Biopsy Overview
Biopsy is procedure in which a piece of skin, tissue, organ, or suspected tumor is surgically removed and sent to a lab for testing, analysis and diagnostics. In some cases, your doctor may decide that he or she needs a sample of your tissue or your cells to help diagnose an illness or identify a cancer. The removal of tissue or cells for analysis is called a biopsy. While a biopsy may sound scary, it’s important to remember that most are entirely pain-free and low-risk procedures. Depending on your situation, a piece of skin, tissue, organ, or suspected tumor will be surgically removed and sent to a lab for testing.
Purpose of Biopsy
If you have been experiencing symptoms normally associated with cancer, and your doctor has located an area of concern, he or she may order a biopsy to help determine if that area is cancerous. A biopsy is the only sure way to diagnosis most cancers. Imaging tests like CT scans and X-rays can help identify areas of concerns, but they can’t differentiate between cancerous and noncancerous cells. Biopsies are typically associated with cancer, but just because your doctor orders a biopsy, it doesn’t mean that you have cancer. Doctors use biopsies to test whether abnormalities in your body are caused by cancer or by other conditions. For example, if a woman has a lump in her breast, an imaging test would confirm the lump, but a biopsy is the only way to determine whether it’s breast cancer or another noncancerous condition, such as polycystic fibrosis.
Types of Biopsies
There are several different kinds of biopsies. Your doctor will choose the type to use based on your condition and the area of your body that needs closer review. Whatever the type, you’ll be given local anesthesia to numb the area where the incision is made.
Bone marrow biopsy
Inside some of your larger bones, like the hip or the femur in your leg, blood cells are produced in a spongy material called marrow.
If your doctor suspects that there are problems with your blood, you may undergo a bone marrow biopsy. This test can single out both cancerous and noncancerous conditions like leukemia, anemia, infection or lymphoma. The test is also used to check if cancer cells from another part of the body have spread to your bones. Bone marrow is most easily accessed using a long needle inserted into your hipbone. This may be done in a hospital or doctor’s office. The insides of your bones cannot be numbed, so some people feel a dull pain during this procedure. Others, however, only feel an initial sharp pain as the local anesthetic is injected.
Endoscopic biopsy
Endoscopic biopsies are used to reach tissue inside the body in order to gather samples from places like the bladder, colon, or lung. During this procedure, your doctor uses a flexible thin tube called an endoscope. The endoscope has a tiny camera and a light at the end. A video monitor allows your doctor to view the images. Small surgical tools are also inserted into the endoscope. Using the video, your doctor can guide these to collect a sample. The endoscope can be inserted through a small incision in your body, or through any opening in the body, including the mouth, nose, rectum or urethra. Endoscopies normally take anywhere from five to 20 minutes. This procedure can be done in a hospital or in a doctor’s office. Afterward, you might feel mildly uncomfortable, or have bloating, gas, or a sore throat, these symptoms will all pass in time.
Needle biopsies
Needle biopsies are used to collect skin samples, or for any tissue that is easily accessible under the skin. The different types of needle biopsies include the following:
- Core needle biopsies use medium-sized needle to extract a column of tissue, in the same way that core samples are taken from the earth.
- Fine needle biopsies use a thin needle that is attached to a syringe, allowing fluids and cells to be drawn out.
- Image-guided biopsies are guided with imaging procedures such as X-ray or CT scans, so your doctor can access specific areas, such as the lung, liver, or other organs.
- Vacuum-assisted biopsies use suction from a vacuum to collect cells.
Skin biopsy
If you have a rash or lesion on your skin which is suspicious for a certain condition, does not respond to therapy prescribed by your doctor, or the cause of which is unknown, your doctor may perform or order a biopsy of the involved area of skin. This can be done by using local anesthesia and removing a small piece of the area with a razor blade, a scalpel, or a small, circular blade called a “punch.” The specimen will be sent to the lab to look for evidence of conditions such as infection, cancer, and inflammation of the skin structures or blood vessels.
Surgical biopsy
Sometimes a patient may have an area of concern that cannot be safely or effectively reached using the methods described above or the results of other biopsy specimens have been negative. An example would be a tumor in the abdomen near the aorta. In this case, a surgeon may need to get a specimen using a laparoscope or by making a traditional incision.
Biopsy Risk
Any medical procedure that involves breaking the skin carries the risk of infection or bleeding. However, as the incision is small, especially in needle biopsies, the risk is much lower.
Biopsy Preparation
Biopsies may require some preparation on the part of the patient such as bowel prep, clear liquid diet, or nothing by mouth. Your doctor will instruct you on what to do before the procedure. As always before a medical procedure, tell your doctor what medications and supplements you take. You may need to stop taking certain drugs before a biopsy, such as aspirin or nonsteroidal anti-inflammatory medications.
Bone Marrow Biopsy
A bone marrow biopsy may be conducted if your blood tests show your levels of platelets are high, or white or red blood cells are too high or too low. A biopsy will help determine the cause of these abnormalities, which can include:
- Anemia, low red blood cell count
- Bone marrow diseases, such as myelofibrosis or myelodysplastic syndrome
- Blood cell conditions, such as leukopenia, thrombocytopenia or polycythemia
- Cancers of the bone marrow or blood, such as leukemia or lymphomas
- Hemochromatosis genetic disorder in which iron builds up in the blood
- Infection or fever or unknow origin
These conditions can affect your blood cell production and the levels of your blood cell types.
