Biopsies in cancer diagnosis


What is Biopsy


A biopsy is the removal of tissue from any part of the body, to examine for disease. Some biopsies may be required to extract a small sample of tissue with a needle while others may be needed to extract a suspicious nodule or lump. The test can be used to evaluate samples of tissue from any part of the body to allow microscopic examination of the sample. Since most biopsies are minor procedures, patients usually do not need sedation. However, sometimes local anaesthesia may be used. 


How is Biopsy used in cancer?


Biopsies are performed in various areas of the body and for several reasons. Different types of biopsies and the conditions when they may be performed are mentioned below:


  • Abdominal biopsy: To examine whether a lump in the abdomen is cancerous or benign.
  • Bone biopsy: To diagnose bone cancer. 
  • Bone marrow biopsy: To diagnose cancer in the blood, such as leukaemia. 
  • Breast biopsy: To examine if a lump in the breast is cancerous or benign. 
  • Endometrial biopsy: To examine the lining of the uterus and to diagnose cancer. 
  • Kidney biopsy: To evaluate the condition of a failing kidney or a suspected tumour. 
  • Liver biopsy: To diagnose diseases of the liver such as hepatitis, cirrhosis, and cancer. 
  • Lung or chest nodule biopsy: When an anomaly of the lung is noticed on an x-ray/CT scan. 
  • Lymph node biopsy: To examine an enlarged lymph node for cancer diagnosis. 
  • Muscle biopsy: To diagnose infections, defects and diseases of the connective tissue. 
  • Nerve biopsy: To examine damage, degeneration and destruction of the nerve cells. 
  • Skin biopsy: To examine a growth or an area on the skin that has changed its appearance. 
  • Testicular biopsy: To determine if a lump in the testicles is cancerous or benign. 
  • Thyroid biopsy: To find the cause of a nodule in the thyroid gland. 
  • Liquid Biopsy: To confirm the presence of cancer cells in the blood or other body fluids. 


How does the procedure work?


The type of procedure used to conduct the biopsy depends on the location of the tissue that needs to be studied. Biopsy can be performed using a needle tool, in most of the body parts. It is the least invasive option, allowing the patient to return home on the same day. Imaging guidance with x-ray, ultrasound, CT or MRI helps the needle to be precisely positioned to find the best site to extract the tissue sample.

In places that are hard to reach, a surgical biopsy may be necessary. This is performed in a hospital operating room. A surgeon performs surgery to remove the tissue, necessary for the biopsy. The surgeon may use a camera-based instrument to help locate the best place for biopsy and remove the sample of tissue. The surgeon inserts the needle through the skin using imaging guidance. Tissue samples may be removed using one of several methods.


  • Fine needle aspiration uses a very thin needle attached to a syringe to extract a small amount of body fluid or very small pieces of tissue from the tumour.
  • In core biopsy, slightly larger needles are used. They extract tissue in the shape of a small cylinder. Local anaesthesia is used during a core needle biopsy. 
  • In a vacuum-assisted biopsy, the needle is positioned into the tumour. The vacuum device is activated to pull the tissue into the needle, and then the tissue is cut using a sheath. The tissue is then sucked through the needle. 


Types of Biopsies in cancer diagnosis


Excisional Biopsy and Incisional Biopsy

The procedure is called an excisional biopsy when the entire tumour is extracted. If only a part of the tumour is removed, it is called an incisional biopsy. Excisional Biopsy is widely used for suspicious alterations on the skin. Doctors also often use it for tiny, easy to remove lumps under the skin. However, fine-needle aspiration or core needle biopsy is more popular for lumps which can not be seen or felt through the skin.


Endoscopic Biopsy


Endoscopic biopsies are used to gather samples from places like the bladder, colon, or lung to reach tissue inside the body. The doctor uses a flexible thin-tube called an endoscope during this operation. The endoscope has a small camera at the end, a lamp. A video monitor lets your physician access the pictures. They also insert small surgical instruments into the endoscope. Your doctor will use the video to direct these to collect a sample. The endoscope may be inserted into your body through a small incision, or any opening in the body, including the mouth, nose, rectum, or urethra. Endoscopies usually take 5 to 20 minutes. This may be done in a hospital or at a doctor’s office. You may feel mildly uncomfortable afterwards, or you may have bloating, gas or a sore throat. These will all fade in time but you can contact your doctor if you are worried.


Needle biopsies


Needle biopsies are used to extract tissue samples that are easily accessible under the skin. The different types of needle biopsies are:

  • Core needle biopsies use a medium-sized needle to extract a column of tissue in a cylindrical shape.
  • Fine needle biopsies use a thin needle allowing fluids and cells to be extracted.
  • Image-guided biopsies are directed with imaging procedures, such as X-ray or CT scans, This is used to access specific areas, such as the lung, liver, or other organs.
  • Vacuum-assisted biopsies use suction from a vacuum to extract the suspicious cells.


Skin biopsy


If you have a rash or lesion on your skin which is suspicious, your doctor may perform a biopsy of the involved area of skin. This can be done by using local anaesthesia and cutting a small piece of tissue with a razor blade, a scalpel, or a thin, circular blade called a “punch.” The sample will be sent to the laboratory to examine for signs of conditions such as infection, cancer, and inflammation of skin structures or blood vessels.


Bone marrow biopsy


Blood cells are produced in a spongy material called marrow, inside some of your larger bones, like the hip or the femur in your leg. When your doctor thinks you have blood disorders, you can undergo a biopsy of the bone marrow. This test may identify cancerous and non-cancerous conditions such as leukaemia, anaemia, infection, or lymphoma. The test is also used to determine if cancer cells from other body parts have spread to your bones.

The easiest access to the bone marrow is by a long needle inserted into the hipbone. It can be done in a doctor’s office or a hospital. There’s no way to numb the insides of the bones, and some people experience a dull discomfort during this operation. However, some only feel initial acute pain when the local anaesthesia is administered.


Following up after a biopsy


Once the tissue sample has been taken, it will be examined by the physicians. This analysis may be done at the time of the operation, in some cases. However, most frequently the sample may need to be submitted to a testing laboratory. Once the results arrive, your doctor may call you to share the results, or ask you to come in for a follow-up appointment to discuss the next steps.

If the analysis indicates signs of cancer, your doctor will be able to tell the cancer’s type and level of aggression from your biopsy.  If the findings are negative but the concern of the doctor is still high for cancer or other diseases, you may need to have another biopsy or another form of biopsy. Your doctor will instruct you as to the best path you can take. If you have any concerns about the biopsy before the operation or the tests, do not hesitate to speak to your doctor.


What are the side effects of a Biopsy?


A biopsy procedure is usually safe and causes minimal injury. Complications from biopsies may include:


  • Bleeding
  • Infection
  • Accidental injury