Biopsy

Your doctor may recommend a biopsy after seeing or feeling a suspicious lump, mass, or other area on or inside your body. A careful examination of the tissue or individual cells in the sample is necessary to know for sure if disease is present and, if so, the specific type of disease. A biopsy is a common diagnostic tool for cancer, but doctors also use them for other conditions, especially challenging skin conditions. Determining the specific cause of infection or source of inflammation in the body are two examples.

Sometimes, the results from routine screening procedures, such as mammograms, colonoscopies, or imaging tests like X-rays or CT scans may raise concern and a biopsy is ordered. You may or may not have other signs or symptoms.

Other times, a biopsy is ordered because of distinct symptoms. For example, for a persistent cough, unexplained weight loss, and trouble breathing, a doctor might order a chest X-ray or lung scan to see if there are any suspicious lesions in the lungs. The doctor would order a lung biopsy if the imaging tests reveal a spot or lesion, and may also test a sample of mucus or sputum from the airways.

Scans or X-rays can identify abnormal masses, but until the cells within the mass are carefully examined in the lab, there’s no way to determine whether the mass is benign or malignant.

When cancer cells are present, a biopsy can help your doctor figure out its precise identity and how serious or aggressive your cancer is. A pathologist examines the cells under a microscope and assesses if the tissue is noncancerous, precancerous, or malignant (invasive). In general, cells from lower grade tumors more closely resemble normal (noncancerous) cells than cells from higher grade tumors. Low grade tumors typically grow slower as well. Another test of the biopsied material can examine the DNA, or genetic makeup, of the specific diagnosis. The results of genetic studies provide powerful information to your physicians. Test results often help determine the treatment you will be offered.

The healthcare professional who does your biopsy depends on which type of biopsy you are getting. If you have a skin lesion or suspicious mole, a dermatologist performs the biopsy. Other kinds of doctors who perform biopsies include gynecologists, urologists, gastroenterologists, oncologists, radiologists, and primary care providers. General surgeons perform surgical biopsies (and other types of biopsies), which can remove all or part of a piece of tissue for further testing.

Your primary doctor may refer you to a specialist for a biopsy. Or, you may seek a specialist yourself. In either case, a special type of doctor called a pathologist analyzes the sample and looks at the cells under a microscope. The pathologist shares the results and any treatment recommendations with your specialist or primary healthcare provider.

How a biopsy is performed depends on the type of biopsy you have.

Needle biopsies involve removing tissue or fluid samples from muscles, bones or organs. Types of needle biopsies include:

• Fine needle aspiration biopsy with a thin needle to extract a cell sample

• Core needle biopsy with a larger needle to extract a small cylinder or core of tissue

• Image-guided biopsy with MRI, X-ray, or other type of imaging to carefully guide the needle to the suspicious area

Prostate biopsy and breast biopsy are commonly performed with a needle. A lung biopsy may also be performed with a needle. Or, needles can be used to take samples of fluid from bone marrow (usually in the hip) to test for blood cancer. Doctors perform needle biopsies under local anesthesia. There is a brief recovery time and minimal pain. Ice and over-the-counter pain relievers will help ease any pain or soreness.

Testing a sample of a suspicious-looking mole or other lesion can help rule out skin cancer or identify other possible causes of your skin symptoms. Skin biopsies include shave biopsy in which tissue is scraped from the top layers of skin using a razor-like tool, and punch biopsy, where a circular tool takes a sample of tissue from below the surface of the skin. Usually, doctors use a local anesthetic to numb the area first. Most take about 15 minutes, including any necessary sutures and bandages.

These biopsies can be incisional or excisional, depending on the size of the sample. Talk with your doctor beforehand about your anesthesia options because both local anesthesia and general anesthesia may be options. Some take place in the office or outpatient department, while others are more extensive and may require you to stay in the hospital. Recovery times vary; more invasive procedures involve a longer recovery time.

These biopsies use flexible tubes to take samples of tissue from your mouth, throat, lungs, rectum, urinary tract, or through a small skin incision. The doctor then uses tools threaded inside the tubes to snip tissue samples. Cystoscopy, bronchoscopy, upper GI endoscopy, gastroscopy, and colonoscopy for a colon biopsy are all endoscopic procedures. In most cases, you will receive either a sedative or general anesthetic beforehand. Recovery time is at least 24 hours if you had general anesthesia.

In most cases, the doctor performing the biopsy sends the sample to a pathology lab. These results can take several days or longer. Sometimes, the lab tests the sample immediately. This is the case during surgery; if a surgeon is removing a mass that turns out to be cancerous, she may want to excise it and the surrounding tissue during the biopsy. If it’s benign (not cancer), the surgeon may take a different approach.

Biopsies vary, but in general, this is what happens the day of your procedure: 

Your doctor’s nurse or a member of the preoperative team may ask you to put on a hospital gown and remove jewelry or other items that could interfere with the procedure.

