A biopsy is performed to diagnosis some medical conditions, including cancer. A physician will remove a piece of tissue, which is then sent to a pathologist. The pathologist will look at the tissue under the microscope, and may perform additional tests, to determine if there is disease in the tissue.
Patients may need a biopsy after a mass was seen on physical exam or radiological imaging. Biopsies may also be performed when other laboratory tests are abnormal, such as blood counts or Pap smears. A biopsy may be needed to diagnosis a variety of different conditions, including infection, inflammatory diseases, or cancer.
The types of biopsies include:
- Fine needle aspiration – A small needle is inserted into the tissue, and cells or fluids are removed. This type of biopsy removes the smallest amount of tissue. Fine needle aspirations are commonly performed for thyroid or breast masses.
- Incisional biopsy – This type of biopsy removes a slightly larger piece of tissue to allow the pathologist to have a larger specimen to examine. A larger tissue sample is necessary in some cases to determine if disease is present. Often the physician will use a CT scan or ultrasound to help them locate the tissue they want to biopsy. Incisional biopsies are taken of the breast, prostate, or outer portion of the lung.
- Excisional biopsy – In this procedure, the surgeon is attempting to remove the entire diseases tissue. Excisional biopsies are performed with general or local anesthesia because a larger incision into the skin and tissue is necessary. In addition to making a diagnosis, the pathologist will look at the borders of the excisional biopsy to be sure that they are clear of disease. If disease is present at the borders of the biopsy, it may mean that the tumor was not entirely removed. In this case the surgeon may decide to perform an additional procedure to remove more tissue.
- Endoscopic biopsy – This type of biopsy if performed with the help of a fiberoptic endoscope, which allows the physician to visualize internal organs without making a surgical incision. This type of biopsy is commonly performed on the gastrointestinal tract, bladder, joints, chest cavity and abdominal cavity.
- Punch biopsy – Dermatologists perform punch biopsies of skin lesions. A small cylindrical punch is taken of a rash or mass on the skin.
- Bone marrow biopsy – This type of biopsy involves the insertion of a needle into the bone, commonly the hip, with removal of an aspiration of cells and a cylindrical piece of tissue. Bone marrow biopsies are used in the diagnosis of diseases of the blood and bones.
A physician will choose the correct type of biopsy to view the abnormal tissue. Some masses, such as thyroid nodules, can frequently be diagnosed with a fine needle aspiration. Others, such as lymph nodes and breast masses, require more tissue. Patients will be made as comfortable as possible during the procedure. This may involve local anesthesia, general anesthesia, or drugs that will cause sedation and relaxation. Fine needle aspirations and some incisional biopsies can be performed in the doctor office.
The results of a biopsy may be available the following day. In some cases, the pathologist has to perform special tests that require more time in order to provide a diagnosis. In this case, it may take several days or longer to get the results.
Sometimes a biopsy does not provide enough information to determine the diagnosis. If this is because of an inadequate amount of tissue in the original biopsy, the physician may want to perform another biopsy. If a fine needle aspiration or incisional biopsy shows a malignancy, it may be necessary to perform an excisional biopsy to remove the tumor. Some chronic conditions, such as hepatitis or kidney transplantation, may require repeated biopsies to monitor the health of the patient.
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