Biopsy

What is a biopsy for?

• When a scan or x-ray has been requested, this may sometimes show a suspicious area, such as a lump or a growth, Sometimes an examination itself can show a lump or growth. It is often not possible to tell exactly what the diagnosis is by looking at the scan results and sometimes not possible by examination. A biopsy may be necessary to make an accurate diagnosis - this is where aa tiny part of the growth is removed to be looked at under a microscope. A specialist pathologist assesses the cells in the biopsy sample and makes a diagnosis. In this way, biopsies are useful to diagnose cancer but they are also used to diagnose non-cancerous conditions.

• Biopsies are also used in non-cancerous conditions to help make the diagnosis and to guide what treatment should be used.

• Sometimes a condition may already have been diagnosed but a biopsy can help to assess how the severity. For example, a biopsy may be used to assess the severity of inflammation in an organ such as the liver.

There are many different procedures to obtain biopsy samples, depending on which part of the body is being biopsied. Here are some examples:

A 'punch' biopsy

This is useful to diagnose skin conditions. A special instrument punches a small hole through the top layers of the skin to remove a sample of skin. To make the procedure painless, some local anaesthetic may be injected into the area beforehand.

A 'needle' biopsy

This can be used to take samples of tissue from organs or lumps beneath the skin. For example, a long needle can be inserted through the skin into the kidney, liver, thyroid, bone marrow or abnormal lumps in order to obtain biopsies.

A local anaesthetic will usually be injected into the skin using a fine needle first. This is to make the procedure relatively painless. In some cases, the biopsy might be taken whilst having an ultrasound scan or magnetic resonance imaging (MRI) scan. This is to ensure the needle is going into exactly the right area.

See also the separate leaflets called Liver Biopsy.

Endoscopic biopsy

An endoscope is a thin flexible telescope which is used to look into parts of the body such as the stomach, colon, bladder or womb (uterus). A biopsy of tissue is commonly taken during these procedures. One example is a gastroscopy, when an endoscope is passed through the mouth and into the stomach and a biopsy of the stomach lining may be taken.

Excisional biopsy

During an excisional biopsy, the entire abnormal growth is removed and all of it is examined under a microscope. This may be done under a local or general anaesthetic, depending on the site of the lump. For example, this type of biopsy may be done for certain breast lumps.

Perioperative biopsy

Sometimes, during an operation, a surgeon may remove a small sample of tissue which can be examined within a few minutes. This may enable a surgeon to decide how much tissue needs to be removed during the operation. A peri-operative biopsy would be discussed ahead of time.

Taking a biopsy with a needle is very quick and may only take a few seconds. However it is important to ensure that the right section is removed in the biopsy and it can take a longer time to prepare for this, either by perfect positioning or by arranging a scan. This can take half an hour or more.

Prostate biopsy

• There is more than one way to do a prostate biopsy: a urologist will advise you on which will be used.

• One way is to use an ultrasound probe inside the back passage so that, on a screen, the doctor can see the prostate gland. A tiny needle is then inserted into the prostate gland to take a biopsy. This procedure is usually performed whilst awake, although pain relief can be used if needed.

• On other occasions, several biopsies will be taken of the prostate through the skin and this is usually done under a general anaesthetic.

• Read more about diagnosing prostate cancer in the separate leaflet called Prostate Cancer.

Breast biopsy

• A biopsy of a breast lump is often done using a small needle and an ultrasound scan to confirm that the needle is in the right place. Local anaesthetic will usually be injected into the skin first to numb the area.

• Sometimes a small vacuum device is attached to the needle to remove the tissue. This is known as a vacuum assisted biopsy.

• Read more about diagnosing breast cancer in the separate leaflet called Breast Cancer.

Endometrial biopsy

• The endometrium is the lining of the womb and it cannot be accessed through the skin. It has to be looked at or biopsied from the inside of the womb.

• A hysteroscopy (using a thin tube and camera to look inside the womb) is passed through the vagina and cervix. A small needle is sometimes used to take a biopsy of the lining of the womb; at other times, a small amount of the endometrium is removed using a syringe.

• See the separate leaflet called hysteroscopy.

Once the biopsy is taken it needs to be prepared with chemicals and 'set' in a microscope slide. A specialist doctor (a histopathologist) then looks at it under a microscope and writes a detailed report. The report is then sent back to the doctor who originally ordered or performed the biopsy. The results can then be given to the patient. The time this takes varies from hospital to hospital but is usually a few weeks; it tends to be faster if cancerous cells are being looked for and slower if cancerous cells are not expected. Some results will be sent via letter from the hospital; on other occasions the results will be explained during a hospital appointment.