What is a Biopsy in Cancer?

A Biopsy is the removal of tissue from any part of the body, to examine for the 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 anesthesia 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 Leukemia.
  • 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 tumor.
  • 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. A Biopsy can be performed using a needle tool, on 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 tumor. In core biopsy, slightly larger needles are used. They extract tissue in the shape of a small cylinder. Local anesthesia is used during a core needle Biopsy. In a vacuum-assisted biopsy, the needle is positioned into the tumor. 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 tumor is extracted. If only a part of the tumor 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 that 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 afterward, 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 that is suspicious, your doctor may perform a Biopsy of the involved area of the skin. This can be done by using local anesthesia 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 leukemia, anemia, 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 anesthesia 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 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:

  • Excessive bleeding
  • Infection
  • Accidental injury
  • Skin numbness around the biopsy location.
  • Puncture damage to nearby tissue or organs.

A biopsy is a medical procedure in which a sample of tissue or cells is taken from the body for examination and analysis. It plays a crucial role in diagnosing various medical conditions and is an important tool in healthcare for several reasons.

Importance of Biopsy

Diagnosis: Biopsies are performed to determine the presence of diseases or conditions. They help doctors make accurate diagnoses by providing essential information about the nature and extent of abnormalities or changes in tissues or cells. Biopsies can help identify various conditions, including cancer, infections, autoimmune disorders, and inflammatory diseases.

Treatment planning: Biopsy results provide crucial information that helps guide treatment decisions. By analyzing the biopsy sample, doctors can determine the specific characteristics of a disease, such as its type, stage, and aggressiveness. This information is vital for developing an appropriate treatment plan tailored to the individual patient’s needs.

Prognosis: Biopsies can provide valuable prognostic information by revealing the extent and severity of diseases. For example, in cancer cases, biopsy results can help determine the prognosis, including the likelihood of metastasis (spread) and the potential response to different treatment options. This information is essential for estimating the expected outcome and survival rates.

Monitoring disease progression: Biopsies can be performed at various stages during the course of a disease to monitor its progression or response to treatment. By comparing biopsy samples taken at different times, doctors can evaluate the effectiveness of therapies, assess disease progression or regression, and make necessary adjustments to the treatment plan.

Research and advancements: Biopsy samples are valuable resources for medical research and the development of new treatments. They provide researchers with direct access to diseased tissues and cells, enabling them to study the underlying mechanisms, identify biomarkers, and develop targeted therapies. Biopsy-derived data contributes to scientific knowledge, helps improve diagnostic techniques, and facilitates the discovery of new treatment modalities.

It’s important to note that while biopsies are generally safe, they are invasive procedures that carry some risks, such as bleeding, infection, or damage to nearby structures. The decision to perform a biopsy is based on a careful assessment of the potential benefits and risks, considering the specific medical situation and individual patient factors.