Everything you need to know about Biopsy



A biopsy is a medical procedure that involves the removal of abnormal tissue or a small sample of cells from a particular organ for further testing. It is more frequently done for the confirmation or identification of different types of cancer; however, it can also be done to identify infection or inflammation. Biopsies are generally performed by surgeons, intervention radiologists, gynecologists, oncologists, dermatologists, or pathologists.

WHEN IS A BIOPSY RECOMMENDED?

Biopsies are advised by a doctor when a person presents with suspicious lesions, infection, or appearance of a mass in the body for which the exact cause is not known. For example

  • A woman may present with a mass palpable in the breast during a self physical examination or after a doctor's visit. Some women may also present with lumps in the breast visualized on mammograms or other imaging techniques.
  • Ultrasound abdomen showing increased thickness of the inner layers of the uterus, or in case of altered menstrual cycles where biopsies may be mandatory.
  • Some patients present with a solid mass lesion in the neck region, generally due to lymph node enlargement which requires a biopsy to rule out the possibility of cancer or infection.
  • Suspicious moles or superficial skin lesions may need biopsies to identify the exact natures of the lesion.
  • Involvement of other solid organs either generalized lesions like in cirrhosis or single mass lesion may also need further confirmation with biopsies.
  • Biopsies may also be done in order to understand the extent of spread in an already diagnosed cancer patient or in confirming autoimmune diseases, post organ transplant rejection, etc.

    • WHAT ARE THE DIFFERENT TYPES OF BIOPSIES?

    The different types of biopsy options selected for a particular patient are based on the location, size, organ involved, the amount of tissue required, and accessibility.

  • Needle biopsy: they are the most common type of biopsy done, where a sharp needle attached to a syringe may be used to extract the tissue from a targeted region. It is generally done using the help of a guided imaging technique like Ultrasound, CT guided, MRI guided, or rarely under X-ray guidance.
  • Fine needle aspiration, where relatively less amount of cells is aspirated for initial confirmation of cancer cells.
  • Bone biopsy: it is done in patients with suspicion of bone-related cancer or infections like osteomyelitis.
  • Bone marrow biopsies: where a larger needle is used to biopsy the pelvic bone, especially in patients suspected of blood cancers or lymphoma.
  • Skin biopsy: can be punch, shave, or excision biopsy where the particular skin lesion is completely removed and sent for further testing.
  • Endoscopic guided biopsy is usually done for stomach ulcers or lesions when an endoscope is inserted through the mouth up to the stomach where a punch biopsy of the edge of the ulcer is taken for pathological testing.
  • Laparoscopic biopsies are generally performed by surgeons to visualize the abdominal cavity with the help of a laparoscope which is a thin tube-like structure with a video camera attached at one end. The abnormal areas visualized are biopsied and sent for further testing.
  • Liquid biopsies- where a routine blood sample is assessed for cancer cells. They are considered much less invasive, can be done multiple times, and have lesser risk or side effects.

    • HOW IS IT DONE?

    Biopsies are often done under the effect of anesthesia, depending on the type of biopsy being performed.

    Fine needle aspiration or liquid biopsies are generally easily tolerated and don't require the need for anesthesia. They are often almost painless and are done as an outpatient.

    Needle biopsies or image-guided biopsies are done under the effect of local anesthesia; however larger biopsies like laparoscopic biopsies may require IV sedation or general anesthesia. These types of biopsies require hospital admission and the patients are advised a few hours of nil per mouth or only liquid diet before the procedure. Post-procedure, patients may experience some amount of pain and are adequately managed with pain medications.

    IMPORTANCE OF BIOPSY

    Biopsies are extremely important in day-to-day medical practice especially because the whole treatment plan depends on the results of the biopsy. In case of infection, patients are generally treated with antibiotics. However in the case of biopsy-proven cancer; the type of pathology, the extent of spread of cancer cells, and further genetic and immunohistochemical testing form the crucial part of cancer treatment.

    Like any procedure, biopsies may also have their associated disadvantages like pain, undue bleeding post-procedure, risk of infection, injury to nearby organs, or anesthesia-related side effects. Nevertheless, the importance of biopsy in all fields of medical diagnosis is integral and will always remain integral for further management.