• A nurse or assistant will measure your vital signs—blood pressure, temperature and pulse.

• If necessary, they will start an intravenous (IV) line in your hand or arm in preparation for sedation.

• You may have an X-ray or scan to help the doctor determine precisely where to biopsy.

• You may receive a local anesthetic, usually through injection; this may burn or sting briefly.

• If you are having surgery under general anesthesia, you’ll go to the operating room.

• The doctor takes the tissue or fluid sample.

• With local anesthesia, the part of your body being biopsied will be numb, but you may feel pressure as the doctor excises the tissue.

• The doctor closes the wound, using sutures if necessary. With a local or IV sedation, you may be sent home as soon as your vital signs are stable.

• With general anesthesia and more invasive surgical biopsies, your nurse will monitor you during recovery and take you to a hospital room when your breathing, blood pressure, and pulse stabilize.

• Your nurse will give you post-biopsy care instructions to follow once you’re home.

Biopsy risks and complications vary depending on the type of biopsy, type of anesthesia, and your general health. Any time general anesthesia is administered, there are certain risks, such as breathing problems. However, the risk of complications is very low. Surgical procedures also carry of risk of bleeding.

Other risks of surgery include:

• Adverse reaction to anesthesia

• Blood clot, in particular a deep vein thrombosis developing in your leg or pelvis and traveling to your lungs, where it could result in pulmonary embolism.

• Infection

The vast majority of biopsies proceed without incident, but potential complications can happen. These include:  

• Excessive bleeding, bruising and/or pain at the site of the incision or needle insertion

• Localized infection at the biopsy site

• Collapsed lung (pneumothorax), which can occur during lung biopsy

• Scarring at the biopsy site

You can reduce your risk of complications by:

• Following recommendations before your surgery and during recovery concerning what to eat or drink, what medications to take, and what type of activity is safe

• Provide a list of all medications you are taking including prescriptions, over-the-counter drugs, and herbal pills, teas, oils or other supplements; blood thinners like Coumadin and aspirin are especially important to notify your care team about beforehand

• Telling all members of your care team if you have allergies to medications, latex, iodine, tape, anesthetics or other substances

• Notifying your doctor immediately about any problems after the procedure, such as bleeding, fever, or increase in pain

What you should do before your biopsy varies, with some biopsies requiring different preparation than others. In general:

• Meet with your doctor beforehand to go over instructions.

• If you are having surgery under anesthesia, follow restrictions on food and drink in the hours before the procedure.

• If you are having a biopsy via colonoscopy, follow prep instructions to clean out your bowel.

• Stop taking blood thinners—including aspirin—in the days preceding the biopsy. Your doctor will give you precise instructions.

• Make arrangements ahead of time for transportation to and from the biopsy facility, which may be your doctor’s office or treatment room, a surgical center, or a hospital.

• If you are going home following IV sedation or general anesthesia, arrange to have someone stay with you the rest of the day or night and help with chores and other care.

Before you have a biopsy, you want to fully prepare for the procedure and be sure it’s in your best interest. Your doctor is the best source of information. Start with these questions:

• What type of biopsy do you think I need and why?

• What exactly will you do?

• How long will it take?

• Will I be awake or asleep during the biopsy?

• Will I need someone to take me home after the biopsy?

• When will the biopsy results come back? What are the possible results? Will you notify me or do I need to call?

A successful recovery can depend on planning and preparation. Knowing what is likely to happen is one of the best ways to plan ahead.

If you had a minor procedure, such as fine needle aspiration, you should be ready to resume normal activities right away or up to 24 hours afterward. The more invasive the procedure, the longer the time to recover will be. If your biopsy involved sedation or general anesthesia, you could be back to work after 24 hours. This could be longer if you have a physically demanding occupation. Wound healing can take from a few weeks to two months.

For many biopsies, over-the-counter pain medicines, such as acetaminophen (Tylenol) are sufficient to block the pain at the biopsy site. Ice packs also help reduce pain as well as swelling. Prescription pain relievers may be necessary for larger incisions or extensive biopsies. Talk with your doctor’s office for what they recommend for your pain management.

Before your biopsy, you should have a follow-up appointment scheduled plus a plan for how to find out your biopsy results. However, while recovering from your biopsy, call doctor right away or seek immediate medical care if you have:

• Fever

• Chills

• Pain at the biopsy site that worsens or that medication doesn’t help

• Swelling, redness or drainage at the biopsy site

• Bleeding that doesn’t stop with pressure or bandaging

• Inability to pass urine (especially after a prostate biopsy or other biopsy involving the genitourinary tract)

• Shortness of breath

• Chest pain

• Difficulty breathing or pain with breathing

• Coughing up blood

If your biopsy is benign (no sign of disease), you may not need any further treatment. If the biopsy results are positive for cancer or other pathology, you will likely need additional treatment. It’s important to have good communication with your doctor and care team to help you know what your options are and how best to plan for your future health.