What Is a Biopsy? Types, Who Needs One and How It Is Performed

What is a biopsy?

A biopsyis the removal of cells or tissue to analyze a disease. Its purpose is to characterize the sample's structural and histological features and, in some cases, test for specific molecular biomarkers . In oncology, a biopsy is important to determine whether cancer is present and assess other characteristics that guide disease management decisions.

Educating patients about what to expect during and after a biopsy is important to reduce prebiopsy anxiety (anxiety before biopsy). Patients typically worry about pain or discomfort during a biopsy. One study found that, before a biopsy, anticipating painincreased the pain felt during the procedure. Another study found that preparing patients for a biopsy was associated with lower anxiety levels.

Before a biopsy

There are several different biopsies; types of biopsyvary according to the amount of tissue removed and how the tissue is cut. Doctors choose the biopsy type according to its overall purpose and the organ from which the sample will be taken.

The following three examples may help you better understand different biopsies:

1. Although a small number of cells may be enough simply to determine whether cancer is present, more tissue may be needed to analyze biomarkers.
2. If lymphoma is suspected, the entire lymph node may need to be removed by excisional biopsy , whereas, if another solid-organ cancer is suspected to have spread to the lymph node by metastasis , removing only a piece of tissue from the lymph node using a tru-cut (core needle) may be sufficient.
3. To diagnose thyroid cancer, from the thyroid a fine-needle biopsyis sufficient.

Does a biopsy cause cancer to metastasize (spread)?

Patients and their relatives have long worried that "cutting into a tumor spreads the cancer" . But the reality is often this: Particularly in the past, cancers were usually diagnosed at stage 4, when they had already spread to other organs; in other words, metastases were already present when the biopsy was performed.

With modern biopsy techniques, concern that a biopsy may seed tumor cells capable of initiating metastases is no longer necessary. Studies show this is a potential but very rare risk for many cancers.

A systematic review of 7 studies on head and neck cancer estimated cancer cell seeding in only % 0.00012 of cases undergoing fine-needle aspiration biopsy and % 0,0011 undergoing core needle biopsy. A systematic review of prostate cancer reported that the risk of cancer spread through biopsy was less than % 1.

Another study on breast cancer states that even when cancer cells are seeded by biopsy, they cannot remain viable because this is not a naturally occurring metastasis. Vacuum-assisted biopsy was also found to be associated with a lower seeding risk than conventional automated tru-cut devices.

How is a biopsy performed?

Most biopsy procedures are performed on an outpatient basis using local anesthesia (hospital admission is not required). More complex biopsies, such as those involving a deep internal organ, may require more extensive anesthesia. Patients should understand instructions about whether they need someone to accompany them, whether eating and drinking are allowed before the procedure, and the day of the biopsy.

Most patients do not experience pain during a biopsy. A study of 136 women undergoing ultrasound-guided breast biopsy reported that % 40 and % 49 experienced no pain or mild pain, respectively, while only % 12 experienced moderate or severe pain during the biopsy. Patients expecting pain during the biopsy were also more likely to experience it, emphasizing the importance of educating and informing patients before the procedure about what to expect.

- What You Need to Know Before a Breast Biopsy

- What Is a Breast Biopsy and How Is It Performed? (Detailed)

After a biopsy

Immediate recovery time after a biopsy varies according to the level of anesthesia and biopsy site. For example, patients undergoing a more complex biopsy may need several hours of observation before discharge (such as a lung biopsy). Patients and caregivers should be educated about what to expect immediately after the procedure, approximately how long they will stay at the facility, how long they may need to wait before functioning independently, and any need to limit physical activity.

Possible complications after a biopsy (procedure-related side effects) also vary. Patients and caregiversshould be informed about which complications are normal and about the signs and symptoms of complications after a biopsy.

Common potential complications after a biopsy include discomfort at the biopsy site, bruising and / or bleeding.

A study of 351 women undergoing image-guided breast biopsy reported mild postbiopsy pain:

• with ultrasound-guided biopsy, out of 10, an average score of 2.3
• a score of 3.1 with vacuum-assisted stereotactic biopsy
• reported pain decreased as physician experience increased, regardless of the type of biopsy needle used or the number of biopsy samples taken.

A study of more than 900 men undergoing transrectal (through the rectum) ultrasound-guided prostate biopsy reported that % 44 experienced pain within 35 days after the biopsy, but only % 7 described it as a serious or moderate problem.

- What Is a Prostate Biopsy? When Should It Be Performed, and How Is It Done? (Detailed)

Patients should be educated about possible bleeding, bruising and swelling after biopsy, because these signs and symptoms may cause anxiety. For example, a prostate biopsy study reported rates of % 93, % 66 and % 37 for hematospermia (blood in semen), hematuria (blood in urine) or hematochezia (blood in stool). People experiencing such side effects report greater anxiety.

Biopsy results

Understandably, most patients want biopsy results as quickly as possible. For suspected melanoma , a multicenter study of 301 patients undergoing biopsy found that % 52 wanted results through a rapid method such as a phone call, voicemail, email or online portal. If results were abnormal, approximately % 70 preferred notification by phone, while %28 preferred a face-to-face discussion. For normal results, approximately %32 considered voicemail acceptable, followed by approximately % 28 and % 24 preferring email or a phone call. An online portal was preferred by younger patients and those with higher education levels.

Although most patients prefer receiving results quickly, some may prefer a face-to-face conversation. This should be discussed and decided before the biopsy. For patients preferring a rapid method of receiving results, the news should be conveyed in a measured, considerate manner.