabsorption.

Excisional biopsy

An excisional biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is the removal of an entire lump for examination. This is usually to diagnose or exclude cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.; however, an abnormal lump will not always be cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body.. For example, it may be a benign tumourAn abnormal swelling that is not cancerous; in other words, it does not invade local tissues or spread to distant parts of the body., which remains localised, or some other cause such as an abscessInfection resulting in a collection of pus walled off by inflamed tissues. - a walled off infectionInvasion by organisms that may be harmful, for example bacteria or parasites. - or a cyst.

A special procedure called sentinel lymph node biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. is increasingly used to assess the possibility of spread to the lymph nodesSmall swellings along the lymphatic system that filter lymph, a fluid derived from the blood, and produce antibodies and a type of white blood cells, lymphocytes. in certain types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., especially breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. or malignantDescribes a tumour resulting from uncontrolled cell division that can invade other tissues and may spread to distant parts of the body. melanoma. It involves injecting a radioactive substance followed, a few hours later, by a blue dye. The surgeon can then identify on a scanner the first lymph node most likely to be involved in any spread of the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., so that it can be removed for examination. This avoids removing large numbers of lymph nodesSmall swellings along the lymphatic system that filter lymph, a fluid derived from the blood, and produce antibodies and a type of white blood cells, lymphocytes., and so reduces potential side-effects.

See Cancer - an overview

Punch biopsy

This type of biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. can be helpful in diagnosing conditions of the skin. Under local anaestheticA medication that reduces sensation in a part of the body., a small hole is punched through the top layers of the skin to remove a tiny sample of skin cells.

Some biopsies may be followed by a dull ache, most notably when they are taken from a major organ such as the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats.

After-effects and complications

While biopsies are usually straightforward, simple procedures, there are some possible after-effects. These may be specific to the site of the biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.. For example, biopsies of the uterus or cervixAny neck-like structure; most commonly refers to the neck of the uterus. may be followed by light vaginal bleeding in women; a small degree of bleeding in such instances is normal. Similarly, men who undergo prostate biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. may find that their urine contains a small amount of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. afterwards. Cramping pains are common both during and after endometrial biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself..

Some biopsies may be followed by a dull ache, most notably when they are taken from a major organ such as the liverA large abdominal organ that has many important roles including the production of bile and clotting factors, detoxification, and the metabolism of proteins, carbohydrates and fats.. Painkillers can help to ease this discomfort.

Serious bleeding following a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. may occur in rare instances. Biopsies may also be a source of infectionInvasion by organisms that may be harmful, for example bacteria or parasites.; antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. can help to reduce this risk. Concerns have been raised that  taking a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. of a cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. tumour could occasionally spread the cells along the path of the needle. This risk is thought to be very small, however.

Getting the results

How long it takes to get the results of a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. varies depending on where the test is done, local procedures and the urgency of the case. It may be a matter of days or could be several weeks. If an abnormal lump in the body is discovered during the course of a surgical procedure, a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. may be taken and examined in the laboratory while the surgery is still in process, so that the surgeon can use the results to plan the course of the remainder of the operation.

It is important to note that biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. results do not always give a definite answer and further tests may be needed, or even a repeat biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself.. Furthermore, biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. results are not always 100% accurate, although most are highly reliable.

Waiting for the results of a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. can be a nerveBundle of fibres that carries information in the form of electrical impulses.-wracking experience, particularly if a diagnosisThe process of determining which condition a patient may have. of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is a possibility. Finding ways to cope with anxiety can be important during this difficult time.

See also Cancer - an overview