What Is A Biopsy?

A biopsy is a procedure that removes a sample of your cells or tissue from your body so it can be examined under a microscope and tested for a variety of medical conditions, such as cancer. A pathologist, or a medical doctor who specializes in the body's tissues, will be the person who performs the test and provides you with a medical diagnosis of the condition(s) you are being tested for. 

Purpose

A biopsy is a common medical test that can diagnose different types of cancer, certain infections, and other inflammatory or autoimmune disorders. People undergoing an organ transplant usually undergo a biopsy before their transplant to confirm that the new organ will be a good match. 

If your healthcare provider notices an abnormal lump or suspicious finding during a physical exam, they will likely recommend a biopsy to determine the cause. Currently, a biopsy is the only way to accurately diagnose cancer. 

Types of Biopsies

There are several types of biopsies that a healthcare provider can perform. Your healthcare provider will recommend a type of biopsy based on your symptoms, physical exam results, and what condition they suspect that you might have.

Needle Biopsy

A needle biopsy involves inserting a needle through the skin and into the area of concern. Your provider then removes a tissue sample or fluid through the needle and sends the sample to the lab for testing. 

The types of needle biopsy include:

• Fine-needle aspiration: A healthcare provider will insert a syringe with a small needle into your body to remove cells or tissue.
• Core biopsy: Uses a wide, hollow needle attached to a spring-loaded device and inserts the device into your body to remove tissue.

Needle biopsies are usually performed with imaging tests to guide the needle to the correct spot in your body. Your healthcare provider may use an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI). 

Surgical Biopsy

When a needle biopsy is not possible, your healthcare provider may recommend a surgical biopsy. A surgeon (or, a medical doctor who specializes in surgery) will perform this type of biopsy.

A surgical biopsy is considered a surgical procedure. That said, this biopsy will be performed in a hospital operating room. The procedure involves making cuts into the skin and removing tissue samples from the area of concern.

During a surgical biopsy, you will receive local or general anesthesia. This means that you will be sedated (relaxed) or asleep during the procedure. The type of surgical biopsy used depends on which condition your healthcare provider suspects you have.

Common types of surgical biopsies include:

• Excisional biopsy: Removes the entire lump or growth from your body
• Incisional biopsy: Takes a sample of tissue from a lump or growth
• Laparoscopic biopsy: Makes small cuts to access the area of interest and remove a tissue sample
• Endoscopic biopsy: Uses an endoscope (thin, flexible tube with a light and camera on the end) to pass through the throat and into the esophagus to take tissue samples 
• Sentinel lymph node biopsy: Incorporates the use of a colored dye and imaging tests to determine if cancer has spread to the lymph nodes and then takes a tissue sample of the affected area
  

Skin Biopsy

A skin biopsy can diagnose skin cancer and other skin conditions. During this procedure, your provider will remove a small amount of skin and examine the sample under a microscope. 

The types of skin biopsies include:

• Shave biopsy: Removes the outer layers of skin (diagnoses basal cell and squamous cell skin cancer)
• Punch biopsy: Cuts out deeper layers of skin (diagnoses melanoma)
  

How Does It Work? 

During a biopsy, your healthcare provider removes cells or tissue from your body and then sends it to the lab for examination. Once a pathologist examines the tissue under a microscope, they may either provide you with a diagnosis or conduct other tests. 

Before the Biopsy

Before your biopsy, your healthcare team will talk with you about what to expect. You will learn which type of biopsy you will have and where it will take place. Your healthcare provider will advise you to stop taking any blood thinners because bleeding is a possible complication of a biopsy. Common blood thinners include nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, as well as Coumadin (warfarin) and Plavix (clopidogrel). 

When you arrive at the healthcare facility for your biopsy appointment, you will check in with the reception area. Be sure to bring your insurance card and any questionnaires that you received beforehand. 

Once you’re checked in for your appointment, you will be given a questionnaire to fill out. Be prepared to list all of your medications, including vitamins and supplements. Write down your allergies, and alert the healthcare providers right away if you could be pregnant. This is because many providers use imaging studies during a biopsy, which isn't safe during pregnancy. 

When it’s time for your appointment, a hospital staff member will take you to a private room and give you a hospital gown to change into. If you are undergoing a surgical biopsy, they will guide you to the operating room for surgery.

Most biopsies are performed while you are lying down. To prepare, your surgeon or radiologist (a doctor who specializes in diagnosing conditions by using imaging technology) will prep the area of your body that is being tested by cleaning the skin and numbing it with medication. During surgical biopsies, you will be under anesthesia to sedate you or put you to sleep during the procedure. Keep in mind: you may feel a sharp pinch when the provider injects the anesthesia into your body. 

During the Biopsy

Your biopsy experience will depend on which type of biopsy you’re having. During a needle biopsy, your healthcare provider will numb the area and then use imaging (X-ray, CT scan, or MRI) to determine the exact spot of the tumor, lump, or area of concern. 

Once your provider locates the exact area of your body, they will insert the needle into the space and draw back the syringe to remove a sample of tissue. Your provider may have to do this more than once. The area of the skin should be numb but you may feel a sharp pinch or a feeling of pressure when they inject the syringe into your body.

