Biopsy

Approved by the Lineagotica Editorial Board, 01/2018

For most types of cancer, a biopsy is the main way doctors diagnose it. During a biopsy, a doctor removes a small amount of tissue to examine under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a diagnosis.

Your doctor may recommend a biopsy if he or she finds something suspicious during a physical exam or other tests:

  • You may have the biopsy in your doctor's office. But sometimes surgery or another procedure may be needed to get a tissue sample.

  • Your doctor may perform the biopsy with the help of an imaging test (see below).

  • The type of biopsy you receive depends on where the possible tumor is located.

Types of biopsies

  • Image-guided biopsy. Some types of biopsies can be image guided. Your doctor may use an image-guided approach when he or she cannot feel a tumor or when the area is deeper inside the body but appears on an imaging scan. During this procedure, your doctor guides a needle to the location with the help of an imaging technique. Your doctor can do an image-guided biopsy using a fine needle, core, or vacuum-assisted biopsy (see below). This depends on the amount of tissue needed, possible diagnoses, and other factors. The type of imaging your doctor uses depends on the location and other factors. He or she may use one of the following imaging scans:

  • Fine needle aspiration biopsy. During this minimally invasive biopsy, the doctor uses a very thin, hollow needle attached to a syringe. He or she collects a small amount of tissue from the suspicious area to examine and test further. Your doctor may use this biopsy for a mass that can be felt through the skin or use it with image-guided biopsy (see below).

  • Core needle biopsy. A core needle biopsy uses a larger needle to remove a larger sample of tissue. This type of biopsy is similar to a fine needle biopsy and is also minimally invasive.

  • Vacuum-assisted biopsy. This type of biopsy uses a suction device to collect a tissue sample through a specially designed needle. Your doctor can collect multiple or large samples from the same biopsy site with this method. A vacuum-assisted biopsy can sometimes be image guided.

  • Excisional biopsy. During an excisional biopsy, your doctor removes the entire suspicious area. This type of biopsy is common for suspicious changes on the skin. Doctors also sometimes use it for a small, easily removable lump under the skin. However, fine needle aspiration or a core biopsy are more common for lumps that cannot be seen or felt through the skin.

  • Shave biopsy. For this type of biopsy, the doctor uses a sharp tool to remove tissue from the skin surface.

  • Punch biopsy. During a punch biopsy, the doctor inserts a sharp, circular tool into the skin to take a sample from below the surface of the skin.

  • Endoscopic biopsy. An endoscope is a thin, lighted, flexible tube with a camera. Doctors use endoscopes to view the inside of the body, including the bladder, abdomen, joints, or gastrointestinal (GI) tract. They insert endoscopes into the body through the mouth or through a tiny surgical incision. The attached camera helps the doctor see any abnormal areas. Doctors also use it to take tiny samples of the tissue using forceps. The forceps are also a part of the endoscope. Find out more about the different endoscopic techniques.

  • Laparoscopic biopsy. This type of biopsy is used for the abdomen. Similar to an endoscopic biopsy, the doctor inserts a thin tube with a video camera called a laparoscope into the abdomen through a tiny incision. The camera helps the doctor see any abnormal areas. Then, doctors can insert a small needle and take a tissue sample.

  • Bone marrow aspiration and biopsy. These two procedures are similar. Doctors often do them at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy removes a small amount of solid tissue using a needle. Doctors use these procedures to find out if a person has a blood disorder or blood cancer. Blood cancers include leukemia, lymphoma, or multiple myeloma. 

    A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The doctor usually numbs the skin in that area with medication beforehand. Other types of medication to block the awareness of pain, or anesthesia, may be used. Learn more about what to expect during a bone marrow biopsy.

  • Liquid biopsy. This minimally invasive procedure can test a blood sample for cancer. During a liquid biopsy, a health care professional collects a routine sample of blood, which is then analyzed in a specific way. Compared to a tissue biopsy, a liquid biopsy has less risks to patients, and doctors can easily perform it multiple times. It may also allow doctors to check the progress of a tumor and see how well a treatment is working. This type of biopsy is still new, and more research is being done to learn about its uses. For now, this type of biopsy is not used for most people with cancer.

    This information is based on a joint review of liquid biopsy research by ASCO and the College of American Pathologists. Please note this link takes you to another ASCO website.

Who does a biopsy and who analyzes the sample?

Because there are different types of biopsies, members of the medical team involved in the procedure may vary.

