Everything You Need to Know About Biopsy Procedures

What is a biopsy?

A biopsy is a medical procedure, which is mostly used in diagnosing cancer. In this procedure, a small tissue sample is taken from your body for a closer examination under the microscope. A biopsy is usually recommended by your doctor if initial tests in your body suggest an abnormality in your tissues. Your tissue sample may be examined in different ways. For example, your tissue may be tested using some chemical reagents so as to help identify the abnormal chemical that may be present in your tissue sample. Sometimes, a sample of your abnormal tissue may be tested for bacteria and other disease-causing microorganisms.

Why is it done?

The main purpose of a biopsy is to look for cancer in abnormal and suspicious tissues. However, a biopsy can also be used to identify other health conditions. Your doctor may call an abnormal tissue a mass, a lesion, or a tumor. These are the usual words, which are used to indicate the unknown nature of your tissue. Through a biopsy, the suspicious tissues can be closely examined and identified as cancerous or not.

Your doctor may recommend a biopsy if there is a medical question that the procedure could answer. A few examples are:

• In case a mole on your skin has changed its shape, melanoma, which is a type of skin cancer, is possible.
• A mammogram examination shows a mass or lump that may indicate a possibility of breast cancer.
• If an individual has chronic hepatitis and wants to know if liver cirrhosis is present.

Most biopsies are performed to help diagnose a health problem or determine the best therapy that people should have for their health condition.

How a Biopsy Is Done

There are different types of biopsy procedures and all of them depend on the part of the body where the tissue sample is taken from and the size of the tissue to be removed. They include:

• Punch biopsy - This procedure is very useful in diagnosing skin conditions. A certain instrument is used to punch through the top layers of the skin to remove a sample of the skin tissue to be tested. Local anesthesia is applied or injected on the site where the tissue is removed to numb the cells and make the whole procedure painless.
• Excisional biopsy - It is a biopsy procedure that involves the removal of the entire suspicious area for examination. This type of biopsy is common in the examination of breast lumps and suspicious changes on your skin.
• Endoscopic biopsy - In this procedure, an endoscope is used. An endoscope is a thin and flexible tube fixed with a camera and a light at the end. Endoscopes are used to view internal parts of the body, which include the gastrointestinal tract, bladder, joints, and the abdomen. Endoscopes can be inserted into your body through an incision or through the mouth. The camera attached to the endoscope is used by doctors to see the body's abnormal areas. Forceps, which are also a part of the endoscope, are then used to take tiny tissue samples.
• Fine needle aspiration biopsy - In this type of biopsy, doctors use a thin and hollow needle, which is attached to a syringe. This fine needle is then used to take a small sample of tissue from the suspicious area for examination. This biopsy procedure can be performed along with an image-guided biopsy to give accurate results.
• Core needle biopsy - This procedure is almost similar to the fine needle biopsy. However, it uses a larger needle to extract a larger tissue sample for examination.
• Vacuum- assisted biopsy - It is a type of biopsy that uses suction to extract a sample of your tissue through a special type of needle. This means that your doctor won't have to make another incision for collecting larger tissues. The doctor can collect more than one sample from the same biopsy site.
• Image-guided biopsy - This biopsy procedure is used when your tumor cannot be seen by your doctor. It is also used to examine deep areas of your body, which can be seen through a scan. With the help of an imaging technique, a needle is guided to the suspicious area of your body to take a tissue sample. This procedure can be performed along with the vacuum-assisted biopsy, core needle biopsy, as well as fine needle biopsy, depending on the size of the tissue sample needed for examination. The type of scan also depends on the area of your body where the tissue is to be removed. The following are types of imaging tests or scans:

1. X-ray
2. Ultrasound
3. Magnetic resonance imaging (MRI)
4. Fluoroscopy
5. Computed tomography (CT) scan 

• Aspiration and biopsy of the bone marrow - These procedures are almost similar and mostly used at the same time to examine your bone marrow. Since your bone marrow has both liquid and solid parts, bone marrow aspiration is used to remove a sample of the fluid. This type of biopsy is used to examine whether one has blood cancer or a blood disorder. Blood cancers include lymphoma, multiple myeloma, and leukemia. The pelvic bone is the main site for a bone marrow biopsy and aspiration.

Biopsy Specialists 

Due to the different types of biopsies, healthcare team members may also vary. The doctors who will be involved in your biopsy will depend on your affected body part and the type of biopsy you may need. The members of a medical team may include:

• Surgeon - performs surgical biopsies, both excisional and incisional.
• Pathologist - This type of doctor deals with laboratory test interpretations, especially in the evaluation of tissues, cells, and organs. In a biopsy, a pathologist analyzes the tissue samples removed from your body.
• Radiologist - This specialist is the one who can interpret imaging test results.
• Cytologist - It is a doctor who specializes in the study of cells. A cytologist usually performs a fine needle aspiration biopsy. 
• Dermatologist - a specialist who deals with skin conditions.
• Gynecologist - a specialist who deals with the biopsy of women’s reproductive system.
• Gastroenterologist - a doctor who deals with the disorders and abnormalities in the gastrointestinal tract.

Biopsy Risks

Biopsies usually involve breaking the skin. These procedures may result in excessive bleeding and the risk of developing infections. However, some procedures such as needle biopsies carry lower risks because they only involve small incisions on your skin.

Bottom Line

Biopsies are important medical procedures because they are used to help examine suspicious tissues in your body. In cases where simple laboratory tests and physical examination cannot tell the problem with your tissues, a biopsy is performed for further examination and diagnosis. A biopsy might sound scary to you, but it is important to know that most biopsy procedures are entirely low-risk and pain-free.