What are biopsies?

A biopsy is the removal of tissue in order to examine it for disease. The tissue samples can be taken from any part of the body. Biopsies are performed in several different ways. Some biopsies involve removing a small amount of tissue with a needle while others involve surgically removing an entire lump, or nodule, that is suspicious.

Often, the tissue is removed by placing a needle through the skin (percutaneously) to the area of abnormality. Biopsies can be safely performed with imaging guidance such as ultrasound, x-ray, computed tomography (CT), or magnetic resonance imaging (MRI). These types of imaging are used to determine exactly where to place the needle and perform the biopsy.

What are some common uses of the procedure?

When a nodule is detected, imaging tests may be performed to help determine if it is benign (non-cancerous) or malignant (cancerous). If imaging studies cannot clearly define the abnormality, a biopsy may be necessary.

Usually, a biopsy is performed to examine tissue for disease. Biopsies are frequently used to diagnose cancer, but they can help identify other conditions such as infections and autoimmune disorders. They may also be done to match organ tissue before a transplant.

Biopsies are performed in many areas of the body and for many reasons. The following is a list of common biopsy types and why they may be necessary:

·         Abdominal biopsy is used to diagnose whether a lump in the abdomen is cancerous or benign. The lumps can be located in the fat, deep within the abdomen. A sample of the lump is removed percutaneously under image guidance (ultrasound or CT), or surgically using a laparoscope or by open surgery.

·         Bone biopsy is used to diagnose cancer or infection in the bones. This type of biopsy can be performed through the skin (percutaneously) with a needle or surgically.

·         Bone marrow biopsy is used to diagnose cancer in the blood, such as leukemia. A small sample of the bone and bone marrow are removed using a needle. Sometimes, only the bone marrow is removed for examination.

·         Breast biopsy is used to determine if a lump in the breast is cancerous or benign. It can be performed a number of ways:

- Stereotactic (Mammographically-guided)

- Ultrasound-guided

- MRI-guided

o    Endometrial biopsy may be used when looking for the cause of abnormal uterine bleeding, to examine the lining of the uterus and to diagnose cancer. This type of biopsy can be performed by using a small needle-like device to capture a sample or by using a tool to scrape some of the lining for examination.

o    Kidney (renal) biopsy is used to examine the condition of a kidney with kidney failure, inflammation in the kidney or a suspected tumor (such as cancer). It can also be used to examine a transplanted kidney for signs of transplant rejection. Kidney biopsies are performed with image guidance (ultrasound or CT) using a needle to remove a small sample of the tissue.

·        Liver biopsy is used to diagnose diseases of the liver such as hepatitis C, cirrhosis, infections and cancer. It can also be used to examine a transplanted liver for signs of transplant rejection. This is a frequent indication in children. Liver biopsies are typically performed by inserting a needle through the skin. The liver can also be biopsied via a catheter inserted through the jugular vein (a large neck vein) to capture a tissue sample, or can be biopsied surgically.

·         Lung or chest nodule biopsy is performed when an abnormality of the lung is visible on an x-ray or CT scan. Lung biopsies can be performed through bronchoscopy by insertion of an instrument called a bronchoscope through the patient's mouth to reach the area to be biopsied, through the skin by inserting a needle percutaneously, or by surgically removing the lump.

·         Lymph node biopsy is performed whenever there are enlarged or abnormal lymph nodes. They can be performed with a needle or surgically.

·         Muscle biopsy is used to diagnose infections that affect muscle, defects in the muscle and diseases of the connective tissue and blood vessels. This type of biopsy can be performed using a needle or surgically.

·         Nerve biopsy is used to examine damage to small nerves, degeneration and destruction of the nerve and inflammatory nerve conditions. Nerve biopsies are typically performed surgically.

·         Skin biopsy examines a growth or an area on the skin, such as a mole, that has changed its appearance. Skin biopsies can be performed by shaving a small sample of the skin, removing a sample with a scalpel or by way of an instrument used to punch through a portion of the skin.

·         Testicular biopsy is used when researching male infertility. It is also used to determine if a lump in the testicles is cancerous or benign. Testicular biopsies can be performed using a needle, by a small cut made in the skin or surgically.

·         Thyroid biopsy is used to find the cause of a nodule in the thyroid gland. This type of biopsy is typically performed using a needle with ultrasound guidance.

Almost any organ can be biopsied, including the bladder, heart, neck, prostate, parathyroid glands, etc.

How is the procedure performed?

Imaging-guided, minimally invasive procedures, such as needle biopsies, are most often performed by a specially trained radiologist, an interventional radiologist or a neuroradiologist.

Needle biopsies are usually done on an outpatient basis.

A nurse or technologist may insert an intravenous (IV) line into a vein in your hand or arm so that sedation or relaxation medication may be given intravenously during the procedure. You may be also given a mild sedative prior to the biopsy.

A local anesthesia will be injected to numb the path of the needle.

Some biopsies, such as breast or thyroid biopsies, may be performed without sedation. The nurse or technologist will advise you at the time of the procedure regarding the sedation.

When a biopsy is performed on a child, it is more likely that general anesthesia will be required to keep them comfortable during the procedure.

If the procedure is being performed with fluoroscopy, you will lie down or stand for the procedure.

If the procedure is performed with CT or MRI, you will lie down during the procedure. A limited CT or MRI scan will be performed to confirm the location of the nodule and the safest approach. Once the location of the nodule is confirmed, the entry site is marked on the skin. The skin around the insertion site will be scrubbed and disinfected, and a clean and sterile drape will be applied.

A very small nick is made in the skin at the site where the biopsy needle is to be inserted.

Using imaging guidance, the physician will insert the needle through the skin, advance it to the site of the nodule and remove samples of tissue. Several specimens may be needed for complete analysis.

After the sampling, the needle will be removed.

Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.

You may be taken to an observation area for several hours. X-ray(s) or other imaging tests may be performed to monitor for complications.

Depending on the type of biopsy performed, you may be able to return home immediately after the procedure.

This procedure is usually completed within one hour. You may be required to stay in an area for observation for several hours after the biopsy depending on the type of biopsy performed.

Biopsy procedures are typically performed the same way for children.

For stereotactic breast biopsies, you may lie face down or sit up on a moveable exam table and the affected breast or breasts will be positioned into openings in the table.

In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.

In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with 'cores' of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process may be repeated several times.

In some breast biopsies, the tissue is removed with a vacuum-assisted device (VAD). Vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, several samples of tissue are collected from around the lesion. After this sampling, the needle will be removed.

If a surgical biopsy is being performed, a wire may be inserted into the suspicious area as a guide for the surgeon.

A small marker may be placed at the site, so that it can be located in the future if necessary.

Once the biopsy is complete, pressure will be applied to stop any bleeding, and the skin will be covered with a dressing or bandage.

Benefits & Risks

·         Needle biopsy is a reliable method of obtaining tissue samples that can help diagnose whether a nodule is benign (non-cancerous) or malignant.

·         A needle biopsy is less invasive than open and closed surgical biopsies, both of which involve a larger incision in the skin and local or general anesthesia.

·         Generally, the procedure is not painful and the results are as accurate as when a tissue sample is removed surgically.

·         Recovery time is brief and patients can soon resume their usual activities.

·         Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.

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