Biopsy

A biopsy means taking a sample of tissue so that it can be looked at under a microscope. This is the only way to be certain if an abnormal area is cancer or not. You may also have a biopsy to find out more about the cancer. This includes what type of cancer it is and how fast it is growing.

You can have a biopsy from almost anywhere in your body. This includes your skin, organs and other structures.

Your doctor takes a sample of the abnormal area and sends the sample to the laboratory. This is where a doctor called a pathologist  looks at it under a microscope and checks for abnormal or cancerous cells.

There are different ways to have a biopsy. The type of biopsy you have depends on where in your body the abnormal area is.

How do I prepare for a biopsy?

Your doctor or nurse might give you written information on how to prepare for your biopsy.

If you are having a general anaesthetic, you need to stop eating 6 hours before hand. You can usually drink fluids up to 2 hours before the test. Tell your doctor if this is a problem for you, for example if you have diabetes.

You may be able to eat and drink as normal if you are having a biopsy under local anaesthetic.

Tell your doctor if you take medicines that change how your blood clots. This includes:

• aspirin
• clopidogrel
• warfarin

You may need to stop taking these medicines for some time before your biopsy.

How you have a biopsy

How you have a biopsy depends on where your doctor is taking the sample from. You might have a biopsy under general anaesthetic. This means you are asleep and won’t feel anything.

Or you might have it under local anaesthetic. This means that your doctor numbs the area before taking the tissue sample. Sometimes you may have a drug to make you drowsy (sedation) if you’re having a local anaesthetic.

Doctors can use scans such as ultrasound or CT scans to help guide many types of biopsies.

Types of biopsy

There are different types of biopsies. This page explains some of the different types.

Needle biopsy

A needle biopsy is when your doctor uses a thin needle to take a sample of tissue from an abnormal area. There are 2 types of needle biopsy:

• fine needle aspiration (FNA)

• core needle biopsy

You usually have a needle biopsy under local anaesthetic.

Fine needle aspiration (FNA)

Your doctor uses a thin needle to go through the skin and into the abnormal area. They take out a sample of tissue through the needle and into a syringe.

Your doctor can feel where to put the needle if the abnormal area is near the surface of your skin. For areas deeper in your body, they may use an ultrasound or CT scan to help guide the needle.

Core needle biopsy

This is similar to having an FNA, but the doctor uses a thicker needle. This means they can remove a larger sample of tissue. A core needle biopsy is often more useful than an FNA as it allows doctors to do more tests on the tissue sample.

Surgical biopsy

This is when your doctor uses a scalpel to take a sample of tissue by making one or more small cuts through the skin. They may remove the whole abnormal area if it isn’t too large. For example, they may remove a swollen (enlarged) lymph node . This is called an excisional biopsy.

Or you may have just part of the abnormal area removed. This is an incision biopsy. This can happen when the abnormal area is too large or too complicated to remove. For example, it might be near an important part of your body.

You have a surgical biopsy under local anaesthetic or general anaesthetic.

Biopsy during endoscopy

An endoscopy is a test that looks inside the body, for example in your stomach or bowel. The endoscope is a long flexible tube that has a tiny camera and light at the end. Your doctor can see the images on a TV screen.

There are different types of endoscopy depending on which part of the body is being looked at. For example:

• a colonoscopy looks at the inside of your large bowel (colon)

• a cystoscopy looks at the inside of your bladder

• a bronchoscopy looks inside your windpipe (trachea) and lungs

• an endoscopic retrograde cholangio pancreatography (ERCP) looks at your liver, pancreas and bile ducts

During an endoscopy, your doctor can put small surgical instruments through the endoscope to take samples of tissue.

Bone marrow biopsy

Your doctor may want to take samples of your bone marrow. The bone marrow is the spongy tissue that is inside your bones. It makes your blood cells.

During the test, your doctor uses a needle to remove a sample of bone marrow. They may then use a second needle to take out a piece of more solid bone marrow tissue. This is usually from the back of your hip bone. 

Lumbar puncture

A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord. This is called the cerebrospinal fluid or CSF.

Doctors can use a thin needle to take a sample of the CSF from your lower back. They then can check the fluid for cancer or infection.

Biopsy to take a sample of fluid from your lungs or tummy (abdomen)

Cancer can sometimes cause fluid to collect around the lungs (pleural effusion) or tummy (ascites).

Doctors can use a need to take a sample of fluid to check for cancer cells. You usually have this done under local anaesthetic.

After the test

Your doctor sends the tissue samples to the laboratory, where a pathologist looks at the cells under a microscope.

You usually have a dressing covering the biopsy site. This is the area where the doctor took the biopsy from. You may also have some stitches or Steri-Strips holding the wounds closed. This depends on the type of biopsy you had.

You may go home the same day or the next day.

Having a biopsy can be uncomfortable and your doctor may give you painkillers. The team will tell you if you need to follow any instructions when you get home, such as how to care for the wound.

Possible risks

A biopsy is a safe procedure but as with any medical procedure, there are possible risks. Your doctor makes sure the benefits of having a biopsy outweigh any possible risks.

Some of the possible risks of having a biopsy include:

Bleeding

You may have some bleeding from the biopsy site. Contact your doctor or nurse if you notice bleeding. 

Infection

There is a risk of getting an infection during this test. Tell your doctor or nurse if you have symptoms of an infection. These include:

• a temperature over 37.5°C or below 36°C

• feeling cold or shivery

• aching muscles

• feeling generally unwell

You might need antibiotics to treat an infection.

Pain

You may have some pain at the biopsy site for a few days after the test. Your doctor or nurse will give you painkillers to help with this. Contact them if the pain gets worse.

Getting your results

You usually get the results within 2 weeks. The doctor who arranged the biopsy will give them to you.

Waiting for test results can be worrying. It may help to talk to a close friend or relative about how you feel.