During a surgical biopsy, you will lie down on the table in the operating room and receive anesthesia to feel more relaxed or asleep. A nurse will place an IV and the anesthesiologist (a medical doctor who specializes in anesthesia and pain management) will administer the medication through the IV. Once you receive anesthesia, the biopsy should be pain-free. 

Your surgeon will make small cuts to access the area of concern and then remove tissue samples. Most biopsies take less than one hour to perform. Once the tissue sample has been removed, it will be sent to the lab for a pathologist to examine and test. 

After the Biopsy 

Recovery after a biopsy will vary depending on the type of biopsy you receive and how much tissue was removed. Generally, it is much quicker to heal from a needle biopsy than from a surgical biopsy. 

After a needle biopsy, your provider will apply pressure to the site and cover the biopsy wound with a clean dressing, such as a bandage or gauze. You will likely not require stitches after the procedure. Your provider may recommend a course of antibiotics to prevent infection at the biopsy site, which is commonly recommended after a prostate biopsy. 

If you received any anesthesia to relax you, you will need to stay at the medical facility until the anesthesia wears off. You will also need a friend or family member to drive you home.

After a surgical biopsy, a hospital staff member will take you to the post-anesthesia care unit (PACU). This is the area of the hospital where people go to recover from surgery and wake up from anesthesia. You will likely still have an IV in place and nurses will closely monitor you with a blood pressure machine and pulse oximetry monitor (to assess if your blood has enough oxygen). 

Most people spend the night in the hospital after having a surgical biopsy on an internal organ like the liver or kidneys. Once you have been cleared to leave the PACU, a staff member will move you into a hospital room.

Keep in mind: it's common to feel sore at the biopsy site for a few days after the procedure. If the pain is unbearable, your healthcare provider can prescribe pain medication. Once your provider approves removing your bandage or gauze, you will be able to shower or bathe as normal.

Risks and Precautions

Biopsies are common procedures that have a low risk of complications. However, there is a small possibility of experiencing some complications, such as:

• Bleeding or bruising
• Infection
• Damage to the surrounding organs or tissues 

It's essential to note that people who are pregnant should not undergo a biopsy that involves any imaging studies like an X-ray or MRI. 

How to Prepare for a Biopsy 

Going in for a biopsy can be scary. Knowing what to expect can help. Here are a few tips to keep in mind when preparing for a biopsy:

• Location: The location depends on which type of biopsy you’re having. A skin biopsy will take place in a dermatologist’s office. A needle biopsy tends to happen in a hospital or outpatient facility. For a surgical biopsy, you will have to go into an operating room of a hospital. 
• Attire: Plan to wear loose, comfortable clothing to your biopsy appointment. You will likely change into a hospital gown once you arrive at your appointment. Leave any jewelry at home. You will need to remove it if your healthcare provider uses an imaging study during your test. 
• Food and drink: If you will receive anesthesia during your biopsy, do not eat or drink for eight hours before the test. Ask your healthcare provider if you should fast.
• Medications: It is OK to continue most of your medications before your biopsy. However, do not take any blood thinners before your test. If you are fasting from food and drink, you can take your pills with small sips of water.
• Items to bring: Plan to bring your insurance card, ID, and any questionnaires that your healthcare team sent to you in the mail or online. Leave any valuables at home.
• Emotional support: Ask your healthcare team if you are able to bring a friend or family member with you. They will not be allowed in the room during your procedure but could wait in the waiting room. If you receive any anesthesia during the biopsy, you will need a ride home. 
• Cost and insurance: Biopsies are usually covered by insurance. You may be responsible for a copay depending on your insurance. Before your test, call your hospital billing department and insurance company to ask for an estimate of how much you can expect to pay out of pocket.

Results

The results from a biopsy are usually back within a few days. Once your tissue sample goes off to the lab, a pathologist runs the needed tests and then sends a full report to your primary healthcare provider. 

Once your provider receives the results, they will contact you by phone or electronic medical record. Your provider may sometimes ask you to come in for a follow-up appointment as well. 

Interpreting Your Results 

Reading a medical report is often confusing. Don’t hesitate to ask questions when you don’t understand something. The results of a biopsy usually come back with the following classifications:

• Normal result: Normal results mean that your tissue or cells appeared normal under the microscope and no diagnosis has been made.  
• Abnormal result: An abnormal result means the tissues or cells appeared abnormal in their shape, size, structure, or condition. This finding may result in a medical diagnosis.  
• Inconclusive result: If the pathologist did not have enough tissue to conduct their tests, the results may be inconclusive and require further testing. This means that you may need an additional biopsy to obtain a larger sample. 

A Quick Review

A biopsy is a procedure that removes cells or tissue from the body so a pathologist can examine the sample for a variety of health conditions, including cancer. There are several types of biopsies including needle biopsies, surgical biopsies, and skin biopsies. 

Your provider can take a biopsy from any area of the body. The exact area of your biopsy will depend on where the area of concern, lump, or tumor is located in your body. You will likely have to go into a hospital clinic or office to undergo a needle or skin biopsy. Surgical biopsies are a type of surgical procedure that will require you to go into a hospital's operating room. Generally, you can receive results within a few days.

Undergoing a biopsy can feel scary. This is normal and it's OK to feel however you feel. Talk to your healthcare team about any questions or concerns you have and whether you can bring a loved one to your appointment for emotional support.