What is a Biopsy?

A biopsy may be performed in several different ways to examine suspicious areas that may contain lesion or cancerous masses. It would benefit a patient to avoid an invasive surgical biopsy if some type of needle or endoscopic biopsy option is available. Biopsies are performed so pathologists can examine tissue samples and offer their expert opinion. If the pathologist believes cancer cells or some other type of infection is present, the patient's doctor will have to lay out a treatment plan. Biopsies are relatively painless procedures that can produce life-changing results. Just a 20 minute procedure can discover malignancies under the skin. Biopsies are usually scheduled after an imaging test such as a mammography or ultrasound discover suspicions material or activity in a certain area. If enough tissue samples are collected and a pathologist diagnoses the sample, the results of the biopsy should be conclusive and accurate.

Biopsies are usually performed either with a biopsy knife, different types of needles, or with an endoscope. Fine needle aspirations and core needle biopsies have the ability to suck tissue samples from a mass under the skin. Biopsy knives can be used to cut pieces of tissue from a patient or remove an entire lesion. Endoscopic biopsies use a long black tube that is inserted in a patient's mouth and through the gastrointestinal tract. The endoscope has a camera and light attached to it so the doctor can directly examine inside a patient in a way imaging tests cannot.

Fine Needle Aspiration

Fine needle aspirations are performed to collect tissue samples from growths or suspicious areas underneath the skin. This type of biopsy uses a needle with a fine needle attached to it. The needle also has a suction device that can gather tissue samples and then release them into a preservation container to be sent to a pathologist. The procedure takes about 15-20 minutes. Some local anesthesia may be applied to the area that will have the fine needle inserted into it. The small tissue samples will be examined and checked for malignancies. Inconclusive results may require another or a different type of biopsy, perhaps one that collects larger tissue samples.

Fine needle aspiration offer a minimal amount of pain. Major complications are rare, but some bruising or bleeding may occur during or after the procedure. Infections are extremely rare due to the fact the environment the biopsy is performed in is sterile.

Core Needle Biopsy

A core needle biopsy is a procedure women with suspicious mammogram results should have. The biopsy uses a hollow needle called a "core needle" to collect small samples of tissue from a patient's breasts. The needle penetrates deep into the skin of the breast. If there is a tumor or lesion that can be felt with a doctor's hand the needle should be inserted directly into it. For lesions or other masses that cannot be easily felt with the hands of a doctor, the use of a mammography or ultrasound can help guide the needle to the correct location. The needle used during a core needle biopsy is larger than the needle used during a fine needle aspiration biopsy.

During a core needle biopsy, the patient's breasts will be numbed with anesthetic. The core needle will penetrate past the skin and into a mass. The mass will either be located with the doctor's hands or an image testing machine such as a mammography or ultrasound will aid in locating the mass. The needle will make clicking noises as it collects samples of tissue. There is not a significant amount of pain to be dealt with during or after the procedure. Some normal bruising or bleeding may occur. Even though the core biopsy collects more tissue than the fine needle aspiration, a misdiagnosis is still possible, since the entire suspicious mass is not removed and examined by a pathologist.

Endoscopic Biopsy

An endoscope biopsy is characterized by the removal of tissue from the digestive tract with the use of a tool called an endoscope. During the procedure, a long black flexible tube is inserted in the mouth and sent down the esophagus. The tube extends down past the stomach and reaches to the first part of the small intestine called the duodenum. A bright light on the endoscope and camera connected to a monitor allow the doctor to get a direct view inside the digestive tract. The endoscopic biopsy offers views that other imaging tests such as x-rays cannot capture. The endoscope is capable of taking pieces of tissue to be examined by a pathologist. Any cell abnormalities will be found and diagnosed by the pathologist. The endoscope can be used to identify possibly malignant ulcers, heartburn causes, intestinal bleeding and inflammation occurring in the lining of the stomach.

Patients may be asked to refrain from eating for eight hours prior to the procedure. An IV line will be inserted into the patient to administer sedatives. The sedatives relax patients and stops the gag reflex from taking effect. Patients will be asked to swallow to help ease the flexible tube down the esophagus. The procedure is relatively painless. The endoscope is only used for viewing purposes but can also collect tissues samples. The endoscope has the ability to blow air and water to assist in viewing certain areas of the digestive tract. Any ulcers or growth found inside the digestive tract can be removed or partially removed with the endoscope. The removed tissue will be sent to a pathologist to be diagnosed. Procedural complications are rare.

Excisional Biopsy

During an excisional biopsy, an entire lesion or tumor is removed. This is to assure the correct diagnosis and prognosis are made following the biopsy. Melanomas are commonly diagnosed through biopsies. Therefore, the entire lesion or tumor must be removed because all of the cells of a melanoma must be examined to make a proper diagnosis. If the entire melanoma is not collected down to the subcutaneous fat layer the diagnosis could be wrong, leading to the wrong prognosis and wrong treatment plan.

Some doctors do not want to commit to an excisional biopsy and cause a patient unnecessary pain. Instead of performing an excisional biopsy, some doctors will perform multiple punch biopsies. Multiple punch biopsies can serve as a good strategy for collecting a large amount of tissue samples but not performing the more complicated excisional biopsy. Based on the results of the biopsy as described by a pathologist, an excisional biopsy may or may not be necessary.

Punch Biopsy

A punch biopsy is characterized by cutting a disc shaped piece of skin from the surface of a patient's body. The skin could come from an arm, leg, or other body part. The doctor should cut a piece of skin ranging from 1 mm to 8 mm. The average piece of skin is about 3.5-4 mm. One millimeter pieces are often to small to see and should not be cut that small. When cutting out a piece of skin for a punch biopsy, the entire thickness of skin should be included. It is important to obtain the entire thickness of the skin so the subcutaneous fat layer is included in the biopsy. Many cells reside in the lowest region of human skin that is the subcutaneous layer.

During a punch biopsy, the skin should be slightly pulled so that it is tight. This allows for the fastest healing time after the procedure. The best area to select for a punch biopsy is the area that looks like it is the most infected with a disease. That way, the biopsy is sure to diagnose the area most likely to be home to a disease. Anesthesia should then be applied to numb the area so the patient will feel minimal pain if at all. The punch biopsy tool should be pressed down directly on the infected area. A biopsy needle should be used to help raise the skin and the doctor can then cut the skin free from any tissue still connecting the skin to the patient's body. Once the skin is placed in a safe container to be sent to a pathologist, the wound is stitched and cleaned.