A bone marrow biopsy can take about 60 minutes. Bone marrow is the spongy tissue inside your bones. It’s home to blood vessels and stem cells that help produce:
- Red and white blood cells
- Platelets
- Fat
- Cartilage
- Bone
There are two types of marrow: red and yellow. Red marrow is mainly found in your flat bones such as the hip and vertebrae. As you age, more of your marrow becomes yellow due to an increase in fat cells. Your doctor will extract red marrow, usually from the back of your hip bone. And the sample will be used to check for any blood cell abnormalities. The pathology lab that receives your marrow will check to see if your bone marrow is making healthy blood cells. If not, the results will show the cause, which may be an infection, bone marrow disease, or cancer.
Risks of Bone Marrow Biopsy
All medical procedures carry some form of risk, but complications from a bone marrow test are extremely rare. The main risk of this procedure is hemorrhage, or excessive bleeding but the chances of it happening is less than 1%.
Other reported complications include:
Talk to your doctor before the biopsy if you have a health condition or take medication, especially if it increases your risk for bleeding.
Bone Marrow Biopsy
Discussing your concerns is one of the first steps of getting ready for a bone marrow biopsy. You should tell your doctor about all of the following:
- Any medications or supplements you are taking
- Your medical history, especially if you have a history of bleeding disorders
- Any allergies or sensitivities to tape, anesthesia, or other substances
- If you’re pregnant or think you might be
- If you have extra anxiety about having the procedure and need medication to help you relax
Having someone come with you on the day of the procedure is a good idea. Especially if you’re getting medication like sedatives to help you relax, although this is not usually needed. You shouldn’t drive after taking them as these medications can make you feel drowsy. Follow all of your doctor’s instructions before the procedure. Your doctor may ask you to stop taking certain medications beforehand. But never stop taking a medication unless your doctor instructs you to do so. Getting a good night’s rest and showing up on time, or early, to your appointment may also help you feel less tense before the biopsy.
Pain preparation
On average, the pain from the biopsy is reported to be short-lived, average, and less than anticipated. Some studies show that the pain is connected to the duration and difficulty of a biopsy. Pain is significantly reduced when an experienced doctor takes less than 10 minutes to complete the biopsy. Another important factor is your anxiety level. People who were knowledgeable about their procedure report experiencing a lot of pain less often. People also report lower levels of pain with subsequent biopsies.
Bone Marrow Biopsy Procedure
Biopsy can be performed in the doctor’s office, a clinic, or hospital. Usually a doctor who specializes in blood disorders or cancer, such as a hematologist or an oncologist, will perform the procedure. The actual biopsy itself takes about 10 minutes.
Before the biopsy, you’ll change into a hospital gown and have your heart rate and blood pressure checked. Your doctor will tell you to sit on your side or lie on your stomach. Then they’ll apply a local anesthetic to the skin and to the bone to numb the area where the biopsy will be taken. A bone marrow biopsy is most commonly taken from the ridge of your rear hipbone or from the chest bone. You may feel a brief sting as the anesthetic is injected. Then your doctor will make a small incision so a hollow needle can easily pass through your skin. The needle goes into the bone and collects your red marrow, but it does not come near your spinal cord. You may feel a dull pain or discomfort as the needle enters your bone. After the procedure, your doctor will hold pressure to the area to stop any bleeding and then bandage the incision. With local anesthesia, you can leave your doctor’s office after about 15 minutes.
Post Bone Marrow Biopsy
You may feel slight pain for about a week after the procedure but most people will not. To help manage the pain, your doctor may recommend over-the-counter pain relievers like ibuprofen or acetaminophen. You will also need to care for the incision wound, which involves keeping it dry for 24 hours after the biopsy.
Avoid strenuous activities for about one or two days to avoid opening your wound. And contact your doctor immediately if you experience:
The lab will test your bone marrow during this time. Waiting for the results can take one to three weeks. Once your results come in, your doctor may call or schedule a follow-up appointment to discuss the findings.
Bone Marrow Biopsy Result
A primary purpose of the biopsy is to find out whether your bone marrow is functioning properly, and if not to determine why. Your sample will be examined by a pathologist who will perform several tests to help determine the cause of any abnormalities. If you have a certain type of cancer like lymphoma, a bone marrow biopsy is done to help stage the cancer by determining whether or not the cancer is in the bone marrow. Abnormal results may be due to cancer, infection, or another bone marrow disease. Your doctor may need to order more tests to confirm a diagnosis. And they will discuss the results and treatment options if needed and plan your next steps during the follow-up appointment.
Biopsy Follow up
After the tissue sample is taken, your doctors will need to analyze it. In some cases, this analysis can be done at the time of procedure. More often, however, the sample will need to be sent to a laboratory for testing. The results can take anywhere from a few days to a few weeks. Once the results arrive, your doctor may call you to share the results, or ask you to come in for a follow-up appointment to discuss the next steps. If the results showed signs of cancer, your doctor should be able to tell the cancer’s type and level of aggression from your biopsy. If your biopsy was done for a reason other than cancer, the lab report should be able to guide your doctor in diagnosing and treating that condition.
If the results are negative but the doctor’s suspicion is still high either for cancer or other conditions, you may need another biopsy or a different type of biopsy. Your doctor will be able to guide you as to the best course to take. If you have any questions about the biopsy prior to the procedure or about the results, don’t hesitate to talk with your doctor. You may want to write down your questions and bring them with you to your next office visit.
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