The health care team member who performs your biopsy often depends on the type of biopsy you need and what part of the body is being examined. Your biopsy may be done by:

  • A surgeon

  • A radiologist specializes in taking and reading medical images.

  • An oncologist specializes in treating cancer.

  • A gastroenterologist specializes in the function and disorders of the GI tract. The GI tract includes the stomach, intestines, and associated organs.

  • A pathologist specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. He or she analyzes the tissue sample(s) removed during a biopsy.

  • A cytologist specializes in the study of cells. He or she may perform a fine needle aspiration.

  • A dermatologist specializes in skin conditions.

  • A gynecologist specializes in conditions related to a woman’s reproductive system.

  • A family practice doctor

  • Other specialists

Getting ready for a biopsy

Preparation for a biopsy depends on the type of biopsy you will have. For example, there is little preparation for a fine needle biopsy performed in a doctor's office. In some cases, you will need to remove your clothing and wear a gown.

Before your biopsy:

  • Ask your doctor or nurse whether you can eat or drink anything before the biopsy procedure.

  • Also ask if you should take your regular medications that day. For certain biopsies, your doctor will want to know if you are taking blood thinners or aspirin. Tell your doctor about all medications and supplements you are taking.

  • Tell your doctor about any drug allergies or other medical conditions you may have.

  • A member of your health care team will explain the procedure to you.

  • You will be asked to sign a consent form that states you understand the benefits and risks of the biopsy and agree to have the test done.

  • Talk with your doctor about any concerns you may have.

During the procedure

Depending on the part of your body the doctor will biopsy, you may lay on your stomach or back or sit up during the procedure. For some types of biopsies, you may need to hold your breath while a biopsy needle is inserted or remain still. Your health care team will let you know ahead of time what to expect during the procedure.

Before the procedure, you will usually receive a type of anesthesia to block the awareness of pain. The type of anesthesia the doctor uses depends on the type of procedure and where in the body the biopsy is needed. The following types of anesthesia may be used:

  • Local anesthesia is an injection that numbs the area where a procedure is being done. You may feel some stinging pain when the doctor injects a local anesthetic by needle to numb the area.

  • Conscious sedation or monitored anesthesia care uses medication to relax you. It is usually given through an intravenous (IV) tube and is often combined with a local or regional anesthesia.

  • General anesthesia makes you unconscious during a major procedure, such as surgery. If you receive a general anesthetic, you will not be aware of the procedure.

After the procedure

Your recovery period depends on the type of biopsy:

  • The least invasive procedures require no recovery time. You may be able to go back to your normal activities immediately after the procedure.

  • More invasive procedures may require a longer recovery time.

  • If you receive sedation as part of the anesthesia, you will usually need someone to drive you home after the procedure.

After a biopsy, talk with your doctor or nurse about taking care of the biopsy area. Also, be aware of the potential complications from the procedure. Contact your doctor’s office if you experience infection, severe pain, fever, or bleeding.

Getting your results

The amount of time it will take for you to receive the results of the biopsy depends on how many tests are needed on the sample to make a diagnosis. Based on this analysis, a pathologist determines whether the tissue removed contains a tumor and what type it is.

A tumor can be benign or malignant:

  • A benign tumor is not cancerous.

  • A malignant tumor is cancerous and can possibly spread to other parts of the body.

A result can often be given within 2 to 3 days after the biopsy. A result that requires a more complicated analysis can take 7 to 10 days. Ask your doctor how you will receive the biopsy results and who will explain them to you. 

Questions to ask your health care team

Before a biopsy, consider asking your doctor the following questions:

  • Why do you recommend I have a biopsy?

  • What are the risks of not having the test?

  • When will I learn the results of the biopsy? How will I receive the information? Who will explain the results to me?

  • What will happen during the biopsy?

  • Who will perform the biopsy?

  • How long will the procedure take?

  • Will I receive local or general anesthesia?

  • Will it be painful?

  • Is there a risk of infection, bleeding, or other side effects after the biopsy?

  • Will the biopsy leave a scar on my body?

  • Will the biopsy be performed in the clinic or in the hospital? If in the hospital, will I need to stay

  • How do I need to prepare for the biopsy? Are there any restrictions on what I may eat or drink the day before?

  • What specific care, if any, is required for the biopsy site after the procedure?

in the hospital after the biopsy?

  • Will I need to avoid any activities after the biopsy? If yes, for how long?

  • Will I need to have someone drive me home afterward?

  • Will I need to undergo any additional tests or procedures?

Related Resources